Respiratory System Diseases Pathophysiology By Dr: HANA OMER

Review of Anatomy & Physiology

UPPER RESPIRATORY TRACT RESPIRATORY MUCOSA lined with ciliated mucus producing cells 125cc/ day purifies air NOSE paranasal sinuses frontal, maxillary, sphenoid, ethmoid lighten skull sound resonant chambers conchae (3 pairs) warm & humidify air lacrimal ducts olfactory receptors

UPPER RESPIRATORY TRACT PHARYNX 3 parts: Nasopharynx, Oropharynx, Laryngopharynx Tonsils(3 pairs) pharyngeal (adenoids) palatine lingual Eustachian (auditory) tubes open into nasopharynx equalizes pressure between middle ear & the outside LARYNX composed of pieces of cartilage Thyroid cartilage= Adam’s apple epiglottis & glottis

LOWER RESPIRATORY TRACT TRACHEA composed of C- shaped cartilaginous rings

LOWER RESPIRATORY TRACT BRONCHI, BRONCHIOLES, ALVEOLAR DUCT, ALVEOLI Gas exchange occurs in alveoli occurs via Passive Diffusion Respiratory Membrane 2 cell thick layer surfactant = reduces surface tension to keep alveoli distended lining of alveolus (alveolar epithelium) lining of capillary ( capillary endothelium)

LOWER RESPIRATORY TRACT

LOWER RESPIRATORY TRACT Lungs & Pleura Right Lung = 3 lobes; Left Lung = 2 lobes lower part of lung resting on diaphragm = Base of lung upper part of lung under clavicle = Apex of lung Pleura = serous membrane (i.e. secretes some fluid) Parietal Pleura lines thoracic cavity Visceral Pleura lines organs (viscera)

Respiratory System Diseases General Outline INFECTIOUS DISEASES Upper Upper respiratory infection Croup Epiglottitis Flu (Influenza) Lower Bronchiolitis Pneumonia TB Fungal diseases

RESPIRATORY SYSTEM DISEASES

RESPIRATORY SYSTEM DISEASES GENERAL OUTLINE 2) COPD (chronic obstr. pulm. dis) Emphysema Chronic bronchitis 3) Restrictive lung diseases Chest wall abnormalities Connective tissue abnormalities Pneumoconioses 4) Obstructive lung diseases Cystic fibrosis Cancer Aspiration pneumonia Asthma

RESPIRATORY SYSTEM DISEASES GENERAL OUTLINE 5) Vascular disorders Pulmonary edema Pulmonary embolism 6) Expansion disorders Atelectasis Pleural effusion Pneumothorax Resp. distress syndrome Infant adult

Manifestations of Pulmonary Disease Sneezing = reflex response to irritation of upper respiratory tract Coughing = reflex response to irritation of lower respiratory tract Sputum production If yellowish- green ------ infection If rusty ------- blood + pus = pneumococcal pneumonia If bloody , called “hemoptysis” ---- usually frothy --- seen in pulm. Edema Also seen in pulm. TB & cancer Large amounts & foul = bronchiectasis Thick & sticky = asthma, cystic fibrosis

Manifestations of Pulmonary Disease Breathing patterns Labored (dyspnea) , wheezing, stridor Breath sounds Normal, rales, rhonchi, decreased breath sounds Dyspnea --- discomfort feeling when can’t get enough air Orthopnea = dyspnea lying down Cyanosis --- not a reliable early indicator of hypoxia

UPPER RESPIRATORY TRACT INFECTIONS Definition Acute inflammatory process that affects mucus membrane of the upper respiratory tract Includes one or more of the following Problems Rhinitis also called Coryza Pharyngitis Laryngitis Sinusitis

Upper Respiratory Infection (URI) S/S = low-grade fever, malaise, sore throat, & discharge

INFLUENZA 1) Viral types---- A,B, &C They mutate constantly thus preventing effective immune defense for prolonged time periods 2) Short incubation ---- 3 days

LOWER RESPIRATORY INFECTIOUS DISEASES

Pneumonia Definition It is an inflammatory process of the lung parenchyma that is commonly caused by infectious agents.

Classification of pneumonia According to causes Bacterial (the most common cause of pneumonia) Streptococcus pneumoniae, Haemophilus influenzae Viral pneumonia Respiratory syncytial virus, parainfluenza viruses Fungal pneumonia Candida species, Aspergillus species Chemical pneumonia (ingestion of kerosene or inhalation of irritating substance) Inhalation pneumonia (aspiration pneumonia)

Classification of pneumonia According to areas involved Lobar pneumonia; if one or more lobe is involved Broncho-pneumonia; the pneumonic process has originated in one or more bronchi and extends to the surrounding lung tissue.

RADIOLOGIC IMAGE OF BRONCHOPNEUMONIA

RADIOLOGIC IMAGE OF LOBAR PNEUMONIA

Mode of transmission WAYS YOU CAN GET PNEUMONIA INCLUDE: Bacteria and viruses living in your nose, sinuses, or mouth may spread to your lungs. You may breathe some of these germs directly into your lungs (droplets infection). You breathe in (inhale) food, liquids, vomit, or fluids from the mouth into your lungs (aspiration pneumonia).

Predisposing factors 1. Immuno-suppresed patients 2. Cigarette smoking 3. Difficult swallowing (due to stroke, dementia,parkinsons disease, or other neurological conditions) 4. Impaired consciousness ( loss of brain function due to dementia, stroke, or other neurological conditions)

Predisposing factors 5. Chronic lung disease (COPD, bronchostasis) 7. Other serious illness such as heart disease, liver cirrhosis, and DM 8. Recent cold, laryngitis or flu.

PATHOPHYSIOLOGY OF PNEUMONIA BACTERIA REACH THE ALVEOLI (INHALATION OF PATHOGENS) CAUSE INFLAMMATION EXUDATION OF FLUID WBCs MIGRATE TO ALVEOLI CONSOLIDATION AND EDEMA BLOCKAGE OF ALVEOLI AND BRONCHI POOR ALVEOLAR OXYGEN

CLINICAL MANIFESTATION OF PNEUMONIA Shaking chills Rapidly rising fever ( 39.5 to 40.5 degree) Stabbing chest pain aggravated by respiration and coughing

CLINICAL MANIFESTATION OF PNEUMONIA Tachypnea, nasal flaring Patient is very ill and lies on the affected side to decrease pain Use of accessory muscles of respiration e.g. abdomen and intercostals muscles

CLINICAL MANIFESTATIONS….. Cough with purulent, blood tinged, rusty sputum Shortness of breath Flushed cheeks Loss of appetite, low energy, and fatigue Cyanosed lips and nail beds

DIAGNOSTIC TESTS FOR PNEUMONIA History taking Physical examination Chest x-ray Blood test Sputum culture

MEDICAL MANAGEMENT OF PNEUMONIA Antibiotic, depending on sputum and blood culture Oxygen therapy Chest physiotherapy

COMPLICATIONS Acute respiratory distress syndrome (ARDS) Pleural effusion Lung abscesses Respiratory failure (which requires mechanical ventilator) Sepsis, which may lead to organ failure

LOWER RESPIRATORY TRACT INFECTION BRONCHITIS LOWER RESPIRATORY TRACT INFECTION

BRONCHITIS DEFINITION Bronchitis is defined as the inflammation or infection of bronchi and bronchioles. Depending on the duration of disease , it can be 1. Acute (lasts for few days) 2. Chronic (for prolonged time)

BRONCHITIS CAUSES FOR ACUTE TYPE 1. Viral infections 90% Influenza virus A,B ,adenovirus , respiratory syncytial virus. 2. Bacterial infections 10% Mycoplasma pneumoniae, streptococcus pneumoniae

BRONCHITIS PREDISPOSING FACTORS Chronic sinusitis Chronic obstructive pulmonary disease Asthma Bronchiectasis Smoking and second hand smoke. Alcoholism

BRONCHITIS History of dry or productive cough 5- 10 days Body aches Clinical manifestations SYMPTOMS History of dry or productive cough 5- 10 days Body aches Chest pain on coughing Soar throat

BRONCHITIS SIGNS Mild to moderate fever Increased respiratory rate Increased heart rate Wheezing on auscultation

BRONCHITIS MANAGEMENT Goals of management are To releive the symptoms To prevent the Pneumonia Treatment Symptomatic treatment to relieve the pain, fever and cough Increase the rest time Increase the hydration(8-10 glasses of water) Avoid the aggravating factors