Respiratory System Diseases and Disorders Chapter 9 Respiratory System Diseases and Disorders 1

Anatomy and Physiology Chest, lungs, and conducting airways Two parts: Upper respiratory system consists of nose, mouth, sinuses, pharynx, and larynx Lower respiratory system consists of trachea, bronchi, and bronchioles 2

Anatomy and Physiology Alveoli At distal end of terminal bronchioles Place of carbon dioxide-oxygen exchange Inhalation and exhalation Air movement in and out of lungs 3

Common Signs and Symptoms p. 187 Dyspnea—difficulty breathing Orthopnea—lying position causes difficulty Apnea—no breathing Wheezing – high pitched sounds caused by partial obstruction hypoxemia –low blood oxygen levels cyanosis—a blue color in nail beds and lips Coughing—productive or non productive Nasal discharge—present in infections, inflammation and allergic reactions 4

p. 188 haemochromatosis, lupus erythematosus ( koilonychia) iron-deficiency anaemia haemochromatosis, lupus erythematosus http://www.nhs.uk/Conditions/nail-abnormalities/Pages/Introduction.aspx

lung cancer, bronchiectasis, or endocarditis Fingernail or toenail abnormalities can tell you a lot about your health. They're often a sign of a fungal nail infection or injury, but can sometimes indicate a more serious underlying disease. *Spoon shaped: iron-deficiency anaemia, haemochromatosis, Raynaud’s disease, lupus erythematosus, Clubbing: lung cancer, bronchiectasis, or endocarditis inflammatory bowel disease, stomach cancer or bowel cancer cirrhosis (scarring of the liver) polycythaemia, “splinters” (dried blood) if many nails are affected, these splinters may be a sign of lupus erythematosus, psoriasis, an infection of the heart valves (endocarditis) or another underlying disease.

White spots – zinc deficiency Color White spots – zinc deficiency Yellow nails – liver and/or gallbladder issues Bluish or grey colored nails – heart condition Brown nails – adrenal gland dysfunction Ridges Vertical ridges – metabolic disorders or lung issues Horizontal ridges – gout, heart and circulation conditions Small bulges – nail fungi or iron deficiency Shape Spoon shaped – iron deficiency or damage from harsh detergents Hourglass shape – bronchial or lung conditions Read more: http://www.care2.com/greenliving/how-your-fingernails-reflect-your-health.html#ixzz3Hl1LV1MO

Diagnostic Tests p. 189 Auscultation Breathing quality and rate—deep, shallow, times per min Tachypnea Rapid respirations Crackles or rales Musical (crackling sounds) heard on inhalation Rhonchi Rattling sounds in bronchi due to obstruction 8

Diagnostic Tests Chest X-ray Sputum culture Tissue biopsy Bronchoscopy Arterial blood gases Pulmonary function tests 9

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Bronchoscopy 12

Pulmonary function tests are a group of tests that measure how well the lungs take in and release air and how well they move gases such as oxygen from the atmosphere into the body's circulation.

Incentive Spirometer

Diseases of the Upper Respiratory Tract p. 189-193 Smoking is the number one risk behavior for developing chronic respiratory disease Upper respiratory infection (URI)—a broad term referring to several infectious diseases of the upper respiratory tract Account for approximately 50% of all acute illnesses Most commonly caused by rhinovirus– the common cold. There are several hundred virus strains that cause a cold. 18

Diseases of the Upper Respiratory Tract URI Treatment: Rest Fluids Antipyretics Analgesics Antibiotics for secondary infections Prevention: Regular hand washing 19

Diseases of the Upper Respiratory Tract Common cold Acute rhinitis Hay fever Allergic rhinitis Sinusitis—sinus infections should not be ignored Pharyngitis—sore throat, most common cause is viral. Streptococcus bacteria can also occur, Laryngitis—can be caused by viral or bacterial infections or by irritants or strain 20

Diseases of the Bronchi and Lungs p. 193-203 Diseases usually more severe than URIs Many can be life-threatening Often more dangerous in older populations 21

Diseases of the Bronchi and Lungs p. 193 Asthma—most common cause of missed school days Hypersensitivity reaction results in constriction of bronchi leading to difficulty breathing Episodes of wheezing and dyspnea Treatment: Avoid causative allergens, desensitization, medications such as bronchodilators Prevention: Identify and control allergic factors 22

Diseases of the Bronchi and Lungs p.193 Acute bronchitis Inflammation of lining of bronchus Short-term following URI Symptoms: Fever Tight feeling behind sternum Productive cough (bringing up sputum) 23

Diseases of the Bronchi and Lungs Acute bronchitis--bronchitis that is short-lived; the bronchitis lasts about two weeks and usually people recover with no permanent damage to the bronchial tree Treatment: Rest Increased fluids Cough syrup Antipyretics Analgesics Antibiotics for secondary infections 24

Diseases of the Bronchi and Lungs p.194 Influenza Highly contagious respiratory infection Viral disease with many strains spread by coughing of respiratory secretions (A,B,C) Symptoms: Onset of fever, chills, and headache Back and muscle pain Cough, runny nose, sore throat, and sneezing Hoarseness Nausea and vomiting Diarrhea 25

Influenza viruses are divided into three types, designated A, B, and C, with influenza A types usually causing the most problems in humans. Influenza A undergoes frequent antigenic changes that require new vaccines to be developed and people to obtain a new vaccination every year. New vaccine technology is being developed. In April 2009, a new flu virus termed novel H1N1 swine flu developed in Mexico, rapidly spread worldwide, and caused the WHO to declare a flu pandemic. Eventually, the WHO declared the pandemic over in 2010. In 2012, a new type of flu strain developed, H3N2v, but has not developed into any epidemic situations currently. Bird flu (H5N1) mainly infects birds but it also infects humans who have close contacts with birds.

Influenza Influenza Symptomatic treatment: Rest Analgesics Antipyretics Antivirals Prevention—vaccination is the best way to prevent influenza. Antiviral medications are also effective in prevention. 27

Diseases of the Bronchi and Lungs p. 194 Chronic obstructive pulmonary disease (COPD) Group of pulmonary diseases primarily, but not solely due to cigarette smoking Two most common types: Chronic bronchitis Emphysema Diagnosis by history and physical, chest X-ray, pulmonary function tests, and arterial blood gases 28

Diseases of the Bronchi and Lungs COPD Symptomatic treatment: Bronchodilators Inhalers Mucolytics Cough suppressants Avoidance of contact with people with URIs Influenza vaccine Quit smoking 29

Diseases of the Bronchi and Lungs p. 196-197 Chronic bronchitis-- a cough that occurs every day with sputum production that lasts for at least 3 months, two years in a row. Inflammation and scaring of bronchial tubes Bronchiectasis with pooling of mucus and foul-smelling cough (smoker’s cough) Emphysema -- Air trapping –alveoli break down causing large spaces instead of small. Air cannot be exhaled --pursed-lip breathing –victim trying to exhale stale air in large alveoli -- barrel chest—set costal muscles due to prolonged chest expansion Increased production of mucus (with exacerbation)causing air trapping in the alveoli 30

Diseases of the Bronchi and Lungs p. 197 Atelectasis Collapse or airless state of the alveoli or parts of the lung Causes: Surgical pain (not inhaling due to pain) Fractured ribs Blockage of airway by mucus plug Not ambulating after surgery Treatment: Ambulation Frequent deep breathing and coughing Analgesics for pain 32

Diseases of the Bronchi and Lungs p. 197-198 Pneumonia—bacterial pneumonias tend to be the most serious. Vial pneumonias are the most common. Aspiration pneumonia caused by food or liquids aspirated into the lungs Inflammation of bronchioles and alveoli due to infection by bacteria, virus, or other pathogen Symptoms related to area and tissue involved Diagnosis by history and physical, chest X-ray, and sputum culture Treatment depends on cause Prevention – not smoking, frequent hand washing, wearing a mask when working with fumes, dust, mold 33

Pneumonia 34

Diseases of the Bronchi and Lungs p. 199 Pulmonary abscess Collection of infectious material within capsule May be complication of pneumonia, tuberculosis, lung cancer, or aspiration of food or foreign body Symptoms: Chills Fever Chest pain Cough 35

Pulmonary Abscess 36

Pulmonary abscess

Diseases of the Bronchi and Lungs Pulmonary abscess Treatment: Long-term antibiotic therapy Surgical resection if large area or unsuccessful antibiotic therapy 38

Diseases of the Bronchi and Lungs p. 199-201 Pulmonary tuberculosis (TB) Infection caused by Mycobacterium tuberculosis Acquired by breathing air infected with bacteria or by coughing and sneezing Diagnosis by skin testing, chest X-ray, and sputum culture Treatment: Extended antibiotic therapy 39

http://www.cdc.gov/TB/topic/treatment/default.htm TB disease can be treated by taking several drugs for 6 to 9 months. There are 10 drugs currently approved by the U.S. Food and Drug Administration (FDA) for treating TB. Of the approved drugs, the first-line anti-TB agents that form the core of treatment regimens include: Of the approved drugs, the first-line anti-TB agents that form the core of treatment regimens include: isoniazid (INH) rifampin (RIF) ethambutol (EMB) pyrazinamide (PZA)

Tuberculosis 42

Diseases of the Bronchi and Lungs p. 202 Adult respiratory distress syndrome (ARDS) Follows episode of severe trauma Causes acute respiratory failure needing mechanical ventilation Symptoms: sudden and acute extreme dyspnea High mortality rate even with proper treatment 43

Diseases of the Bronchi and Lungs Sudden acute respiratory syndrome (SARS) Severe, easily transmissible new disease Caused by previously unknown type of coronavirus Antibiotics ineffective – viral infection May require ventilatory support 44

p. 203 Lung cancer Leading cause of cancer deaths in United States Often asymptomatic until metastasizes to brain, bone, and liver Most often caused by cigarette smoking 45

Diseases of the Bronchi and Lungs Lung cancer Symptoms: Dyspnea Coughing Hemoptysis Diagnosis by X-ray and tissue biopsy Treatment: Chemotherapy Radiation Surgery 46

Diseases of Pleura and Chest p. 203-205 May be caused by infection, trauma, or other diseases Symptoms: Pain Shortness of breath 49

Diseases of Pleura and Chest Common diseases: Pleurisy (pleuritis) Inflammation of the membranes covering the lungs Pneumothorax Air in pleural cavity—usually treated with chest tube Hemothorax Blood in chest cavity—usually treated with chest tube Pleural effusion (hydrothorax) Fluid in chest Empyema Pus in chest cavity - 50

Pneumothorax 51

Diseases of the Cardiovascular and Respiratory Systems p. 206-207 Pulmonary embolism (PE) Sudden blockage of artery by embolism Pulmonary edema Tissues and air spaces of lungs fill with fluid Cor pulmonale Right-sided heart failure 53

Trauma p. 207 Pneumothorax and Hemothorax Suffocation Often occur due to some type of trauma Suffocation Not breathing to the point that individual loses consciousness and eventually dies Causes: Aspiration Strangulation Drowning 54

Rare Diseases p. 208-209 Pneumoconioses Environmentally induced diseases causing progressive, chronic inflammation and infection Types: Asbestosis Anthracosis Coal miner’s disease Black lung Silicosis 55

Rare Diseases Fungal diseases Caused by inhaling airborne fungus Two forms: Histoplasmosis Coccidioidomycosis Desert fever Valley fever 56

Rare Diseases Legionnaires’ disease Bacterial pulmonary infection Not limited to pulmonary system May cause liver damage and renal dysfunction 57

Effects of Aging p. 201 Decreased elasticity in respiratory system Becomes less efficient and has less reserve Weakened respiratory muscles Reduced resistance to infection Smoking is the major cause of high incidence of lung cancer 58