Upper and lower Respiratory disordes

Symptoms and Signs of Respiratory Disease

Alveolar-Arterial Gradient
Upper Airway Disorders
Choanal atresia : NB cannot breathe through nose: cyanosis when breastfeeding
Allergic polyp: MC polyp in adults
Child with nasal polyps: order a swear test to R/O CF
Obstructive slepp apnea (OSA)
Excessive snoring with intervals of breath cessation (apnea)
Causes Obesity, tonsilar hypertrophy, nasal septum deviation,
hypothyroidism, and acromegaly
Pathogenenesis
Airway obstruction causes CO2 retention (respiratory acidosis), leading
to hypoxemia (PaO2)
Clinical findings
a.Excessive snoring with episodes of apnea
b.Daytime somnolence often simulating narcolepsy
OSA: risk cor pulmonale (PH+RVH) : 2o polycethemia
Noctural polysomnography : confirmatory test for OSA
Sinusitis
Inflammation of the mucous membranes lining one or more of the
paranasal sinuses
ANATOMY
Sinus infenctions: maxillary adults
Ethmoid children
Sinusitis:blockage sinus drainage in nasal cavity
Fever
Nasal congestion with or without purulent discharge
Pain over the affected sinuses

Painful teeth (associated with maxillary sinusitis ), cough from postnasal

discharge, periorbital cellulitis 9extension of an infenction from ethmoid
sinus
Sinusitis CT scan most sensitive
Nasopharyngeal carcinoma
MC carcinoma cancer nasopharynx; China, Africa
association with EBV
Squamous cell carcinoma, nonkeratinizing squamous carcinoma, or
undifferentiated cancer
b. Metastasizes to cervical lymph nodes
Tx radiotherapy
Laryngeal Carcinoma
MCC cigarette smoking,alcohol,squamous papillomas and pallimatosistrue vocal cord MC site
keratinizing SCC
Clinical findings
Persistent hoarseness often associated with cervical lymphadenopathy
IV. Atelectasis
Loss of lung volume due to inadequate expansion of the airspaces
(collapse)
B. Resorption atelectasis
MCC fever 24 to 36 postsurgery
Airway obstruction by thick secretions prevents air from reaching the
alveoli.
Causes of obstruction
1.Mucus plugs after surgery
2.Aspiration of forein material
3.Centrally located bronchogenic carcinoma
Causes of alveolar collapse
Lack of air and distal resorption of and distal resorpyion of preexisting air

Clinical Findings
Fever, dyspnea 24-36 hours of collapse
Absent breath sounds
Absent vocal vibratory sensation (tactile fremitus)
C.Compression Atelectasis
Air or fluid in the pleural cavity under increased pressure collapses small
airways beneath the pleura
D.Atelectasis due to loss of surfactant
Surfactant reduces surface tension in the small airways
Prevents collapse on expiration, when collapsing pressure is greatest
synthesized by type ii pneumonocytes stored In lamellar bodies
Synthesis begins 28th week of gestation/thyroxine
Phosphatidylcholine is major component
Cortison/thyroxine surfactant synthesis
Insulin synthesis
Respiratory distress syndrome (RDS)in newbors
Decreased surfactant in the fetal lungs
Causes
a.Prematurity
b. Maternal diabetes (poorly controlled)
fetal hyperglycemia increases insulin release
Cesarean section lack of stress induced increased in cortison from
vaginal delivery
Widespread atelectasis results in massive intrapulmonary shunting
b. Collapsed alveoli are lined by hyaline membranes
-derived from proteins leaking out of damaged pulmonary vessels
c.Clinical dinding
respiratory difficulty begins within a few hours after birth
Grunting-

Tachypnea
Intercostal retractions-
Infants develop hypoxemia and respiratory acidosis
/
Complications
1.Superoxide free radical damage from O2 therapy
may result in blindness and permanent damage to small airways
(bronchopulmonary dysplasia)
2) intraventricular hemorrhage
3)Pantent Ductus arteriosus due persistent hypoxemia
4)necrotizing enterocolitis intestial ischemia allows entry of gut bacteria
into the intestinal wall
5)hypoglycemia in newborn (maternal diabetes)
Tx CPAP therapy with endotracheal tube with O2 and surfactant
V. Acute Lung Injury
Pulmonary edema
1. Edema due to alterations in Starling pressure (transudate)
a. Increased hydrostatic pressure in pulmonary capillaries
left-sided heart failure, volume overload and mitral stenosis
b. Decreased oncotic pressure
nephrotic syndrome and cirrhosis
2. Edema due to microvascular or alveolar injury
a. Infenctions
Sepsis, pneumonia
b.Aspiration
drowing and gastric contentstemi
c. drugs
heroin
d. High altitude

e. Acute distress syndrome

B. ARDS
1.Noncardiogenic pulmonary edema resulting from acute alveolar
capillary damage
2.Epidemiology
a. Due to direct injury to the lungs or systemic diseases

Atelectasis
Acute Lung Injury
Pulmonary Infections
Vascular lung Lesions
Restrictive Lung Diseases
Chronic Obstructive Pulmonary Disease
Lung Tumors
Mediastinum and Pleural Disorders