V.

PATHOPHYSIOLOGY WITH ANATOMY AND PHYSIOLOGY

To better understand pneumonia, it is important to be familiar with the basic anatomic features
of the respiratory system. The anatomy will direct your assessment process. Visualizing the
anatomical landmarks and underlying structures will enable you to perform the assessment accurately,
and understanding the physiology will allow you to interpret your findings.
The human respiratory system begins at the nose and mouth, where air is breathed in
(inspired) and out (expired). The air tube extending from the nose is the nasopharynx. The tube
carrying air breathed in through the mouth is the oropharynx. The nasopharynx and the oropharynx
merge into the larynx. The oropharynx also carries swallowed substances, including food, water, and
salivary secretion, which must pass into the esophagus and then the stomach. The larynx is protected
by a trap door called the epiglottis, which prevents substances that have been swallowed, as well as
substances that have been regurgitated (thrown up), from heading down into the larynx and toward the
lungs. The larynx flows into the trachea, which is the broadest part of the respiratory tree. The trachea
divides into two tree limbs, the right and left bronchi. Each one of these branches off into multiple
smaller bronchi, which penetrate the lung tissue. Each bronchus divides into tubes of smaller and
smaller diameter, finally ending in the terminal bronchioles. The air sacs of the lung, in which oxygencarbon dioxide exchange actually takes place, are clustered at the ends of the bronchioles like the
leaves of a tree. They are called alveoli. The tissue of the lung, which serves only in a supportive role
for the bronchi, bronchioles, and alveoli, is known as lung parenchyma.

The main function of the respiratory system is to provide oxygen, the most important energy
source for the bodys cells. Inspired air (the air that is breathed in) contains oxygen and travels down
the respiratory tree to the alveoli. The oxygen moves out of the alveoli and is sent into circulation
throughout the body as part of the red blood cells. The oxygen in the inspired air is exchanged within
the alveoli for carbon dioxide, the waste product of the human metabolic process. The air that is
breathed out contains the gas carbon dioxide. During expiration, carbon dioxide leaves the alveoli. As
one breathes in oxygen, one breathes out carbon dioxide.

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Bacteria and viruses do not normally reside in significant numbers inside the lung, part of the
upper respiratory system. This absence is in contrast to parts of the gastrointestinal system, where
bacteria dwell even in a healthy state. There are multiple safeguards along the path of the respiratory
system. These are designed to keep organisms from invading and leading to infection. The first line of
defense against infection includes the hairs in the nostrils, which serve as a filter for larger particles.
The epiglottis is a trap door, designed to prevent food and other swallowed substances from entering
the larynx and the trachea. Sneezing and coughing, both provoked by the presence of irritants within
the respiratory system, help to clear such irritants from the respiratory tract. Mucus, produced through
the respiratory system, also serves to trap dust and infectious organisms. Tiny hair-like projections
(cilia) from cells line the respiratory tract and beat constantly, moving debris trapped by mucus
upwards and out of the respiratory tract. This mechanism of protection is called the mucociliary
escalator.

The cells that line the respiratory tract produce several types of immune substances that
protect against various organisms. Other cells (macrophages) along the respiratory tract actually
ingest and kill invading organisms. Thus, the organisms that cause pneumonia are usually carefully
kept from entering the lungs by virtue of these host defenses. However, when an individual encounters
a large number of organisms at once, the usual defenses may be overwhelmed and infection may
occur. This may occur either when contaminated air droplets are inhaled, or when aspiration of
organisms that inhabit the upper airways takes place.

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PATHOPHYSIOLOGY OF PULMONARY TUBERCULOSIS

High Risk Factors:

Etiological Agent:

Environmental Factors:

Old age

Mycobacterium tuberculosis

1. High Risk Communities

Low socio-economic status

Mode of Transmission:

2. Low Income Communities

Malnourished

Droplets Nuclei

3. Health Care facilities

Mode of Entry
Respiratory Tract
Lungs ( Alveoli )

Diagnostic Procedures:
1. Medical History
2. Physical Examination
3. Chest Radiography
4. Microbiological smears & culture

Signs and Symptoms

1. Hemoptysis
2. Productive Cough
3. Night Sweats
3. Tachypnea

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Treatment
Cure

1. Anti- TB drugs