respiratory dis. Presentation1 for gen path.pptx

7/29/2019 respiratory dis. Presentation1 for gen path.pptx

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RESPIRATORYDISEASE


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Major Determinants of

Disease Diseases of one lung compartment tend to affect

the others

The lungs are open to the environment, exposingthem to infectious agents, allergens, irritants, &carcinogens

Most lung disease is caused by inhalation ofmaterial; the most common exception isautoimmune lung disease

Lost pulmonary membrane is not recoverable

Smoking is a major cause of lung disease The heart & lungs are a functional unit; lungdisease usually affects the heart; & heart diseaseusually affects the lungs


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Common Approach Affecting

The airways The interstitium

The pulmonary vascular system

Chronic obstructive pulmonary disease(COPD)

Acute lung injury

Pulmonary infections Diffuse interstitial (restrictive, infiltrative)

lung diseases

Lung tumors


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Chronic Obstructive Pulmonary

Diseases (COPD)

Chronic bronchitis Emphysema

Bronchiectasis

Asthma


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Chronic B ronchi tis

Chronic bronchitis is defined clinically. It is

present in any patient who has persistent cough

with sputum production for at least 3 months in

at least 2 consecutive years, in the absence ofany other identifiable cause.

(1) Progress to chronic obstructive airway

disease (2) Lead to cor-pulmonale and heart failure

(3) Cause atypical metaplasia and dysplasia of

the respiratory epithelium


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Pathogenesis

Tobacco smoke

90% of patients are smokers.

Grain, cotton, and silica dust Air pollution

Infection

Bacterial and viral infections are important

intriggering acute exacerbation of the disease.

Others


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Morphology Grossly

Hyperemic and swollen Mucinous or mucopurulent secretions

Histologically

Chronic inflammation of the airways (predominantly

lymphocytes) Enlargement of the mucus-secreting glands in the

trachea and larger bronchi

Inflammatory cells, largely mononuclear but

sometimes admixed with neutrophils Goblet cell metaplasia, mucus plugging, inflammation,

and fibrosis (small airway disease, (bronchiolitis

obliterans)


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Chronic bronchitis. The lumen of the bronchus is above. Note the markedthickening of the mucous

gland layer (approximately twice normal) and squamous metaplasia of lung

epithelium. (From the teaching collection of the Department of Pathology,

University of Texas, Southwestern Medical School,

Dallas, Texas.)


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Clinical Course

Prominent cough

Production of sputum

Hypercapnia, hypoxemia, and cyanosis

Pulmonary hypertension and cardiac failure Recurrent infections and respiratory failure


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Complications

Emphysema

Cor pulmonale

Bronchiectasis

Bronchopneumonia

Bronchogenic carcinoma of lung


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Emphysema

Definition

Emphysema is a condition of the lungcharacterized by abnormal permanent

enlargement of the airspaces distal to the

terminal bronchiole, accompanied bydestruction of their walls and without

obvious fibrosis.


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Pathogenesis

The genesis of emphysema is not

completely understood.

A consequence of two critical imbalances

The protease-antiprotease imbalance

Oxidant-antioxidant imbalance


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Protease-An tip ro tease Imbalance

Hypothesis

Genetic deficiency of the antiprotease1- antitrypsin

The effect of cigarette smoking in the

development of emphysema Increased elastase availability and

decreased

antielastase activity occur in smokers. Smoking enhances elastase activity in

macrophages


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Oxidant-Ant ioxidant Imbalance

Tobacco smoke contains abundant

reactive oxygen species (free radicals),

which deplete these antioxidant

mechanisms, thereby inciting tissue

damage.

Tissue breakdown is enhanced as a

consequence of inactivation of protective

antiproteases by reactive oxygen species

in cigarette smoke.


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Pathogenesis of emphysema. The protease-antiprotease

imbalance andoxidant-antioxidant imbalance are additive in their effects and

contribute to

tissue damage.1-antitrypsin (1-AT) deficiency can be either

congenital or

"functional" as a result of oxidative inactivation.


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Types of Emphysema

According to its anatomic distribution within

the lobule

Four major types

CentriacinarPanacinar

Paraseptal

Irregular Only the first two cause clinically significant

airflow obstruction.


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en tr iac inar (Centr i lobu lar)

Emphysema

The central or proximal parts of the acini,

formed by respiratory bronchioles, are affected,

whereas distal alveoli are spared. The lesions are more common and severe in

the upper lobes, particularly in the apical

segments. Centriacinar emphysema occurs

predominantly in heavy smokers, often in

association with chronic bronchitis.


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Panacinar (Panlobular)

Emphysema

The acini are uniformly enlarged from the

level of the respiratory bronchiole to the

terminal blind alveoli. Tends to occur more commonly in the lower

zones and in the anterior margins of the lung,

and it is usually most severe at the bases. This type of emphysema is associated with

1- antitrypsin (1-AT) deficiency.


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A, Centriacinar emphysema. Central areas show

marked emphysematous damage (E), surrounded byrelatively spared alveolar spaces.

B, Panacinar

emphysema involving the entire pulmonary

architecture.


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Distal Ac inar (Paraseptal)

Emphysema

The proximal portion of the acinus is normal,

but the distal part is predominantly involved.

The characteristic findings are of multiple,continuous, enlarged airspaces from less than

0.5 cm to more than 2.0 cm in diameter,

sometimes forming cystlike structures. This type of emphysema probably underlies

many of the cases of spontaneous

pneumothorax in young adults.


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A irspace Enlargement w ith Fibros is

(Irregular Emphysema)

The most common form of emphysema

Autopsy shows one or more scars from

a healed inflammatory process.

In most instances, these foci of irregular

emphysema are asymptomatic and

clinically insignificant.


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In ters t i t ial Emphysema

The entrance of air into the connective

tissue stroma of the lung, mediastinum,

orsubcutaneous tissue.

Wound of the chest

Children with whooping cough andbronchitis,

Patients with obstruction to the airways


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Compensatory Hyper inf lat ion

(Emphysema)

Surgical removal of a diseased lung or

lobe.

Designate dilation of alveoli but not

destruction of septal walls.


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Bullous Emphysema

Produces large subpleural blebs or

bullae (spaces more than 1 cm in

diameter in the distended state) Most often subpleural, and occur near

the apex

Pneumothorax


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Bullous emphysema with large subpleural

bullae (upper left).


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Morphology

The diagnosis and classification of emphysemadepend largely on the macroscopic appearance

of the lung.

Panacinar emphysema Produces pale, voluminous lungs that often obscure

the heart when the anterior chest wall is removed at

autopsy.

Centriacinar emphysema

The upper two-thirds of the lungs is more severely

affected than the lower lungs.


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Morphology

DistalAcinar (Paraseptal) Emphysema

Adjacent to the pleurabullae

Spontaneous pneumothorax

Irregular Emphysema

The acinus is irregularly involved, is

almost invariably associated with scarring


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Microscopy

Thinning and destruction of alveolar

walls

Adjacent alveoli become confluent,creating large airspaces

Loss of elastic tissue in the surrounding

alveolar septa The number of alveolar capillaries is

diminished.


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Microscopically at high magnification, the loss of

alveolar walls with emphysema is demonstrated.

Remaining airspaces are dilated.


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Clinical Course

Dyspnea is usually the first symptom

Steadily progressive Cough and wheezing

Weight loss

Pulmonary function tests The ratio of FEV1 to FVC is reduced


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Complications

Cor pulmonale

Pneumothorax

Respiratory failure


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Anatomic distribution of pure chronic bronchitis and pure emphysema. In

chronic bronchitis the small-airway disease (chronic bronchiolitis) results in

airflow obstruction, while the large-airway disease is primarily responsible for

the mucus hypersecretion.


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Bronchiectasis

The permanent dilation of bronchi and

bronchioles caused by destruction of the

muscle and elastic supporting tissue. Resulting from or associated with

chronic necrotizing infections.

Cough and expectoration of copiousamounts of purulent sputum


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Pathogenesis

Obstruct ion

Chronic pers istent in fect ion

Damage to bronchial walls, leading to

weakening and dilation.

Obstructive secretions, inflammationthroughout the wall


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Morphology

Affects the lower lobes bilaterally The airways dilated

Histologically

Intense acute and chronic inflammatoryexudate within the walls of the bronchi and

bronchioles

The desquamation of lining epitheliumcause extensive areas of ulceration

Fibrosis of the bronchial and bronchiolar

walls and peribronchiolar fibrosis


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This is the microscopic appearance of bronchiectasis.

Bronchiectasis is not a specific disease, but a

consequence of another disease process that destroys

airways.


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Clinical Course

Severe, persistent cough with expectoration

of mucopurulent

Fetid, sputum.

The sputum may contain flecks of blood

Hypoxemia, hypercapnia, pulmonary

hypertension, and (rarely) cor pulmonale.


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Complications

Lung abscess

Pyemia--metastatic abscesses

Pulmonary fibrosis

Cor pulmonale


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Asthma


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Pathophysiology

Asthma trigger

- Inflammation & edema of the mucousmembranes.

- Accumulation of tenacious secretionsfrom mucous glands.

- Spasm of the smooth muscle of thebronchi & bronchioles decreasesthe caliber of the bronchioles.


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Clinical manifestations

A) General manifestations:

1. The classical manifestations are: dyspnea,wheezing, & cough.

2. The episode of asthma is usually beginswith the child feeling irritable &

increasingly restless. Asthmatic child

may complain headache, feeling tired, &

chest tightness.


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Clinical manifestations:

B) Respiratory symptoms:

- Hacking, paroxysmal, irritating and nonproductive cough due to bronchial edema.

Accumulation of secretion stimulate cough thatbecomes rattling & productive (frothy, clear,gelatinous sputum).

- Shortness of breath, prolonged expiration,wheezy chest, cyanosed nail beds, & dark redcolor lips that may progress by time to blue.


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C) On chest examination:

- Inspection reveals major changes in the form ofsupraclavicular, intercostals, subcostal, &

sternal retractions due to the frequent use of

accessory muscles of respiration.

With repeated episodes: chest shape is changed

to barrel chest, & elevated shoulder.

- Auscultation reveals loud breath sounds in theform of course crackle, grunting, wheezes

throughout the lung region.


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Diagnostic evaluation:

1. Clinical manifestations,history, physical examination,

& Lab tests.

2. Radiographic examination.

3. Pulmonary function tests

provide an objective method

of evaluating the degree of

lung disease.


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Coughing

Wheezing, a whistlingsound

Shortness of breath

Chest tightness

Sneezing & runny

nose

Itchy and inflamed

eyes


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Asthma

Therapeutic

management

- Allergic control

to preventattacks.

Drug therapy:

B- adrenergic,

Theophyllin, &

corticosteroids

preparations + chest

physiotherapy (onlyin between attacks).

Clinical

T

Anatomic

Sit

Major

P th l i

Etiology Signs/

S t


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Term Site Pathologic

Changes

Symptoms

Chronic

bronchitisBronchus Mucous gland

hyperplasia,

hypersecretion

Tobacco

smoke, air

pollutants

Cough,

sputum

production

Bronchiectasis Bronchus Airway dilation

and scarring

Persistent or

severe

infections

Cough,

purulent

sputum, fever

Emphysema Acinus Airspace

enlargement;

wall

destruction

Tobacco

smoke

Dyspnea

Asthma Bronchus Smooth

muscle

hyperplasia,

excess mucus,

inflammation

Immunologic

or undefined

causes

Episodic

wheezing,

cough,

dyspnea

Lower Respiratory Tract


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Lower Respiratory Tract

Infections: Bronchiolitis (RSV

Infection) 2-12 month Caused by syncytial virus Transmitted by oral droplet Predisposing factors (asthma, smoking) Causes necrosis and inflammation of small bronchi and

bronchioles

Signs Wheezing and dyspnea Rapid, shallow respirations Cough

Rales

Chest retractions Fever

Treatment Supportive and symptomatic


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Pulmonary Infections

Pneumonia can result

whenever these defense

mechanisms are impaired

or whenever theresistance of the host in

general is lowered.

Most deadly infectious disease in the U.S.

6th leading cause of death

P i


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Pneumonia

Etiological classification

Bacterial pneumonia

Viral pneumonia

Fungal pneumoniaetc.

Anatomical classification

Lobar pneumoniaLobular pneumonia

Interstitial pneumonia


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Pulmonary Infections or

Pneumonia

Pneumonia can be very broadly definedas any infection in the lung. It may

present as acute, fulminant clinical

disease or as chronic disease with amore protracted course.

Pathogenesis


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Pathogenesis

Streptoco ccus Pneumon iaeThe most common cause of acute pneumonia.

Exam inat ion o f Gram -stained sputum is an important step

in the diagnosis o f acute pneumon ia.

Pneumococcal pneumonias respond readily to penicillin

treatment, but there are increasing numbers of

penicillinresistant

strains of pneumococci.

Haemoph i lus Inf luenzae A major cause of life-threatening acute lower respiratory

tract

infections and meningitis in young children.

Moraxella Catarrhal is


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Streptococcal pneumon iae,pneumococcal

Infection localized in 1 or morelobes

Congestion


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Inflammation andvascular congestion in

alveolar wall

Exudate forms in alveoli Interferes with oxygen

diffusion

Consolidation

Neutrophils, RBCs, fibrinaccum in exudate Form solid mass

RBCs break down,infection resolves

Macrophages break downexudate

Expectorated or resorbed


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Pleurae typically involved Infection in pleural cavity Emphysema

Adhesions betweenmembranes

Manifestations Sudden onset Systemic signs: high fever,

chills, fatigue

Dyspnea, tachycardia Pleuritic pain Rales Productive cough


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Lung cancer

Lung cancer is currently the mostfrequently diagnosed major cancer in the

world and the most common cause of

cancer mortality worldwide. Cancer of the lung occurs most often

between ages 40 and 70 years, with a

peak incidence in the fifties or sixties.

The 5-year rate for all stages combined is

only 15%.


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Cigarette smoking

Passive smokingincreases the risk of

developing lung cancer to

approximately twicethat of nonsmokers.

Industrial Hazards

Air Pollution

Molecular Genetics


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Squamous dysplasia

and carcinoma in situ

Atypical adenomatous

hyperplasia

Diffuse idiopathic

pulmonary

neuroendocrine cellhyperplasia


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Squamous cell

carcinoma (25% to

40%)

Adenocarcinoma

(25% to 40%)

Small cell carcinoma

(20% to 25%) Large cell carcinoma

(10% to 15%)

I idi


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Insidious onset Normally metastized

before diagnosis 4 possible categoriesof signs of lung cancer

Direct effects oftumorSystemic effects ofcancer

Paraneoplasticsyndromes

Metastizes at othersites


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Persistent, productivecough, dyspnea,

wheezing Detection on chest X-ray Hemoptysis

Pleural involvement Chest pain Hoarseness

Facial, arm edema;headaches Dysphagia


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Systemic signsWt. loss, anemia,

fatigue

Paraneoplasticsyndrome

Signs of endocrinedisorder

Depends on hormonebeing secreted

Signs of metastasisdepends on site


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Chest X-rays Bronchoscopy Pulmonary function tests


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Surgery on localizedlesions Chemotherapy and

radiation

Poor prognosis unlesstumor in early stages

of development

Wh t i t b l i (TB)?


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What is tuberculosis (TB)?

Tuberculosis (TB) is a disease caused bybacteria called Mycobacterium tuberculosis.

The TB bacteria can affect any part of the

body, but usually affects the lungs. If not treated properly, a person who has TB

infection can develop TB disease.

If a person develops TB disease and does

not get appropriate medical treatment he/she

can die.

H d t TB?


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How do you get TB?

TB is generally spread through the airwhen a person who has TB diseasefrequently sneezes, coughs, speaks or

sings near others for a long period of time.Persons who breathe in air containingTB germs can become infected with TB.Typically, only close contacts of a

person who has TB disease areconsidered to be at risk.


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Mycobacterium tuberculosis

Chronic granulomatous inflammation with

caseous necros

Pathogenesis


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Pathogenesis

How is TB infection different


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How is TB infection different

from TB disease?

People with TB infection have a positive

TB skin test but they: are not sick, do not

have symptoms, cannot spread TB to others,can develop TB disease if not treated for

TB infection.

When TB infection is treated it greatlyreduces the chance that you will ever develop

TB disease.

How do I get tested for TB?


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How do I get tested for TB?

A TB skin test is performed byinjecting a small amount of fluid in the skin on the

lower part of the arm. You will need to return within

48-72 hours to have a trained health care worker see if

the skin test is positive or negative. You can get a skin test at your local health

department or at your healthcare providers office.

If you have a positive reaction to the skin test (TB

infection), your healthcare provider may do other

tests to see if you have developed TB disease.

Wh t th t f TB?


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What are the symptoms of TB?

Symptoms of TB disease include:feelings of sickness or weakness,

weight loss, fever, and night sweats.

When TB disease affects the lungs,additional symptoms may include: a bad

cough that lasts longer than 2 weeks,

shortness of breath, pain in the chest andcoughing up blood.

Remember


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Remember

TB infection occurs when a person hasbreathed in the TB germ, but the person is not

sick.

TB disease can develop in a person withTB infection if they do not get medical

treatment.

A person with TB disease is sick and mayhave several symptoms of the disease.

If left untreated, persons with TB disease

can die from TB.

How is TB treated?


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How is TB treated?

TB disease can usually be curedby taking several medicines for 6-12 months. It is very important that people who have TBdisease take the medication exactly as

prescribed. If you stop taking the medication too soon,you can become sick again. Also, if you do not take the medicationcorrectly, the germs may become resistant tothose medications and become more difficult totreat.


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An inflammation of the larynx.

It causes hoarse voice or the

complete loss of the voicebecause of irritation to thevocal folds.

Bronchitis


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BronchitisBronchitis is an inflammation of the main airpassages to the lungs

Most prevalent in winter

Generally part of an acute URIIt may develop after a common cold orother viral infection of the nasopharynx,

throat, or bronchi

Often with secondary bacterial infection


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1.Malaise


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. a a se2.Chilliness

3.Slight fever4.Back and muscle pain

5.Sore throat6.Onset of a distressingcough usually signals

onset of bronchitis7.Cough starts off dry and

later produces mucous.


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Tonsillitis


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Tonsillitis

What is tonsillitis?

Tonsillitis is a viral or bacterial infection inthe throat that causes inflammation of the

tonsils. Tonsils are small glands (lymphoid

tissue) in the pharyngeal cavity.

In the first six months of life tonsilsprovide a useful defense against

infections. Tonsillitis is one of the mostcommon ailments in pre-school children,

but it can also occur at any age.

Tonsillitis


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Tonsillitis

Palatinetonsils

(Visible duringoralexamination)


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Tonsillitis: Children are most often

affected from around the

age of three or four, when

they start nursery or

school and come intocontact with many new

infections.

A child may have tonsillitis ifhe/she has a sore throat, a fever

and is off food.


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Tonsillitis is caused by a variety of

contagious viral and bacterial

infections. It is spread by close

contact with other individuals and

occurs more during winter

periods. The most common

bacterium causing tonsillitis is

streptococcus.

Otitis media


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Otitis media

Background:

Otitis media (OM) is the second most

common disease of childhood, after upper

respiratory infection (URI).

Definition:

Otitis media is an inflammation of the middleear.

Otitis media:


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Otitis media:

Otitis media can be classified into many

variants on the basis of etiology,duration, symptomatology, and physical

findings as the following:

Acute Otitis media: implies rapid onsetof disease associated with 1 or more ofthe following symptoms:

Otalgia, Fever, Otorrhea, Recent onset ofanorexia, Irritability, Vomiting, &

Diarrhea


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Acute Otitis media (AOM):These symptoms are

accompanied by abnormal

otoscopic findings of the

tympanic membrane (TM),

which may include thefollowing:

- Opacity

- Bulging

- Erythema

- Middle ear effusion (MEE)
http://www.emedicine.com/ped/images/Large/1784NEWNormal_TM_2.jpg


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Healthy Tympanic

Membrane
http://www.emedicine.com/ped/images/Large/1784NEWNormal_TM_2.jpg


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1.Administration ofantibiotic

(Ampicillin or

Amoxicillin) & anti-inflammatory

(analgesic &

antipyretic).

Croup Syndrome:


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Croup Syndrome:Acute infection of the

larynx characterized by severe

involvement of voice & breathing appears

in the following clinical pictures:hoarseness of voice, resonant cough, &

varying degrees of respiratory distress.

Croup syndromes are usually describedaccording to primary anatomic area

affected e.g., laryngitis,

laryngotracheobronchitis (LTB).


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- Therapeutic management:1. Hospitalization for

continuous observation &

for possible tracheostomy

or endotracheal intubation.

2. Provide cool mist oxygen.3. Patients may respond to

corticosteroid therapy.

The disease is usually selflimited.

Home care:


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Home care:1. Encourage bed rest.2. Provide warm, high humidity

atmosphere, especially

during periods of coughing &

during sleep.3. Encourage inhalation of

warm steam to prevent

recurrence.

4. Keep the child calm most oftime (avoid crying, &

excessive talking).

Bronchiolitis:B hi liti i ill
http://www.kidshealth.org/parent/general/body_basics/lungs.html


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Bronchiolitis is a common illness

of the respiratory tract usually

caused by viral infection. Itaffects the tiny airways, called

the bronchioles, that lead to the

lungs. As these airways become

inflamed, they swell and fill withmucus, making breathing

difficult.

The variable degrees of

obstruction produced in airpassage by these changes lead

to hyperpnoea & progressive

emphysema.
http://www.kidshealth.org/parent/general/body_basics/lungs.htmlhttp://www.kidshealth.org/parent/general/body_basics/lungs.html


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Normal lungs

& alveoli

Bronchiolitis:- Incidence:


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- Incidence:

- Typically occurs during the first 2years of life, with peak occurrence

at about 3 to 6 months of age.

- Is more common in males,

children who have not beenbreastfed, and those who live in

crowded conditions.

-Day-care attendance and

exposure to cigarette smoke also

can increase the likelihood that an

infant will develop bronchiolitis.

Bronchiolitis:


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Bronchiolitis:- Nursing Assessment (S &

S):

The first symptoms of bronchiolitis

are usually the same as those of

a common cold:

-Stuffiness runny nose, mild

cough, &mild fever

These symptoms last a day or two

and are followed by worsening of

the cough and the appearance of

wheezes (high-pitched whistling

noises when exhaling).
http://www.kidshealth.org/parent/infections/common/cold.htmlhttp://www.kidshealth.org/parent/infections/common/cold.html


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Bronchiolitis: Diagnostic evaluation:

- Chest X-ray.

- Culture from respiratory

secretions.

Therapeutic management:


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Therapeutic management:

Fortunately, most cases of

bronchiolitis are mild andrequire no specific treatment.

Antibiotics aren't useful

because bronchiolitis

is caused by a viral infection.

Medication may sometimes be

given to help open a child's

airways e.g., bronchodilators,corticosteroids.

Cough suppressants.

Encourage bed rest.

Secondary bacterialinfection


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infection Obstruct drainage in 1 or

more paranasal sinuses

Common causativeorganisms Pneumococci Streptococci Haemophilus influenzae

Exudate accumulates Signs Nasal congestion, fever,

sore throat

Diagnosis confirmed byradiograph, transillumination

Decongestants, analgesics Antibiotics


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Naso-pharyngitis: =


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Naso-pharyngitis: =Common cold.

Def:

Viral infection of the nose& throat.

Assessment (S &S):

1.

Younger childFever, sneezing, irritability,

vomiting & diarrhea

2. Olderchild

Dryness & irritation of nose &throat, sneezing, &muscular aches.

Complications of


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Complications of

nasopharyngitis:

- Otitis media- Lower respiratory tractinfection

- Older child may developsinusitis

Medication:Acetaminophen

Pharyngitis:=Sore


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y g

throat including tonsils.

- Uncommon in childrenunder 1 yr. The peak

incidence occurring

between 4 & 7 yrs of age.

- Causative organism:virusesorbacterial (group A beta-hemolytic streptococcus).


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Assessment (S &S)


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of pharyngitis:

1.

Younger child

Fever, anorexia, general malaise, &

dysphage

2. Older

child

Fever (40 c), anorexia, abdominal

pain, vomiting, & dysphagea.

Complications ofpharyngitis:


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pharyngitis:

- Retro pharyngeal abscess.- Otitis media.- Lower respiratory tract

infection.

- Complications of GABHSInfection: Peritonsillarabscess; occurs in fewer

than 1% of patients treated

with antibiotics that leads to

rheumatic fever, oracute

glomerulonephritis.

Symptoms of influenza


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Symptoms of influenzainfection:

Headache

Fever, chills Muscle aches Nasal discharge Unproductive cough Sore throat

Influenza infection can causemarked inflammation of therespiratory epithelium and a loss ofciliated cells that protect therespiratory passages from otherorganisms.

As a result, influenza infection may

lead to co-infection of the respiratorypassages with bacteria. It is also possible for the influenza

virus to infect the tissues of the lungitself to cause a viral pneumonia.

Treatment of influenza: Bed rest, fluids, warmth


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, ,

Antiviral drugs

Influenza vaccine :

Provides protection against certainA and B influenza strains that areexpected to be prevalent in acertain year.

The vaccine must be updated andadministered yearly to be effectivebut will not be effective againstinfluenza strains not included in thevaccine.

The influenza vaccine is advisedfor elderly people, in individualsweakened by other disease and inhealth-care workers


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Carcinoma of theL


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Larynx

Common Mostly in malesmokers over 40

Alcohol abuseincreases the risk Presents with

hoarseness pain cough dysphagia hemoptysis


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Restrictive LungDi


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Disease

Chronic inflammationmaking lungs stiff &inelastic

Affects diffusion Scar tissue accumulates

in the interstitium Mostly cause is

unknown

Equal decline in FEV1 &FVC

Usually presents withshortness of breath Can lead to pulmonary

HTN

Interstitial Fibrosis withoutGranulomatous Inflammation


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G a u o atous a at o

Usually middle-agedmen at time ofdiagnosis

Shortness of breath;may progress to corpulmonale, hypoxia

Pneumoconioses black lung disease silicosis

most commonchronicoccupationaldisease

asbestosis mesothelioma

Interstitial Fibrosis with


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Interstitial Fibrosis with

Granulomatous Inflammation

Sarcoidosis

cause unknown

affects many tissues butmostly lungs

present with shortness of

breath, cough, chest pain,hemoptysis

Pulmonary Edema


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Pulmonary Edema

Fluid in alveoli Increased BP in lung normal is 25/8 mmHg

with average at 15 mmHg

Microvascular injury due to

toxic fumes hot gases septicemia IV drug abuse

Main symptom is SOB

PulmonaryThromboembolism


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Thromboembolism

About 50,000 deaths annually Mostly from DVT Inflammation predisposes you to

it

Promoted by

CHF pregnancy birth control pills prolonged bed rest metastatic cancer

genetics Most associated with nosymptoms but some cause lung infarcts chest pain & dyspnea death

Pulmonary Hypertension


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y yp Sustained systolic pressure over 30

mmHg or average in excess of 25mmHg

Vicious cycle Most common cause is increased

pulmonary vascular resistance

Usually secondary to

COPD heart disease collagen vascular diseases recurrent pulmonary

thromboemboli

With R heart failure is cor pulmonale Thickening of arteriolar walls SOB

chest pain fatigue

Adult Respiratory Distress Syndrome


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ARDS Alveolar or pulmonary capillary damage Pathogenesis

injury to endothelium or alveoli neutrophils infiltrate protein-rich fluid exudes into alveolar space SOB occurs with rapid breathing which dries the fluid into a thick

membrane stiffens lungs limits airflow & interferes with diffusion hypoxia 50% fatality

Causes sepsis smoke inhalation near drowning

O2 toxicity burns DIC fat embolism endotoxic shock


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Lung Abscess


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Purulentinflammation withtissue necrosis &liquefaction

Usually haveseveral types ofbacteria withanaerobic

Most commonly dueto aspiration ofgastric contents

Foul-smellingsputum

Mostly due to


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y

metastasis

Bronchogeniccarcinoma is the most

common

most common of allcancers#1 cancer death

about 90% arecigarette smokers

Bronchogenic Carcinoma


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Bronchogenic Carcinoma

Mostly caused by cigarettes Direct relationship between incidence of

cancer & number of cigarettes smoked

Direct relationship between precancerous

changes in bronchial mucosa & number of

cigarettes smoked


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