Professional Documents
Culture Documents
and
Its diseases
Submitted By:
Constante, Quolette M.
BSN IV-B NCM 104
Submitted to:
Mr. Carlo Hidalgo
Primary Function
The exchange of gases between the environmental
air and the blood.
– Ventilation
– Diffusion
– Perfusion
Nonrespiratory Functions of the Respiratory
System
Water loss and heat elimination
Warms and humidifies inspired air
Enhances venous return
Contributes to normal acid-base balance
Enables speech, singing, etc.
Defends against inhaled foreign matter.
Removes, modifies, activates various materials passing through
the pulmonary circulation.
Inactivates prostaglandins
Activates angiotensin II
Nose - organ of smell
Structure of the Respiratory System
Respiratory airways
– Nasal passages
– Pharynx
– Trachea
– Bronchi
– Bronchioles
Lungs - left lung - 2 lobes; right lung - 3 lobes
– Alveoli
• Type I alveolar cells
• Type II alveolar cells
• Alveolar macrophages
• Pores of Kohn
Alveolar fluid lining
with pulmonary surfactant Alveolar
Type II alveolar cell macrophage
Interstitial fluid
Alveolus
Pulmonary
capillary
Erythrocyte
Lungs, contd.
– Pulmonary capillaries
– Elastic connective tissue
– Pleural sac
Thorax
Respiratory Mechanics
Air moves from an area of high pressure to an
area of low pressure, following the pressure
gradient.
Pressure considerations
– Atmospheric pressure
– Intra-alveolar pressure
– Intrapleural pressure
Major Inspiratory Muscles
Quiet breathing
– Diaphragm
– External intercostal muscles
Deeper inspirations
– Accessory inspiratory muscles
Expiration
Expiration is normally a passive process.
Inspiratory muscles relax
Chest wall and lungs recoil
Intra-alveolar pressure increases
Air leaves the lungs
Clinical Assessment
Symptoms of Pulmonary Disease
Dyspnea
– Sensation of breathlessness that is excessive for any given
level of physical activity.
Paroxysmal nocturnal dyspnea
– Inappropriate breathlessness at night.
Orthopnea
– Dyspnea on recumbency.
Platypnea
– Dyspnea on the upright position relieved by recumbency.
Persistent cough
– Always abnormal
– Chronic persistent cough may be caused by cigarette
smoking, asthma, bronchiectasis or COPD.
– May also be caused by drugs, cardiac disease, occupational
agents and psychogenic factors.
– Complications include (1) worsening of bronchospasm, (2)
vomiting, (3) rib fractures,
(4) urinary incontinence, and (5) syncope.
Stridor
– Crowing sound during breathing.
– Caused by turbulent airflow through a narrowed upper
airway.
– Inspiratory stridor implies extratracheal variable airway
obstruction.
– Expiratory stridor implies intratracheal variable airway
obstruction.
– Stertorous breathing is an inspiratory sound due to
vibration in the pharynx during sleep.
Wheezing
– Continuous musical or whistling noises caused by
turbulent airflow through narrowed intrathoracic airways.
– Most, but not all, are due to asthma.
Hemoptysis
– Expectoration of blood.
– Often the first indication of serious bronchopulmonary
disease.
– Massive hemoptysis: coughing up of more than 600 ml of
blood in 24 hours.
Signs of Pulmonary Disease
Tachypnea
– Rapid, shallow breathing.
– Arbitrarily defined as a respiratory rate in excess of
18/min.
Bradypnea
– Slow breathing.
Hyperpnea
– Rapid, deep breathing.
Hyperventilation
– Increase in the amount of air entering the alveoli.
Kussmaul respiration (air hunger)
– Deep, regular sighing respiration, whether the rate be normal slow or
fast.
– Occurs in diabetic ketoacidosis and uremia, as an exaggerated form of
bradypnea.
Cheyne-Stokes respiration
– Commonest form of periodic breathing.
– Periods of apnea alternate regularly with series of respiratory cycles.
In each series, the rate and amplitude increase to a maximum
followed by cessation.
Biot breathing
– Uncommon variant of Cheyne-Stokes respiration.
– Periods of apnea alternate irregularly with series of breaths of equal
depth that terminate abruptly.
– Most often seen in meningitis.
Singultus
– Sudden, involuntary diaphragmatic contraction producing
an inspiration interrupted by glottal closure to emit a
characteristic sharp sound.
– Causes:
• Reflex stimulation without organic disease
• Diseases of the central nervous system
• Mediastinal disorders
• Pleural irritation
• Abdominal disorders
• Diaphragmatic stimulation
Physical chest deformities
The thorax is usually symmetric, both sides rise equally on
inspiration.
Chest asymmetry at rest:
• Scoliosis
• Chest wall deformity
• Severe fibrothorax
Conditions with unilateral loss of lung volume
Symmetrically reduced chest expansion during deep inspiration:
• Neuromuscular disease
• Emphysema
• Ankylosis of the spine
Asymmetric chest expansion during inspiration:
• Unilateral airway obstruction
• Pleural or pulmonary fibrosis
• Splinting due to chest pain
• Pleural effusion
• Pneumothorax
Expansion on the chest, collapse of the abdomen on
inspiration:
• Weakness or paralysis of the diaphragm
Chest collapse, rise of the abdomen on inspiration:
• Airway obstruction
• Intercostal muscle paralysis
• Flail deformity of the chest
Pulsus paradoxicus
The arterial blood pressure normally falls about 5 mmHg to a
maximum of 10 mmHg on inspiration.
Exaggeration of the normal response.
Seen in:
• Severe asthma or emphysema
• Upper airway obstruction
• Pulmonary embolism
• Pericardial constriction or tamponade
• Restrictive cardiomyopathy
Cyanosis
Bluish discoloration of skin or mucous membranes.
Caused by increased amounts (>5 g/dL) of unsaturated / reduced
hemoglobin.
Presents as either central or peripheral cyanosis
Digital clubbing
Anteroposterior thickness of the index finger at the base of the
fingernail exceeds the thickness of the distal interphalangeal joint.
Helpful clues:
• Nail bed sponginess
• Excessive rounding of the nail plate
• Flattening of the angle between the nail plate and the proximal nail skin
fold
Percussion sounds (resonance, dullness, hyperresonance)
Auscultatory sounds (vesicular, bronchial,
bronchovesicular)
Adventitious sounds
Abnormal sounds on auscultation
May be classified as continuous (wheezes, rhonchi) or
discontinuous (crackles, crepitations)
Wheezes
– High-pitched sounds which results from bronchospasm, bronchial
or bronchiolar mucosal edema, or airway obstruction by mucus,
tumors, or foreign bodies.
Rhonchi
– Low-pitched sounds caused by sputum in large airways and
frequently clear after coughing.
Crackles
– Generated by the snapping open of small airways during
inspiration.
– Fine crackles are heard in interstitial diseases, early pneumonia or
pulmonary edema, patchy atelectasis and in some patients with
asthma or bronchitis.
– Coarse crackles are heard late in the course of pulmonary edema
or pneumonia.
Fremitus
Voice vibrations on the chest wall.
Localized reduction in fremitus occurs over areas of air or fluid
accumulation in the lungs.
Increased fremitus suggests lung consolidation.
Bronchophony
Increased intensity and clarity of the spoken word during auscultation.
Heard over areas of consolidation or lung compression.
Whispered pectoriloquy
Extreme form of bronchophony in which softly spoken words are
readily heard by auscultation.
Egophony
Auscultation of an “a” sound when the patient speaks an “e” sound.
TYPICAL CHEST EXAMINATION FINDINGS IN SELECTED CLINICAL CONDITIONS
CONDITION PERCUSSION FREMITUS BREATH VOICE ADVENTITIOUS
SOUNDS TRANSMISSION SOUNDS
Normal Resonant Normal Vesicular Normal Absent
Consolidation Dull Increased Bronchial Bronchophony, Crackles
or Atelectasis whispered
(with patent pectoriloquy,
airway) egophony
Consolidation Dull Decreased Decreased Decreased Absent
or Atelectasis
(with blocked
airway)
Bronchial Resonant Normal Vesicular Normal Wheezing
Asthma
Diagnosis of Pulmonary Function
Laboratory Assessment
Routine Radiography
Integral part of the diagnostic evaluation of diseases
involving the pulmonary parenchyma, the pleura, and
to a lesser extent, the airways and the mediastinum.
Usually involves a postero-anterior view and a lateral
view.
Lateral decubitus views are often useful for
determining whether pleural deformities represent
freely flowing fluid.
Apicolordotic views visualize disease at the lung apices
better than the standard posteroanterior view.
Chest Radiography
Ultrasonography
Not useful for evaluation of the pulmonary
parenchyma.
Helpful in the detection and localization of
pleural fluid.
Computed Tomography
Offers several advantages over conventional
radiographs.
Use of cross-sectional images makes it
possible to distinguish between densities.
Better at characterizing tissue densities and
providing accurate size of lesions.
Magnetic Resonance Imaging
Pulmonary Function Tests
Objectively measure the ability of the
respiratory system to perform gas exchange by
assessing ventilation, diffusion and mechanical
properties.
Composed of the spirometry test and
ventilation-perfusion (V/Q) test.
Indications:
Evaluation of the type and degree of pulmonary dysfunction
(obstructive or restrictive)
Evaluation of dyspnea, cough and other symptoms
Early detection of lung dysfunction
Surveillance in occupational settings
Follow-up or response to therapy
Preoperative evaluation
Disability assessment
Relative contraindications:
Severe acute asthma or respiratory distress
Chest pain aggravated by testing
Pneumothorax
Brisk hemoptysis
Active tuberculosis
Spirometry
– Allows for the determination of the presence and severity
of obstructive and restrictive pulmonary dysfunction.
– The hallmark of obstructive pulmonary dysfunction is
reduction of airflow rates.
– Restrictive pulmonary dysfunction is characterized by
reduction in pulmonary volumes.
Diseases of the Respiratory
System
Nose, Paranasal Sinuses and Larynx
Influenza
Influenza viruses, members of the
Orthomyxoviridae family, include types A, B
and C.
Outbreaks occur virtually every year and
communicability is influenced by antigenic
shifts and viral mutations that “confuse” the
affected patient’s immune system.
Clinical Manifestations
Incubation period of 3-6 days.
Acute illness usually resolves over 2-5 days.
Most patients largely recover within 1 week.
Symptoms and Signs:
Abrupt onset of headache
Fever and chills
Myalgia and malaise
Cough, sneezing and sore throat
The major problem posed consists of its
complications:
Primary influenza viral pneumonia
Secondary bacterial pneumonia
Mixed viral and bacterial pneumonia
Extrapulmonary complications:
• Reye’s syndrome
• Myositis, rhabdomyolysis and myoglobinuria
• Encephalitis, transverse myelitis
• Guillain-Barré syndrome
Treatment
Treatment for uncomplicated influenza is symptomatic
Salicylates should be avoided in children because of its association
with Reye’s syndrome.
Increased oral fluid intake.
Ascorbic acid
Antivirals:
Amantadine (Influenza A)
Rimantadine (Influenza B)
Ribavirin (Influenza A and B)
Prophylaxis:
– Vaccination against Influenza A and B
– Amantadine and rimantadine
Viral Rhinitis
The nonspecific symptoms of the ubiquitous common
cold are present in the early phases of many diseases
that affect the upper aerodigestive tract.
Rhinoviruses, members of the Picornaviridae family, are a
prominent cause of the common cold, with seasonal
peaks in the early fall and spring.
Infections highest among infants and young children and
decrease with age.
The infection is spread by contact with infected
secretions or respiratory droplets or by hand-to-hand
contact, with autoinoculation of the conjunctival or nasal
mucosa.
Clinical Manifestations
Incubation period of 1 to 2 days.
Illness generally lasts 4 to 9 days and resolves
spontaneously.
Symptoms:
Headache
Nasal congestion
Water rhinorrhea
Sneezing
Scratchy throat
General malaise and occasionally fever
Signs:
Reddened, edematous nasal mucosa
Water nasal discharge
Rhinoviruses are not a major cause of lower
respiratory tract disease.
Rhinoviruses may cause exacerbations of asthma and
chronic pulmonary disease in adults.
Complications:
Transient middle ear effusion
Secondary bacterial infection
Because of the mild nature and short duration of the
illness, a specific diagnosis is not commonly needed;
however, viral cultures can be performed.
Treatment
No proven specific treatment.
Supportive measures:
Decongestants should not be used for more than a week
because of rebound congestion noted after cessation
(rhinitis medicamentosa).
Antipyretics
Liberal fluid intake
Ascorbic acid
Other Viral URTI:
Coronavirus
Account for 10 to 20% of common colds.
Most active in late fall, winter and early spring –
a period when the rhinovirus is relatively
inactive.
Symptoms are similar to those of rhinovirus, but
the incubation period is longer (3 days) and
usually lasts 6 to 7 days.
Mutations of the virus brought about the SARS
phenomenon.
Other Viral URTI:
Respiratory Syncytial Virus
Belongs to the Paramyxoviridae family.
Major respiratory pathogen of young children
and is the foremost cause of lower respiratory
disease in infants.
Transmitted by close contact with fingers or
fomites as well as through coarse (not fine)
aerosols produced by coughing or sneezing.
Incubation period of 4 to 6 days.
Viral shedding may last two weeks in children but
is much shorter in adults.
Clinical Manifestations:
Rhinorrhea
Low-grade fever
Mild systemic symptoms
Cough and wheezing
25-40% with lower respiratory tract involvement
Treatment:
Antiviral ribavirin for children and infants.
No specific treatment for adults.
Other Viral URTI:
Parainfluenza Virus
Single-stranded RNA virus of the Paramyxoviridae
family.
Important cause of mild illnesses and croup
(laryngotracheobronchitis), bronchiolitis and
pneumonia.
Clinical Manifestations:
Cold or hoarseness with cough
Acute febrile illness with coryza
Barking cough and frank stridor in children
Treatment:
– In mild illness, treatment is symptom-based.
– Mild croup may be treated with moisturized air
from a vaporizer.
– More severe cases require hospitalization and
close observation for development of respiratory
distress.
– No specific antiviral treatment is available.
Other Viral URTI:
Adenovirus
Infections occur frequently in infants and children
with a seasonal distribution of fall to spring.
Certain serotypes are associated with outbreaks
of acute respiratory disease in military recruits.
Transmission can take place via inhalation of
aerosolized virus, through the inoculation of the
conjunctival sac, and probably by the fecal-oral
route.
Clinical Manifestations:
Rhinitis
Pharyngoconjunctival fever (bilateral conjunctivitis, low-
grade fever, rhinitis, sore throat and cervical
lymphadenopathy)
In adults, the most frequent syndrome is the acute
respiratory disease seen in military recruits, with
prominent sore throat, fever on the second or third day of
illness, cough, coryza and regional lymphadenopathy.
Diagnosis and Treatment:
Diagnosis is established by isolation of the virus.
No specific antiviral therapy is available.
A live oral vaccine is available and used widely to prevent
outbreaks among military recruits.
Acute Bacterial Sinusitis
Symptoms of rhinitis plus clinical signs and symptoms
that indicate involvement of the affected sinus or
sinuses such as pain and tenderness over the involved
sinus.
Occurs when an undrained collection of pus
accumulates in a sinus.
Typical Pathogens:
– Streptococcus pneumoniae
– Other streptococci
– Haemophilus influenzae
– Staphylococcus aureus
– Moraxella catarrhalis
Signs and Symptoms:
Pain on pressure over the cheeks (maxillary sinuses are the
most common sinuses affected).
Discolored nasal discharge and poor response to
decongestants.
Headache “in the middle of the head” or in the forehead.
Imaging:
Transillumination
Caldwell view (frontal)
Waters view (maxillary)
Lateral view (sphenoid)
Submentovertical view (ethmoid)
CT scan for recurrent sinusitis
MRI if malignancy in suspected
Treatment
Uncomplicated:
Outpatient management
Oral decongestants and nasal decongestant sprays
Appropriate oral antibiotics for at least two weeks
* Amoxicillin provides better sinus penetration than
ampicillin.
Complicated:
Failure of sinusitis to resolve after a completed course of
antibiotic treatment.
Hospitalization for intravenous antibiotics.
Complications:
– Lower respiratory tract infections
– Osteomyelitis and mucocoele
– Intracranial complications
– Malignancy (?)
Allergic Rhinitis
“Hay fever”
Symptoms mimic that of viral rhinitis but more
persistent and show seasonal variation.
Symptoms:
Watery rhinorrhea
Eye irritation, pruritus, erythema and tearing
Signs:
Pale or violaceous turbinates
Occasional polyposis
Treatment
Symptomatic in most cases.
Oral decongestants
Antihistamines
Nasal corticosteroid sprays
Maintaining an allergen-free environment
Air purifiers and dust filters
Desensitization
Epistaxis
Bleeding from Kiesselbach’s plexus
Predisposing factors:
Nasal trauma (nose picking, foreign bodies, forceful nose
blowing)
Rhinitis
Drying of the nasal mucosa from low humidity
Nasal septal deviation
Alcohol use
Antiplatelet medications
Bleeding diathesis
Treatment:
Direct pressure on the bleeding site.
Venous pressure is reduced in the sitting position, and
leaning forward lessens the swallowing of blood.
Short-acting nasal decongestant sprays
Cautery
Treatment of other possible underlying causes of bleeding
Diseases of the Respiratory System
CONNECTIVE TISSUE AND Clubbing and hypertrophic Squamous cell, large cell and
OSSEOUS pulmonary osteodystrophy adenocarcinoma
Dermatomyositis All
PARANEOPLASTIC SYNDROMES IN LUNG CANCER
Eosinophilia All
Thrombocytosis All
EXUDATE TRANSUDATE
Further diagnostic procedures Treat CHF, cirrhosis, nephrosis
EXUDATE
Further diagnostic procedures
NO DIAGNOSIS
NO DIAGNOSIS
Negative
Negative Positive:
Treat for TB or CA
Negative
Positive: Treat
PPD for TB