Chapter 9

Non-small cell lung cancer (NSCLC)

-About 85 % of lung cancer is non-small cell, - Squamous cell carcinoma: 30% of all lung cancers, -Adenocarcinoma: 40%, -Large cell carcinoma: 10%

Hemothorax

-Accumulation of blood and other fluids in the pleural cavity, -most common cause is trauma, -Symptoms: chest pain, low blood pressure, pale, cool clammy skin, rapid heart rate, shortness of breath, restlessness

Infectious Mononucleosis: Epstein Barr virus Infection

-Acute herpesvirus infection (glandular fever) -Symptoms: lymphadenopathy, Fever that typically peaks in afternoon, Listlessness, malaise, chills, anorexia, Sore throat, fever, headache, fatigue, and cervical generalized lymphadenopathy, Spread through saliva of infected persons (aka kissing disease)

Causes of Pneumonia (cont.)

-Adenoviruses, -Influenza viruses, -Syncytial viruses, -May also be caused by damage to lungs, such as inhalation of poisonous gas such as chlorine or aspiration of foreign matter.

Atelectasis

-Airless or collapsed state of the pulmonary tissue (incomplete expansion). -Etiology: caused by an obstruction in the bronchial tree; may be mucous plug, foreign object, or bronchogenic cancer, complication of surgery, cystic fibrosis. -risk factors: obesity, upper abdominal or chest surgery, neuromuscular weakness, or any pulmonary disease

Treatment of pulmonary embolism

-Anticoagulant medications (blood thinners), -Thrombolitic medications (clot dissolvers), -Surgery-clot removal

Pulmonary Abscess

-Area of contained infectious material in the lung. -causes: often a complication of pneumonia caused by bacteria, -aspiration of food, foreign object, bronchial stenosis, or neoplasms, -Septic embolism is carried to lung via pulmonary circulation

Causes of pneumothorax

-Can be caused by a blunt or penetrating chest injury, certain medical procedures involving the lungs, or damage from underlying lung disease such as asthma, pneumonia, tuberculosis. -In tall, thin people, small air filled sacs in the lung called as blebs/blisters rupture and leak air into the pleura cavity causing spontaneous pneumothorax

Lung cancer

-Cancerous condition caused by repeated carcinogenic irritation to bronchial epithelium, leading to increased rates of cell division. -Leading cause of death worldwide in both men and women, 30% of all cancer deaths.

Diagnosis and Treatment of Pleurisy

-Causes: other diseases or infections, Presence of injury or tumor -Diagnosis: Chest x-ray, CT scan, Ultrasound, -Treatment: directed at the underlying cause -Antibiotics, Analgesics, Deep breathing exercises

Symptoms of Respiratory Disorder

-Chest pain, -Dyspnea (difficulty breathing), -Productive or nonproductive cough (acute or chronic), -Hemoptysis (spitting up blood), -Dysphonia (hoarseness), -Chills, -Low or high grade fever, -Wheezing, -Fatigue

Diagnosis of Pneumonia

-Chest x-rays, CT scans -Blood and sputum cultures, CBC, -Arterial blood gas analysis, -Bronchoscopy, -Thoracentesis, -Pleural fluid culture

Pulmonary Tuberculosis

-Chronic, acute, or subacute infection of the lungs by Mycobacterium tuberculosis, -Acquired by inhaling a dried droplet nucleus that contains the tubercle bacillus, -Your risk of catching TB increases if you: Are around people who have TB, Live in crowded or unclean living conditions, Have poor nutrition, Have a weakened immune system

Pneumothorax

-Collection of air or gas in the pleura cavity that results in a collapsed or partially collapsed lung. -symptoms: severe shortness of breath, Sudden, sharp chest pain, Falling blood pressure, Rapid, weak pulse, Shallow and weak respirations, May be cyanotic and anxious

Treatment for Pulmonary Tuberculosis

-Diagnosis- mantoux test. Positive PPD is followed by chest x-rays, fiberoptic bronchoscopy, sputum cultures -Treatment for latent TB with isoniazid. -Treatment for active TB- multiple antituberculosis medications

Diagnosis and treatment of hemothorax

-Diagnosis: chest x-ray, CT scan, decreased or absent breath sounds on the affected side. -Treatment: chest tube insertion, surgery to stop the bleeding

Treatment of Pleural effusion

-Diagnosis: chest x-ray, CT scans. -Treatment: remove the fluid, prevent fluid build-up, Treat the cause of the fluid buildup

Treatment of Pneumonia

-Fluids, IV antibiotics, -Respiratory therapy. -In the US, there are several vaccines that prevent infection by bacteria or viruses that may cause pneumonia: Haemophilus influenzae type b (Hib), Influenza (flu), Measles, Pertussis (whooping cough), Pneumococcal, Varicella

Histoplasmosis

-Fungal disease originating in the lungs caused by inhalation of dust containing Histoplasma capsulation. -Most commonly found in midwest. -Often found in soil contaminated by droppings from birds or bats. -Infections associated with disruption of soil, cleaning attics, tearing down old structures

Treatment of pneumothorax

-Goal in treating a pneumothorax is to relieve the pressure on the lung, allowing it to re-expand, and to prevent recurrences. Chest tube insertion, surgery to close the air leak. -Diagnosis Chest x-ray, CT scan

Wheezing

-High pitched sounds produced by narrowing airways. They are most often heard when a person breathes out (exhales). Wheezing and other abnormal sounds can sometimes be heard without a stethoscope.

Influenza

-Highly contagious, acute viral disease that occurs in annual outbreaks. -Transmission is from person to person by inhalation of the virus in airborne mucus discharge.

Diseases of the respiratory system causes

-Infection, circulatory disorders, tumors, trauma, immune diseases, inflammatory disturbances, congenital defects, central nervous system damage or diseases, environmental conditions

Pleurisy (Pleuritis)

-Inflammation of membranes surrounding the lungs and lining the pleural cavity, -Symptoms: Sharp, needle-like pain that increases with inspiration and coughing, -May also experience fever, chills, and shallow breathing

Pneumonia

-Inflammation of the lungs due to infection. -Leading cause of death worldwide and sixth leading cause of death in the US. -More than 3 million cases in the US per year.

Respiratory Syncytial Virus (RSV) Pneumonia

-Inflammatory and infectious condition of the lungs. -Groups at risk for RSV: -Children younger than 3 years old, -Elderly individuals, -Patients with compromised respiratory systems, -Infants who were premature or who have a congenital cardiac defect or preexisting pulmonary disorder.

Signs and symptoms of pulmonary embolism

-Leg pain or swelling, or both, usually in the calf. -Clammy or discolored skin. -Excessive sweating. -Rapid or irregular heartbeat. -lightheadedness or dizziness. -Deep vein thrombosis occurs when a blood clot forms in one or more of the deep veins, usually in the legs

Transmission of Legionellosis (Legionnaires' Disease)

-Legionella bacteria are found naturally in the environment, usually in warm water. -Legionella bacteria are not transmitted from person to person. -People get Legionnaires' disease or Pontiac fever when they breath in a mist or vapor that has been contaminated with Legionella bacteria. -Keeping Legionella bacteria out of water is the key to preventing infection.

Legionellosis (Legionnaires' Disease and Pontiac Fever)

-Legionellosis (Legionnaires' disease): pneumonia caused by the bacterium Legionella pneumophila. -Pontiac fever: milder form of legionellosis

Respiration

-Maintains life by supplying oxygen to organs, tissues, and cells and allows removal of carbon dioxide. -External respiration: in the lungs, oxygen inhaled from the air is exchanged with carbon dioxide from the blood. -Internal respiration: exchange of gases between the blood and tissue cells

Symptoms and Diagnosis of COPD

-Occurs gradually over time, chronic productive cough, hemoptysis, shortness of breath on exertion, wheezing, chest tightness, cyanosis of the lips or fingernail beds, frequent respiratory infections -Diagnosis: Chest x-ray, CT scan, -Pulmonary function tests (measure how well the lungs are able to hold air, to move air and out, and to exchange oxygen and carbon dioxide)

Adult Respiratory Distress Syndrome

-Occurs when fluid builds up in the alveoli; more fluid in the lungs means less oxygen can reach the bloodstream. -Causes severe pulmonary congestion characterized by acute respiratory distress and hypoxemia. Symptoms: sudden, severe dyspnea with rapid, shallow respirations, -typically occurs in people who are already critically ill

Treatment of ARDS

-Oxygen therapy, intensive care, Mechanical ventilation, IV fluids, antibiotics, analgesics, clot prevention, sedation

At risk of complications of influenza:

-Persons over 50 years of age, -Residents of nursing homes, -Patients with chronic pulmonary cardiac disorder, -Patients with chronic metabolic disease, renal dysfunction, hemoglobinopathies, immunosuppression, -Children and teens receiving long-term asprin, -Health care employees

Treatment of COPD

-Procedures: Spirometry (blow into a tube connected to a spirometer), -Arterial blood gas, -Pulmonary rehab, -Wedge resection of lung tissue, -Lung transplant -Treatment: Stop smoking, Bronchodilators, Inhaled/oral corticosteroids, Combination inhalers, Phosphodiesterase-4inhibitors, Oxygen therapy

Prognosis of Lung cancer

-Prognosis for patients with lung cancer is generally poor. -5 year for all stages and types of lung cancer combined is 15%. -Prevention: cessation of smoking, avoidance of exposure to secondhand smoke -Bronchoscopy

Pulmonary Circulation

-Pulmonary arteries: carry deoxygenated venous blood from the heart to the lungs. -Pulmonary capillaries: where gas exchange occurs. -Pulmonary veins: return the freshly oxygenated blood to the heart for systemic circulation

Respiratory failure

-Respiratory failure occurs when not enough oxygen passes from the lungs into the blood or if the lungs can't remove carbon dioxide from the blood, -Conditions which can cause respiratory failure: Lung diseases which cause airway obstruction, Spinal cord injuries, stroke, Drug or alcohol overdose, Injury to the chest

Diagnosis of pulmonary embolism

-Risk factors: high blood pressure, cardiovascular disease, certain types of cancer, prolonged immobility, surgery. -Diagnosis: chest x-ray, CT scans, MRI, -Lung scans, -Pulmonary angiogram

The most common underlying cause of ARDS include:

-Sepsis- serious and widespread infection of the bloodstream. -Inhalation of harmful substances-inhaling high concentrations of smoke or chemical fumes, aspiration of vomit. -Severe pneumonia- usually affect all five lobes of the lungs. -Head, chest or other major injury- Accidents that directly damage the lungs or the portion of the brain that controls breathing.

Causes of COPD

-Smoking, -Exposure to certain gases or fumes in the workplace, -Exposure to heavy amounts of secondhand smoke and pollution, -Recurrent airway infections, -Tuberculosis, -Bronchial obstruction, -Compilation of cystic fibrosis or other childhood infection such as measles and pertussis

Rhonchi

-Sounds that resemble snoring. They occur when air is blocked or air flow becomes rough through the large airways.

Symptoms and Treatment of atelectasis

-Symptoms: difficulty breathing, rapid shallow breathing, coughing, fever. -Treatment: respiratory therapy, inhaled bronchodilators, mucus clearing drugs

Symptoms and Diagnosing of Histoplasmosis

-Symptoms: fever, cough, fatigue, headache, chest pain. -Diagnosis histoplasmosis can be complicated, depending on the area of the body affected. Can take up to 6 weeks to get results from some tests. Can check lung secretions, blood/urine, biopsy lung tissue, bone marrow. -Treatment can include antifungal drugs.

Treatment of Pulmonary Abscess

-Symptoms: productive cough, fever, weight loss, night sweats. -Diagnosis: chest x-ray, CT scan, sputum cultures, culture of pleural fluid, bronchoscopy. -Treatment: IV/oral antibiotics, -Percutaneous or surgical drainage of any abscess that does not respond to antibiotics or of any empyema (collection of pus in the pleural cavity)

Legionnaires' Disease

-The bacterium is named after a 1976 outbreak, when many people who went to a Philadelphia convention of the American Legion suffered from this disease, a type of pneumonia. -A milder infection, also caused by Legionella bacteria, is called Pontiac fever.

Benign or malignant growths on the larynx

-The larynx is the most common site for head and neck tumors. -Hoarseness can be caused by benign or malignant lesions of the larynx. -In most cases the pathology is benign, but malignancies must be ruled out.

Stridor

-Wheeze-like sound heard when a person breathes. Usually it is due to a blockage of airflow in the windpipe (trachea) or in the back of the throat.

Pseumoconiosis

-any disease of the lung caused by long-term dust inhalation. -Also known as Black Lung Disease, -Occupational lung disease caused by inhaling coal dust, -A type of interstitial lung disease: -The lung is damaged (in this case, by coal dust), -The walls of the air sacs are inflamed, -The lung stiffens from scarring of the tissue between the air sacs

Pulmonary emphysema

-chronic obstructive pulmonary disorder characterized by destructive changes in alveolar walls and irreversible enlargement of alveolar air spaces

Chronic Bronchitis

-inflammation persist and worsens, often occurs after colds or flu. -Obstructive and asthmatic symptoms appear, -Dyspnea, scattered rales, and wheezing

Small cell lung cancer (SCLC)

-occurs almost exclusively in smokers, -Also called oat-cell carcinoma, -Tends to spread quickly

Bronchiectasis

-permanent, irreversible dilation or distortion of one or more bronchi, resulting from destruction of muscular and elastic portions of bronchial walls. -Damage to the airways causes them to widen and become flabby and scarred.

Thoracentesis

-procedure to remove excess fluid in the space between the lungs and the chest wall. This space is called the pleural space.

Rales

-small clicking, bubbling, or rattling sounds in the lungs. They are heard when a person inhales. -They are believed to occur when air opens closed air spaces. Rales can be further described as moist, dry, fine, and course

Acute Bronchitis

-symptoms subside within a week, cough may continue for 2 to 3 weeks. -Physical signs within lungs are few or absent.

Active Pulmonary Tuberculosis

-the TB bacteria are growing and causing symptoms. If the lungs are infected with active TB, it is easy to spread the disease to others

Latent Pulmonary Tuberculosis

-the TB bacteria in the body, but the body's immune system is keeping it from turning into active TB; can't be spread to others

Causes of Pneumonia

Bacterial infection: Pneumococci, Staphylococci, Group A hemolytic streptococci, Haemophilus influenzae type B, Klebsiella pneumoniae types 1 and 2, -Atpical pneumonia caused by legionella, mycoplasma, and chlamydia agents

Chronic Obstructive Pulmonary Disease

COPD includes a group of lung diseases that block airflow and make breathing difficult: -Chronic bronchitis, -Bronchiectasis, -Asthma, -Emphysema, -Cystic fibrosis, -Pneumoconiosis

Where is the fungus that causes histoplasmosis normally found?

In dust; in the Midwestern US, often the fungus is found in soil contaminated by droppings from birds or bats

Pleural effusion

In some cases of pleurisy, fluid builds up in the small space between the two layers of tissue (pleural space)

Lower Respiratory System

Larynx (Voice Box), Trachea (Windpipe), Lungs: Bronchi, Bronchioles, Alveoli

Upper Respiratory System

Nose, Nasal Cavity, Pharynx (Throat)

Pulmonary embolism

Occurs when a blood clot or other material, such as a foreign body or tumor, lodges in and blocks an artery in the pulmonary circulation. -Uncomplicated embolism: cough, chest pain, low grade fever, and apprehension. -More extensive: dyspnea, tachypnea, chest pain, occasional hemoptysis. -Massive embosim: sudden onset of cyanosis, shock, and death

Symptoms of Respiratory failure

Shortness of breath, Rapid breathing, Air hunger (feeling like you can't breathe in enough air), In severe cases, signs and symptoms may include cyanosis of the skin, lips, and fingernails, Confusion, Sleepiness

Orderly function of the respiratory system

The primary function of the pulmonary system is respiration, which maintains life by supplying oxygen to organs' tissues and cells and expelling carbon dioxide.

Treatment of Respiratory failure

Treating the underlying disorder, Intensive care, Oxygen therapy, Possible mechanical ventilation

Where are pulmonary abscesses more commonly found?

in the lower portions of the lungs and in the right lung