1. Respiratory System Diseases
Pathophysiology By Dr: HANA OMER

2. Review of Anatomy & Physiology

3. 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

4. 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

5. LOWER RESPIRATORY TRACT
TRACHEA
composed of C- shaped cartilaginous rings

6. 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)

7. LOWER RESPIRATORY TRACT

8. 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)

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

11. RESPIRATORY SYSTEM DISEASES

12. 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

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

14. 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

15. 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

16. 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

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

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

19. LOWER RESPIRATORY INFECTIOUS DISEASES

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

21. 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)

22. 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.

24. RADIOLOGIC IMAGE OF BRONCHOPNEUMONIA

25. RADIOLOGIC IMAGE OF LOBAR PNEUMONIA

26. 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).

27. 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)

28. 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.

29. 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

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

32. 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

33. 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

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

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

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

37. LOWER RESPIRATORY TRACT INFECTION
BRONCHITIS
LOWER RESPIRATORY TRACT INFECTION

38. 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)

39. 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

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

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

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

43. 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