RESPIRATORY SYSTEM & PATHOPHYSIOLOGY

OBJECTIVESo 1. Identify and label structures of respiratory

system.o Describe functions of respiratory organso Explain physiology of respirationso Define four respiratory eventso Define respiratory capacity termso Distinguish between respiratory disorders

Do you know??

o What is snoring?o Why do we yawn?o What is a hiccup?o Can you breath and swallow at

the same time?

Respiratory Structures

Structure Order

1. Nasal Cavity 8. Alveoli2. Pharynx 9. Pleura3. Larynx 10. Mediastinum4. Trachea5. Bronchi6. Bronchioles7. Lungs

Nasal cavity

Nose shapes and sizeso Provides airwayo Moistens and warms

airo Filters airo Resonating chamber

for speecho Olfactory receptors

Nasal Cavity cont.Nose is only visible part of RSTwo oval openings = Nares/NostrilsCavity is divided by Septum-made of ethmoid & vomer bonesCavities are lined with Mucous membranes, which start to warm air, filters air, & moisturizes/humidify air.Nasal hairs called cilia are 1st line of defense-covered with sebum-wax like.

Nasal Cavity-Turbinates

Also called Conchae = Inferior, middle & superior.Warm the air & also lined with mucous membranes, which moisturizes and continues to filter air

Nasal Cavity-SmellOlfactory receptors located in superior part of nasal cavity, are hair like structures which pick up scents.Scents are sent to Olfactory nerve for identification and recognition.

Nasal Cavity & Blood Supply

Nasal Cavity is very vascular (blood helps to supply warmth & moisture.Thus, nosebleeds are common.Tiny blood vessels in mucous membranes of nose can be easily broken due to:Trauma, drying, infection, allergies, HTN &

clotting disorders.

Nose ShapesOur noses are only external structure of RS, and only thing that sticks out of our face….WHY? To help breathe in air.People from different parts of world have noses that adapt to their native regionHot, dry climates=long noses to moisturize as long as possible.Warm, steamy climates=short, flat nosesCold northern climates=long & narrow to warm & moisturize

Palate & Uvula

Palate & UvulaProvides the separation of the Nasal Cavity and the Oral Cavity.Palate has two parts: Hard & SoftHard palate is supported by palatine boneSoft palate contains the uvulaUvula simple acts as divider between oral cavity & posterior throat.

Paranasal Sinuses

SinusesSinuses-air filled cavities of skullThe Paranasal sinus open/drain into the Nasal Cavity-aka—blowing your nose!Sinuses are lined with mucous membranes and help to moisturize and warm the air we breathe.Sinuses also act as resonance chambers for speech

Common Sinus ProblemsRhinitis=inflammation of nasal mucosa, caused by cold viruses & allergens.Inflammation increases mucous production=nasal congestion+postnasal dripThis easily spreads to sinuses.Sinusitis=inflamed sinuses. Passages from sinus to nasal cavity blocked=sinus headache due to pressure.

PharynxNotice: Pharyngeal tonsilsPalatine tonsilsNasopharynxOropharynxLaryngopharynx and Epiglottis

PharynxMuscular passageway about 13cm (5 inches long). AKA-throatCommon passageway for food & air.3 parts: nasopharynx (upper), oropharynx (mid-behind mouth), & laryngopharnx (lowest)Air+food into mouth, travel together to oropharynx, larynxopharynx, then separate….food to esophagus, air to larynx

Upper Airway Infections & Tonsils

Upper Airway is warm, moist & dark plus takes in toxics by way of food, drink and air…thus area of likely infections.Also, eustachian tubes drain into nasopharynx, so direct pathway to middle ear for infections too.Our bodies fight this with multiple clusters of lymphatic tissue called tonsils

Tonsils

#1 Pharyngeal Tonsil #3 Lingual Tonsil#2 Palatine tonsil #4 Epiglottis

TonsilsPharyngeal: aka adenoids are located high in nasopharynx. With infection become inflamed and swollen, so

they obstruct nasopharynx, so you have to breathe through your mouth

Palatine tonsils: the ones we see at end of soft palate in oropharynx. Make it hard to swallow when swollen.

Lingual tonsils: at base of tongueTonsils no longer removed as quickly, unless very hyperplasic.

Larynx & Epiglottis

https://www.youtube.com/watch?v=qrAfEyane2Y

Larynx

Triangular enlargement in upper resp. tract at top of trachea & below pharynxIs passageway for air moving in & out of trachea.Contains Vocal Cords-called voice boxMade of muscles & cartilageLies midline of neck, anterior to 4th-6th cervical vertebrae

Larynx FibrocartilageLarynx is formed of 9 rigid fibrocartilagesLargest is the thyroid cartilage =AKA, Adam’s apple: anterior & lateral walls of larynx.Cricoid Cartilage-below thyroid cartilage: forms base of cartilage & attached to tracheaEpiglottis: leaflike cartilage that protects the superior opening of larynx. “Guardian of the Airways”

Epiglottis

When we are not swallowing, the epiglottis is open to let in air…but once we swallow food or liquid…the epiglottis tips and forms a lid over the opening of the larynx, routing food to esophagusWhat is a cough…?...when anything other than air enters the larynx. It is our reflex to prevent aspiration

Animation of Cough

https://www.youtube.com/watch?v=usAqJoVYVSc

What if you are unconscious—do you still have cough reflex?

Vocal CordsPartially made of mucous membranes forming a pair of foldsThese vibrate with expelling air. This allows us to speakAir passes through glottis & vocal cords, vibrating, making sound waves.We can not speak without breathing!!Size, shape, tension determine pitch of sounds.

Our Voices

Children have short vocal cords-so voices are high pitchedPuberty: male vocal cords become thicker and longer, thus lower tone of voiceOur voices along with vocal cords are unique with how we move our lips, mouth, cheeks and tongue.Speech is amplified by our pharynx, oral cavity, nasal cavity & paranasal sinuses.

Vocal Folds

o Glottis is the space between the vocal cordso Laryngeal muscles control length and size of

opening by moving cartilageso Sound is produced by the vibration of vocal

cords as air is exhaled

Glottis

How the vocal cords work

Muscles control the length & tension of VC.Length of VC determines pitch of soundsTension or force determines amplification of sounds.

Trachea

C-Shaped rings and esophagus

TracheaAKA: Windpipe. Tube like passage 10-12cm (4”) long.Starts at Larynx & ends as part of two primary bronchi.Lined with ciliated mucosa; beat continuously in direction opposite of incoming air….this catches dust particles & debris away from lungs to be swallowed or spit out

Cilia & Smoking

Smoking inhibits and damages cilia.Body can only remove dust & particles by coughing (smoker’s cough).Why would you not want to give a smoker a medication to stop coughing???

Cartilage in TracheaTrachea is fairly rigid due to reinforcement of 15-20 C-shaped rings of hyaline cartilageCartilage serves 2 purposes:Hold trachea open despite pressures of

breathing to maintain airway at all timesPosterior open part of C-shaped rings are

made of smooth muscle & esophagus lies in this space behind trachea—this allows esophagus to expand into trachea with swallowing

Trachea ContinuedTrachea is also lined with Mucous membranes (in addition to ciliated epithelium)Trachea is only way air can enter lungs, so open airway is vital. Obstructions can be relieved with Heimlich maneuver to “pop out” obstructionTracheostomy: creation of opening in trachea through neck & insertion of tube to create alternate opening for airway

Bronchi & BronchiolesPrimary Bronchus

Secondary Bronchus

Tertiary Bronchus

Bronchiole

Bronchi

Bronchus is singularLower end of trachea bifurcates into right & left bronchus at mediastinumMediastinum- central tissue mass where

thoracic cavity divides into two pleural cavities.

Bronchi are two main tubes of lungsRight bronchus supplies right lung & left

bronchus supplies left lung

Right BronchiBecause the heart is located between the lungs, but is left of the midline, the bronchi are not shaped exactly alikeRight Bronchus has a larger diameter than the left and descends toward the lung at a steeper angle…..thus foreign bodies enter the right bronchus more likely than the left,

Bronchial Tree

Primary Bronchi enter each lung and begin to branch several times into smaller and smaller passages.Primary Bronchi~~Secondary Bronchi~~Tertiary or Segmental Bronchi~~BronchiolesBronchi are lined with ciliated epithelium & ringed with hyaline cartilage. (Rings are complete like an “O”.

Bronchioles

Smallest segment of Bronchial TreeDo not contain cartilage ringsAre thinner and made of smooth muscleLined with elastic tissue—but still is ciliated.Ends of bronchioles leads to a tiny air sac called alveoli or alveolar sacs

What is Bronchoscopy?

Procedure to directly visualize inside of bronchi & collect specimens, remove foreign bodiesFiberoptic cable inserted in trachea to bronchus and into passageways of bronchial tree.

Alveoli

Notice:capillaries,smooth muscle and elastic fibers

AlveoliAlveolar sac contains many alveoli composed of single layers of epithelial tissues.30 million alveoli in an adult lung.This alveolar sac resembles a bunch of grapesThese clustered alveoli make up the bulk of the lungs.Alveolar ducts appear as a grape stem and each grape is a single alveoli

Structure of AlveoliWalls of alveoli are composed largely of single layer of squamous epithelial cells—thinner than a sheet of tissue paperOuter surface of alveoli are covered in a “cobweb”, which contains capillaries, elastic fibers and smooth muscles.Capillaries are where gaseous exchanges between air and blood occur

Exchange of Oxygen & CO2Blood capillaries carrying RBC and CO2 come from the cells----they diffuse the CO2 through the capillary wall into the alveoli----CO2 leaves alveoli when we exhale.Oxygen comes into alveoli with inhalation and diffuses into capillaries and RBC to be sent to heart and then cells of body

Exchange of Oxygen & CO2

This exchange happens by way of diffusion. Oxygen in alveoli is higher than concentration in

bloodstream CO2 in blood stream is higher than concentration

in alveoli

Thus our lungs are mostly airspaces. In spite of large size the lungs only weigh 2.5# and feel light, soft and spongy

Interior of AlveoliPrimarily Hollow Air Sac, but covered on inside with lipid material called surfactant=this prevents alveoli from collapsing.Surfactant is lipoprotein produced by secretory cells of alveolar epithelium. This forms a single layer on the inner surface of alveoli.This “lining” reduces surface tension that could collapse alveoli

Surfactant & Premi’sSurfactant is not produced adequately until the 7th month. Infants born before this 7th month will have RDS (respiratory distress syndrome) or Hyaline membrane disease from too little surfactant.Baby born too soon, lungs tend to collapse due to too little surfactant. Baby has to work really hard just to breath.TX: mother is given SAID before birth to speed up surfactant production

Did you know?

Lungs are only organ in body light enough to floatSurface area of lungs is 25% times that of body’s skin surface (skin is largest organ).Weight of lungs: only 2.5#Extend from clavicle to diaphragm.

Hilum

Lung StructureOnly attachment for each lung is hilum on medial side. This is where the bronchi, BV, Lymph vessels and nerves enter the lungEach lung is separated by heart & mediastinum (central area of thoracic cavity). Mediastinum houses heart, Great BV [aorta, pulmonary artery & vein, SVC, IVC], bronchi, esophagus, thymus gland & lymph glands

Mediastinum

Apex, Base, Cardiac Notch

Upper, narrow part of lung (under clavicle) is called APEX.Lower part (on the diaphragm) is BASE.Cardiac Notch: location of heart next to left lung, forming an indention into left lung~~~~thus left lung is smaller due to heart.

Lungso How many lobes

on the right?o How many lobes

on the left?o Why the

differences?o What is the

cardiac notch?

Right Lung

Right Lung:Larger and broader=more volume, but

shorter because of liver placementThree Lobes named for location; divided by

fissuresRight superiorRight middleRight lower

Left Lung

Smaller and more narrow but longer due to cardiac notch.Contains two lobesLeft superiorLeft inferior

What is Pneumonia?

Develops from pathogenic infection or stimulus that causes inflammation of lung (aspirated food or drink).With inflammation, fluid leaks into alveoli causing constriction & swelling of alveoli and bronchioles.Respiratory function decreasesTx: antibiotics

Pleura

PleuraEach lung is enclosed by double layer serous membrane called the pleura.Layer firmly attached to lung is visceral

(organ) pleuraLayer attached to lung at hilum to wall of

thorax to diaphragm called parietal pleuraThe small space between the visceral and parietal pleura is the pleural cavityThis space contains pleural fluid that serves

as prevent friction between two layers.

Conditions of PleuraPleurisy~~inflammation of pleuraCaused by decreased secretions of pleural

fluidPleura surfaces become dry & rough

causing friction, causing pain with each breathe.

Inflammation can also cause increased pleura fluid, causing lung collapse, called atelectasis.

This can be corrected by thoracentesis-draining of fluid

PNEUMOTHORAX HEMOTHORAX

Pneumothorax

Collection of air or gas in pleural cavity, pushing on lung causing it to collapse or partially collapse.Cause is spontaneous or traumaticSOB, severe chest pain, falling BP, rapid

weak pulse, shallow & weak respirationsPrognosis: atelectasis and mediastinal shiftTX: thoracentesis to release air

Hemothorax

Collection of blood in pleural cavity due to traumaS&S: similar to pneumothorax, but shock will be present.DX & TX: same except to treat underlying cause: repairing wound and replacing blood.

Animation of breathing

o https://www.youtube.com/watch?v=zRv5tNCMpyY

o https://www.youtube.com/watch?v=Mf8xTqfspp4

Pulmonary Ventilationaka: breathing

Process of air moving in and out of lungs so that gases in alveoli are changed and refreshed.Air flows because of pressure differences between the atmosphere outside of lungs and gases inside the lungs

Breathing FactsAir, which is a gas, flows from region with higher pressures to lower pressuresThese pressures are created by our muscles moving to expand the chest cavityVolume changes lead to pressure changes, which lead to the flow of gases to equalize pressure.

What is Inspiration?-What is Expiration?

Go into TeamsUse textbook to read about inspiration & expiration.Write up a definition of each in your own words.Write on board

Inspiration-Active Process

Medulla Oblongata + Pons send impulse via Phrenic Nerves to Intercostal Nerves to diaphragm.Diaphragm contracts moving downward, expanding thoracic cavity. This increases volume in lungs, lowering pressure in lungs-air rushes in…This is inspiration

Other Mechanics of Inspiration

Diaphragm flattens & moves downIntercostal muscles contractRibs move up and outwardSternum rises with ribsAbdominal muscles protrude slightly as diaphragm moves down

Expiration-PassiveDiaphragm relaxes-rising upward-making thoracic cavity smaller-lungs move up-ribs move in as intercostal muscles relax.Pressure in lungs is greater than outside air, so air is pushed out of lungs.Remember: elastic muscle returns to rest-like rubber band

Notice:**Diaphragm moves down and ribs move out with inspiration

**Expiration is passive with diaphragm & intercostal muscles relaxing

Nerve Controlo Medulla

Oblongatao Ponso Phrenic Nerveo Intercostal

Nerves

HYPERPNEA

Respiratory RatesAdult 12-20/min (wide range)Rates will increase with activity or temp. or emotions or conscious control like singing or swimmingSex: females 16-20 minAge; Birth 40-60/min; infant 30-50/min;5 years 24-26/min; 15 years 20-22/min; > 25 years 14-18/min

Lung Capacityo Tidal Volumeo Inspiratory Reserve Volumeo Expiratory Reserve Volumeo Vital Capacityo VC=TV+IRV+ERVo Forced Vital Capacityo Residual Volume

Tidal Volume

TVAmount of Air that is inhaled and exhaled during restNormal shallow breath500ml

Inspiratory Reserve Volume

IRVThe extra air that can be inhaled over and beyond the tidal volumeTaking a deep breath2100-3100ml

Expiratory Reserve Volume

ERVAmount of air that can be forced by expiration after the end of a normal exhalation1000ml

Vital CapacityVCThe amount of air one can forcible expire after a maximum inhalationDeep breathe in and deep forced breathe outTotal amount of exchangeable airTypically 4500mlVC=TV+IRV+ERV

Residual VolumeRVAmount of air that remains in lungs even after a forced expiration.It can not be forced out, because some air needs to remain in the lungs to prevent collapseAllows for continuous gas exchangeApproximately 1100ml

Dissection 26 min

http://videos.med.wisc.edu/videos/1253

Format for Pathophysiology1. BRIEF DESCRIPTION 2. ETIOLOGY3. SYMPTOMS AND SIGNS (S&S)4. DIAGNOSIS (DX)5. PREVENTION AND TREATMENT (TX)6. PROGNOSIS (PX)

Types of Respirations

* Eupnea * Hypoxia* Apnea * Suffocation* Dyspnea * Asphyxia* Hyperpnea * Cheyne Stokes* Orthopnea * Cyanosis* Tachypnea* Anoxia

General Manifestationsof Respiratory Disease

Sneezing:Coughing:Sputum: Yellowish-green, cloudy - bacterialRusty or dark-colored – pneumococcal pneumoniaLarge amounts purulent with foul odor – bronchiectasisThick, tenacious mucous - asthma or cystic fibosisBlood tinged – chronic cough, tumor or TBHemoptysis with frothy sputum – pulmonary edema

General Manifestations cont.

Breathing patterns may be altered in respiratory diseases. Normal 12-20/minKussmauls respirations:Wheezing: Stridor:Breath sounds: Rales, Rhonchi, Absence of breath sounds

            

Lung sounds

The R.A.L.E. Repository

Green box on left---repository—normal—wheeze—& other (stridor)

http://www.easyauscultation.com/rhonchi Rales and Rhonchi

Tobacco Related DiseasesDestruction of respiratory ciliaAddictiveCarcinogenic (Lung and oral cancer)EmphysemaCOPDMICardiac arrhythmiasCVAPeripheral Artery DiseaseDuodenal and gastric ulcers“Crows feet”Low birth weigh infants for a smoking mom

Health Effects of SmokingMore than 4,000 individual compounds have been identified in tobacco and tobacco smoke. Among these are more than 60 compounds that are known carcinogens (cancer-causing agents). There are hundreds of substances added by manufacturers to cigarettes to enhance the flavor or to make the smoking experience more pleasant. Some of the compounds found in tobacco smoke include ammonia, tar, and carbon monoxide. Exactly what effects these substances have on the cigarette consumer’s health is unknown.

Health Effects of SmokingAbout half of all Americans who continue to smoke will die because of the habit. Each year, about 438,000 people die in the US from tobacco use. Nearly 1 of every 5 deaths is related to smoking. Cigarettes kill more Americans

than alcohol, car accidents, suicide, AIDS, homicide, and illegal drugs combined.

Health Effects of Smoking

Cigarette smoking accounts for at least 30% of all cancer deaths. It is a major cause of cancers of the lung, larynx (voice box), oral cavity, pharynx (throat), and esophagus, and is a contributing cause in the development of cancers of the bladder, pancreas, cervix, kidney, stomach, and some leukemias. About 87% of lung cancer deaths are caused by smoking. Lung cancer is the leading cause of cancer death among both men and women, and is one of the most difficult cancers to treat. Fortunately, lung cancer is largely a preventable disease.

Other risks of smoking

Higher incidence of SIDS & mothers that smokeChildren's asthma attacks and severity are worsened in home with smoker.Increase risk for hypertensionLeukoplakiaGum recession Stained teeth and halitosis

COPDChronic Obstructive Pulmonary Disease is a group of common chronic respiratory disorders that are characterized by progressive tissue degeneration and obstruction in the airways of the lung.These disorders are emphysema, chronic bronchitis and asthma.Fifth leading cause of death and disability in the U.S.Features in common:

HO smokingDyspnea with progression in severityCough with frequent pulmonary infectionsHypoxia with retained Carbon dioxide

EMPHYSEMAA serious, chronic lung condition where the alveoli enlarge, losing elasticity and capillaries around alveoli are destroyed. (Permanently inflated alveolar air spaces).Patient loses the ability to exhale CO2 and must use incredible amount of energy to exhale.Etiology: cigarette smoking, environment pollutants, genetics.

Emphysema cont.S&S: Onset is insidious…dyspnea, hyperventilation, barrel chest, pursed lips with exhalation, anorexia with weight loss.DX: Chest X-ray, PFT. TX: Avoid irritants, stop smoking, pulmonary rehab programs, bronchodilators, O2, antibiotics with infection, maintain nutrition.PX: Some reversal of airway obstruction with S&S improvement can be obtained initially, but long term the prognosis is less favorable.

Barrel Chest

Permanently inflated Alveoli

DISTENTED ALVEOLI IN EMPHYSEMA.NOTICE THE CO2 TRAPPED IN THE ALVEOLI EVEN AFTER DEATH

CHRONIC BRONCHITISThe mucosa of the LR tract become severely inflamed and produce excessive mucous.Impaired ventilation is the result, with increase risk of pneumonia. (Remember smokers are missing cilia).Etiology: HO cigarette smoking or living in urban industrial area.S&S: constant cough, tachypnea, SOB, thick & purulent sputum, rhonchi & cough worse in a.m., cyanosis, weight loss and signs of cor pulmonale.

Chronic Bronchitiscont.

DX: History, chest X-ray, PFT and bronchoscopy.View:MedlinePlus Interactive Tutorials: BronchoscopyTX: Reducing exposure to irritants, prompt treatment of infection, Use of expectorants, bronchodilators and low flow O2.PX: Guarded; although consistent treatment can slow the progression.

Voluminous sero-mucinous secretion in the trachea in a patient with chronic bronchitis.

ASTHMAChronic condition of increased reactivity of the tracheobronchial tree.Two types: Extrinsic-involves acute episodes triggered by a hypersensitivitiy reaction to an inhaled allergen. Intrinsic, with an adult onset, is a response to other stimuli, e.g. cold, exercise, stress, irritants like smoke.Genetics plays a part in etiology.Characterized by episodes of reversible airway obstruction, due to, bronchoconstriction, mucous production and mucosa edema.

Asthma cont.

S&S: cough, dyspnea, wheezing, possible sternal retractions, thick and tenacious mucous, tachycardia, hypoxia.DX: The best tool is a PFT during attack, then chest X-ray shows hyperinflation, allergy test, and a CBC with elevated eosinophils.TX: Minimize attacks, use of bronchiodilators.PX: Acute episodes can be life threatening. Status astmaticus: is a persistent severe attack of asthma that does not respond to therapy. It may be fatal.

                                                                                                      

Google Image Result for http://kidshealth.org/broadcast/article_images/article43940/1115822895616.button_asthma

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LUNG CANCERLung cancer is common site of both primary and secondary lung cancer.Primary lung cancer is 90% HO smoking. Low cure rate-less than 7% survive over 5 years.Secondary: Metastasis develop as cancer cells travel in blood and lymph from heart to first small vessels in the the lungs.Etiology: Smoking (cilia missing and not able to remove the carcinogens caught in mucous), occupational exposure of chemicals e.g silica, asbestos.

Cancer cont.S&S: Insidious, because “smokers cough” masks S&S. Early: persistent productive cough, hemoptysis, dyspnea, + Chest X-ray. Chest pain as the pleura and/or mediastinum involved.DX: Chest X-ray, bronchoscopy with biopsy.TX: Complete resection of the diseased lung, but with rapid metastasis, often not a choice. Radiation and chemotherapy but many tumors are not responsive.PX: Continues to be poor, unless tumor is in very early stages of development.

Left lung cancer

The lymphatic and circulatory system can deliver cancer cells to the lung = secondary cancer

PULMONARY TUBERCULOSISAn infectious and inflammatory disease of the lungs, acquired by inhaling droplets containing bacteria.Etiology: Mycobacterium tuberculosis is causative agent. The primary lesion is usually in lung with bacteria surviving in dried form for months.. The infection begins with a primary lesion which causes necrosis, fibrosis and

calcification. The infection than goes dormant for possible years.

S&S: Vague with anorexia, malaise, fatique, weight loss. Later- low grade fever, night sweats,hemoptysis, chest pain and weakness.

TB Cont.DX: Mantoux test, Chest X-ray, (walled off lesions are identified), positive sputum culture.TX: Drug therapy with multiple antituberculosis agents. Contacts of patient must receive prophylactic treatment for one year and receive TB testing.TB is considered infectious; therefore good handwashing and respiratory precautions must be practiced. Place patient in isolation with HCW using N-95or HEPA respirator mask & room air is vented for UV ray exposure.PX: Early and complete treatment offers an excellent prognosis. Other organs can be involved without adequate treatment.

Typical X-ray of TB After treatment

Respiratory Syncytical VirusThis viral, infective condition is most common in young & elderly. RSV is one of the most important causes of lower respiratory tract illness and can be fatal.Etiology: RSV is the causative agent. The greatest occurrence is during the winter months. Premature infants are at greatest risks. Most people have experienced several RSV infections in their life. Most are self limiting. RSV is spread by contact with infective secretions.

RSV Cont.S&S: Cold-like symptoms with nasal congestion, otitis media, cough and URI. As the virus progresses downward to the lower respiratory tract, the patient experiences fever, malaise, lethargy, cough and dyspnea.DX: The clinical picture and thorough PE are key. If necessary a nasal lavage with viral culture can be ordered.TX: Palliative. Hospitalization may be necessary to ensure adequate respiration.

CYSTIC FIBROSISCF is a chronic dysfunction of the exocrine glands affecting multiple body systems; it is the most common fatal genetic disease.Etiology: It is an inherited disorder and is transmitted as an autosomal recessive trait.

Each of us inherits two CFTR genes, one from each parent.Children who inherit an abnormal CFTR gene from each parent will have CF.

•Children who inherit an abnormal CFTR gene from one parent and a normal CFTR gene from the other parent will not have CF. They will be CF carriers.

CF CONT.S&S:May be apparent soon after birth or develop in childhood.Primarily attacks the lungs and digestive tract with production of copious thick and sticky mucous that accumulates and blocks glandular ducts.

Meconium ileusSalty sweat (Mom notices with kiss, positive sweat test)Signs of malabsorption (steatorrhea,& abd.distention) Chronic cough and respiratory infectionsFailure to meet normal growth milestones

DX: Sweat test, check stools for fat content and trypsin (pancreatic enzyme) PFT, Chest X-ray, ABG.

CF Cont.TX: CF is considered a fatal disease. However, with early diagnosis and treatment, the life expectancy has improved greatly during the past few decades. High calorie, high NaCl diet, postural drainage, pancreatic enzyme supplementation, O2 prn. Lung transplants are a last resort.

URIInclude: coryza, sinusitis, laryngotracheo-bronchitis, epiglottitis, & influenza.Viral etiology for cold, croup and influenza. Bacterial for sinusitis and epiglottitis. Secondary bacterial infection may follow viral. S&S: Cold and flu-red, swollen mucous membranes of nose & pharynx with increase secretions, rhinorrhea, maybe sore throat and fever. The infection advancing to larynx causes hoarseness and cough (bronchi).

URI cont.S&S: Colds are usually 7 days in duration while the flu is sudden with fever, fatique lasting for weeks. Croup-barking cough,(due to edema and mucous with possible obstruction) with hoarse voice and inspiratory stridor. Epiglottitis-”red ball obstruction”, severe sore throat, refuse to swallow, anxious breathing and inspiratory stridor.DX: History and exam.TX: Viral-palliative, Prevention of influenza with immunization. Bacterial-antibiotics, supportive care.PX: Good with treatment. Secondary infections common.

LRIInclude: bronchiolitis (RSV), acute bronchitis, & pneumonia.Etiology: Acute bronchitis may be bacterial secondary infection following URI, or result of irritative inhalants. Pneumonia may be primary or secondary, bacterial or viral. May follow aspiration when fluids pool or cilia are reduced.Classifications of pneumonia:

The causative agentAnatomic locationPathophysiologic changes.

LRI cont.

S&S: Acute bronchitis is often preceded by URI. Cough is initially dry and nonproductive and then changes to viscid and later abundant and mucoid or mucopurulent. Pneumonia S&S vary: cough, fever, SOB while at rest, chills, chest pain, cyanosis and hemoptysis.DX: History, exam, chest X-ray, sputum C&S.TX: antibiotics, expectorants, broncholdilators.PX” Bronchitis can lead to pneumonia. Pneumonia can range from mild to life threatening, being the 5th leading cause of death in the US.

Pneumonia fills the lung's alveoli with fluid, keeping oxygen from reaching the bloodstream. The alveolus on the left is normal, while the alveolus on the right is full of fluid from pneumonia.

Pneumonia as seen on chest x-ray. A: Normal chest x-ray. B: Abnormal chest x-ray with shadowing from pneumonia in the right lung (left side of image).

REVIEW

http://msjensen.cehd.umn.edu/webanatomy/timed/default.asp Respiratory #1Upper Respiratory #1Bronchial Tree #2Brainscape Measure Vital Capacity and Expiratory Reserve

Respiratory pathwayAir Anterior Nares NasalCavity Over Mucous Membranes of turbinates and septum Naso-pharynx

OropharynxLaryngopharynx past EpiglottisLarynxTrachea Primary bronchus

secondary bronchus, tertiary bronchusbronchioles alveoli capillariesgas exchange