Endometrial PolypEndometrial Polyp

+ +

S/S: S/S: CoughingCoughing

S/SS/S: : shortness of breathshortness of breathChest tightnessChest tightnessWheezingWheezing

Salbutamol neb q 4 Salbutamol neb q 4 PNSS 1l+ 2 amp Aminophylline PNSS 1l+ 2 amp Aminophylline

Increase airway smooth muscleIncrease airway smooth muscle contraction (bronchospams)contraction (bronchospams)

Production of Immunoglobulin E (IgE)Production of Immunoglobulin E (IgE) by B lymphocytesby B lymphocytes

IgE antibodies attach to Mast cells & IgE antibodies attach to Mast cells & basophils in the bronchial walls basophils in the bronchial walls

Mats cells degranulateMats cells degranulate

Increase mucusIncrease mucus secretionsecretion

Cellular infiltrations (neutrophils, Cellular infiltrations (neutrophils, lymphocytes, eosinophil) and lymphocytes, eosinophil) and accumulation in the airways accumulation in the airways

Late phase response (4-8 hrs)Late phase response (4-8 hrs) Release of chemotactic mediatorsRelease of chemotactic mediators

Etiologic Agent:Etiologic Agent: allergens & irritants. (dust, allergens & irritants. (dust, pollenpollen, smokes, smokes, mold, medications, foods,, mold, medications, foods,

respiratory infections) respiratory infections)

Medical Diagnosis:Medical Diagnosis: Bronchial asthma Bronchial asthma anterior exacerbationanterior exacerbation

Risk factors: Risk factors: Family history ofFamily history of asthma and/or allergies, asthma and/or allergies, exposure to smoke, stress, exposure to smoke, stress, exercise, changes in exercise, changes in temperature & strong odorstemperature & strong odors

Capillary leaks fluid protein Capillary leaks fluid protein into tissue spaces into tissue spaces

Vasodilation andVasodilation and Increase capillaryIncrease capillary

permeability permeability

Edema of the airwayEdema of the airway (mucosal edema) (mucosal edema)

Etiologic Agent:Etiologic Agent: Bacteria, viruses, mycoplasma, fungi, Bacteria, viruses, mycoplasma, fungi, parasites & chemicalsparasites & chemicals

Inhalation/aspiration ofInhalation/aspiration of microorganismsmicroorganisms

Microorganisms reachMicroorganisms reach the alveolithe alveoli

Organisms multiply in the serous fluidOrganisms multiply in the serous fluid & spread of infection& spread of infection

Release of bacterial endotoxinRelease of bacterial endotoxin

Transient vasoconstrictionTransient vasoconstriction

Release of chemical mediator of inflammationRelease of chemical mediator of inflammation(histamine, prostaglandin, bradykinins, SRS-A(histamine, prostaglandin, bradykinins, SRS-A

Vascular changes: massive vasodilation andVascular changes: massive vasodilation and increase permeability of capillaries &increase permeability of capillaries &

increase blood flowincrease blood flow

Fluimucil sachet in ½Fluimucil sachet in ½ glass water TIDglass water TIDAmbroxol Hcl 2 tsp TIDAmbroxol Hcl 2 tsp TID P.OP.O. .

Budesonide nebBudesonide nebHydrocortisone 200mg IVTT Hydrocortisone 200mg IVTT

Cefdinir m300mg BID Cefdinir m300mg BID Clindamycin 30mg q 8hrClindamycin 30mg q 8hr IVTTIVTTCeftriaxone sodium 1 gm q 8Ceftriaxone sodium 1 gm q 8 hr IVTThr IVTTZithromax 500mg 1 tab P.O. Zithromax 500mg 1 tab P.O.

Risk factors: Risk factors: advanced age,advanced age, history of smokinghistory of smoking, upper respiratory , upper respiratory infection, tracheal intubations, prolonged immobility, immunosuppressive infection, tracheal intubations, prolonged immobility, immunosuppressive therapy, nonfunctional immune system, malnutrition, altered therapy, nonfunctional immune system, malnutrition, altered consciousness, aspiration of food, liquid or gastric material. consciousness, aspiration of food, liquid or gastric material.

Invasion of microorganisms in theInvasion of microorganisms in the spaces between cells & betweenspaces between cells & between alveoli through connecting poresalveoli through connecting pores

Damage on bronchial & alveolarDamage on bronchial & alveolar mucous membranesmucous membranes

Exposure to allergensExposure to allergens & irritants. & irritants.

Tissue damage Tissue damage

Sputum Examination: Muco-salivarySputum Examination: Muco-salivary Negative Negative

Increase mucusIncrease mucus secretionsecretion

Stasis of secretions inStasis of secretions in large airways (mediumlarge airways (medium for bacterial growth)for bacterial growth)

Damaged cells are Damaged cells are shed into the airwaysshed into the airways

Early phase response (30-60 mins.): Release ofEarly phase response (30-60 mins.): Release of chemical mediator of inflammationchemical mediator of inflammation

(histamine, prostaglandin, bradykinins, SRS-A(histamine, prostaglandin, bradykinins, SRS-A

++

Med. Mgt: Med. Mgt: Thoracentesis/surgery Thoracentesis/surgery

Microorganisms travel from theMicroorganisms travel from the infected lung into the bloodstreaminfected lung into the bloodstream

MicroorganismsMicroorganisms enters pleural cavityenters pleural cavity

MicroorganismsMicroorganisms enters the brainenters the brain

MicroorganismsMicroorganisms enters peritoneumenters peritoneum

MicroorganismsMicroorganisms enters endocardiumenters endocardium

SepsisSepsis

DeathDeath

Septic shockSeptic shock Builds up ofBuilds up of fluid in thefluid in the

pleural cavitypleural cavity (empyema)(empyema)

PleuritisPleuritis

MeningitisMeningitis EndocarditisEndocarditisPeritonitisPeritonitisBlood pressureBlood pressure

S/S:S/S: low-grade fever, cough, low-grade fever, cough, scattered cackles, minimal scattered cackles, minimal dyspnea & respiratory distressdyspnea & respiratory distress

Lab results: Lab results: WBC= 11,2 T/cummWBC= 11,2 T/cummNeutrophil 86%Neutrophil 86%Lymphocyte 10%Lymphocyte 10%Monocyte 2%Monocyte 2%Eosinophil 2%Eosinophil 2%Basophil 0%Basophil 0%

Lymphocytes carryLymphocytes carry exudates away from site ofexudates away from site of

infection infection

S/SS/S: dullness to percussion, : dullness to percussion, increase fremitus, bronchial increase fremitus, bronchial breath sounds, breath sounds, crackles crackles

Airway obstructionsAirway obstructions & narrowing & narrowing

Increases the work ofIncreases the work of breathing breathing

Increase resistance to airIncrease resistance to air flow & decrease flow ratesflow & decrease flow rates

(expiratory flow)(expiratory flow)

Hyperinflation distal toHyperinflation distal to obstructionobstruction

Air trappingAir trapping

Respond of theRespond of the lung receptorlung receptor

triggeringtriggering hyperventilation hyperventilation

Lung Lung volumevolume

HypoxemiaHypoxemia

RespiratoryRespiratory acidosis acidosis

(if severe)(if severe)

ImpairedImpaired expirationexpiration

CO2 retentionCO2 retention Decrease perfusionDecrease perfusion of alveoli of alveoli

Increase intrapleuralIncrease intrapleural alveolar gas pressure alveolar gas pressure

S/S: S/S: Tachypnea Tachypnea

RespiratoryRespiratory failure failure

Uneven ventilation-Uneven ventilation-perfusionperfusion

relationship withinrelationship within different lungdifferent lung

segmentsegment

S/S: S/S: DyspneaDyspnea Prolonged Prolonged

expiration expiration

Attraction of neutrophils, accumulationAttraction of neutrophils, accumulation of fibrinous exudates, RBC & bacteriaof fibrinous exudates, RBC & bacteria in the alveoli (congestion/hyperemia)in the alveoli (congestion/hyperemia)

Exudates liquefiesExudates liquefies

Tissue become solid grayish (GrayTissue become solid grayish (Gray hepatization) & deposition of fibrin onhepatization) & deposition of fibrin on pleural surface; phagocytosis in alveoli pleural surface; phagocytosis in alveoli

Exudates reabsorbedExudates reabsorbed by macrophages by macrophages

Red hepatization (lungs appears red &Red hepatization (lungs appears red & granular) & consolidation of lunggranular) & consolidation of lung

parenchyma parenchyma

Resolution of infection:Resolution of infection: Polymophonuclear leukocytes arePolymophonuclear leukocytes are

replaced by macrophages thatreplaced by macrophages that engulf & destroy the organisms engulf & destroy the organisms

Resolution does not occur Resolution does not occur

Blood flow Blood flow & RBC in the & RBC in the exudatesexudates; leukocytes ; leukocytes (neutrophils & macrophages)(neutrophils & macrophages) infiltrate the alveoli infiltrate the alveoli

Cough outCough out

Conversion of exudatesConversion of exudates to fibrous tissueto fibrous tissue

Affected alveoliAffected alveoli becomes functionlessbecomes functionless

Consolidation ofConsolidation of a large portion a large portion of an entire lungof an entire lung lobe (lobar lobe (lobar pneumonia) pneumonia)

Patchy consolidation Patchy consolidation involving several involving several lobes lobes (Bronchopneumonia)(Bronchopneumonia)

S/SS/S:: cough productive cough productive of of purulent, rust coloredpurulent, rust colored/blood-/blood-streaked sputum;streaked sputum; hemoptysis hemoptysis pleuritic or aching chest pain; pleuritic or aching chest pain; breath sounds & breath sounds & crackles crackles over affected areaover affected area; possible ; possible dyspneadyspnea & cyanosis & cyanosis

S/S: S/S: Wheezing Wheezing

upon upon expiration expiration

Absorption ofAbsorption of air trapped inair trapped in

the alveoli the alveoli

Alveolar sacsAlveolar sacs collapsedcollapsed

(atelectasis)(atelectasis)

PerfusionPerfusion withoutwithout

ventilation shuntventilation shunt (ventilation-(ventilation-

perfusionperfusion mismatch)mismatch)

Hypoxemia Hypoxemia

O2 inhalation O2 inhalation @ 2L/min@ 2L/min

Respiration: 35 cpmRespiration: 35 cpm irregular, and shallowirregular, and shallow

Alveoli becomesAlveoli becomes airlessairless

Sustained perfusion with Sustained perfusion with poor ventilation in the poor ventilation in the consolidated area consolidated area

HypoxemiaHypoxemia

CBC: CBC: Hgb- 11.5 %.Hgb- 11.5 %.

Hct- 35.5 vol% Hct- 35.5 vol%

↓ oxygen-carrying↓ oxygen-carrying capacity of bloodcapacity of blood

(hypoxemia)(hypoxemia)

Tissue hypoxiaTissue hypoxia

LiverLiver(fatty changes; fatty(fatty changes; fatty

changes can alsochanges can also occur in heart andoccur in heart and

kidneys)kidneys)

Weakness, Weakness, fatiguefatigue

Respiratory Respiratory (( respiratory rate respiratory rate, depth,, depth,

exertional dyspnea)exertional dyspnea)

PallorPallor (skin(skin//mucousmucous membranemembrane))

Central nervous systemCentral nervous system ((dizzinessdizziness, , fainting,fainting,

lethargy)lethargy)

IschemiaIschemia

ClaudicationClaudication (Muscle)(Muscle)

↓ Hgb concentration in↓ Hgb concentration in RBCRBC

(Anemic condition)(Anemic condition)

↓ Iron (iron deficient)↓ Iron (iron deficient)

Blood loss Blood loss

Restoration of bothRestoration of both structure & function ofstructure & function of

lung lung

Gas-exchange returns toGas-exchange returns to normal normal

CompensatoryCompensatory MechanismMechanism

CardiovascularCardiovascular RenalRenal

stroke volume stroke volume

heart rate heart rate CapillaryCapillary dilationdilation

HyperdynamicHyperdynamic circulationcirculation

Stimulates boneStimulates bone marrow tomarrow to

produce RBC produce RBC

erythropoietin erythropoietin

Heart (angina)Heart (angina) O2 demands O2 demands for work of heartfor work of heart

Renin-aldosterone Renin-aldosterone responseresponse Salt and H2O Salt and H2O retentionretention Intracellular fluid Intracellular fluid

High-outputHigh-output cardiac failurecardiac failure

Cardiac murmursCardiac murmurs

Extracellular Extracellular fluidfluid

IncreaseIncrease production ofproduction of

RBC RBC

(diphosphoglycerate)(diphosphoglycerate)

DPG cells DPG cells

Release of oxygen Release of oxygen from hemoglobin infrom hemoglobin in

tissues tissues