3 Respiratory System

CHAPTER 3
Respiratory System
1. Bronchopneumonia 14. Emphysema

2. Aspiration Pneumonia 15. Pneumoconiosis
3. Lung Abscess 16. Pulmonary Embolus
4. Tuberculosis 17. Lung Cancer
5. Primary Tuberculosis 18. Bronchogenic Carcinoma
6. Secondary Tuberculosis 19. Pulmonary Metastasis
7. Miliary Tuberculosis 20. Pulmonary Edema
8. Multi-drug Resistant TB 21. Atelectasis
9. Plumbage 22. Pneumothorax
10. Thoracoplasty 23. Subcutaneous Emphysema
11. Histoplasmosis 24. Pleural Effusion
12. Bronchiectasis 25. Infant Respiratory Distress
13. COPD Syndrome
Bronchopneumonia:
 This type of pneumonia is caused by a bacterial infection that originates in the airway and spreads out
to the alveoli.
 It produces an immune response within the lungs that causes the alveolar sacs to fill with an exudate.
Aspiration Pneumonia:
 This type of pneumonia occurs as the result of the patient inhaling a foreign material into their bronchial tree.
 It is often caused by a swallowing dysfunction.
Lung Abscess:
 A lung abscess is a walled-off, necrotic area of lung tissue containing pus.
 It is usually a complication of alcoholism but it can also be caused by bacterial pneumonia.
Tuberculosis (TB) or Consumption:

 TB is caused by inhaling mycobacteria.
 It is spread primarily by air droplets but may be spread by inhaling dried mycobacteria as well.
 Diagnosis
A TB skin test (Mantoux/PPD) is the method of choice to determine exposure.
Small, red bumps will appear within 72 hours after the injection if the patient has been exposed to TB.
Future TB skin tests are no longer necessary as the patient will always test positive.
 A positive test result will be confirmed with a sputum test (AFB) and the presence of the active disease can be ruled
out with a chest radiograph.
Primary TB:
 This refers to the initial attack of TB and it does not cause noticeable symptoms in the early stages.
Fortunately, the victim is not contagious at this point.
 In an attempt to neutralize the infection the body’s immune system will form a wall around the mycobacteria.
 This walled off area will usually appear as a tubercle or a calcification in the upper lung fields on a radiograph.
Secondary or Reinfection TB:

 The proliferation of dormant mycobacteria within the tubercles marks the onset of secondary TB.
 Large scars and cavitation will form within the lungs as the body struggles to once again contain the infection.
The net result is the permanent loss of lung tissue and lung volume.
Miliary or Hematogenous TB:

 The mycobacteria can enter the circulatory system by eroding the pulmonary vein.
 If this occurs, it can seed in such organs as the liver and spleen through the systemic circulation.
 This is a serious condition and if left untreated, it is almost always fatal.
Multi-drug Resistant TB:

 This is a type of TB that is resistant to two or more of the medications used to combat TB.
 This type of TB is often found in HIV positive patients and is due to their already compromised immune system.
 It can also occur when patients do not take their prescriptions properly.
TB Treatment: Plumbage
 Prior to the discovery of isoniazid, early methods to treat patients with TB relied heavily upon rest and isolation in
sanatoriums.
 A common treatment was to collapse the lung in order to allow it to “rest.”
This technique had absolutely no value in fighting this disease.
One method employed to “rest” the lung was to surgically insert ping pong balls into the pleural space of
the upper lung field in order to compress the lung.
TB Treatment: Thoracoplasty
 Another type of treatment for TB prior to the use of effective medications was a procedure called a thoracoplasty
This technique involved removing some of the ribs from the chest wall in order to cause the upper lobe of the lung
to collapse.
Ideally, a total of 7 to 8 ribs would be removed.
Physicians generally would only remove 2 or 3 at a time and as a result, the patient would have to endure several
surgeries.
Histoplasmosis:
 This condition occurs as the result of inhaling soil and/or bat/bird droppings that have been infected with a fungus
called Histoplasma capsulatum.
 It has a similar radiographic appearance to TB.
 Most cases of histoplasmosis are self limiting but in some extreme cases, anti-fungal medications may be indicated.
Bronchiectasis:
 Bronchiectasis is characterized by an irreversible dilation of the bronchi caused by a bacterial infection.
 It usually affects the base of both lungs.
 Signs and symptoms of this disease include a chronic cough, acute pneumonia, and hemoptysis.
 Treatment includes controlling infections, postural drainage, and surgical resection of the affected area.
Chronic Obstructive Pulmonary Disease:

 Chronic obstructive pulmonary disease (COPD) is a term used to describe two lung diseases, chronic bronchitis and
emphysema.
 These two diseases tend to coexist. They also both pertain to an obstruction of the normal flow of air within the
lungs.
 As a result, physicians collectively refer to them as COPD.
 Smoking is the primary risk factor for COPD. Up to 90% of COPD related deaths are related to smoking.
Emphysema:
 Emphysema is a type of COPD that is characterized by a chronic destruction of bronchi and alveoli.
 The destruction and rupture of the alveolar walls will lead to the formation of large pockets of empty space
within the lungs called bulla.
The net result is a decrease in air flow, hyperaeration (barrel chest), and dyspnea.
 Smoking is the primary risk factor for emphysema but it can also be cause by pollution or an inherited lack of an
enzyme called alpha-1-antitrypsin.
Pneumoconiosis:
 This is an occupational disease where dust or particulate matter is inhaled.
 This causes the formation of pulmonary fibrosis.
 Types:
1. Silicosis is caused by inhaling silicon dioxide (sand).
2. Asbestosis occurs as the result of inhaling asbestos dust.
 Patients who present with this disease possesses very distinct radiopaque pleural plaques.
3. Black lung disease is caused by inhaling coal dust.
Pulmonary Embolus (PE):

 Pulmonary emboli are often caused by blood clots that break off from veins in the legs.
 A PE is most often seen in elderly, bedridden patients, and in postoperative patients.
 A chest X-ray may demonstrate an area of consolidation that is commonly referred to as “Hampton’s Hump.
 The following is a list of symptoms for a PE:
 Chest Pain
 Dyspnea (Shortness of Breath)
 Cough
 Hemoptysis (coughing up blood)
 Dyspnea (difficulty breathing)
 Pneumothorax (lung collapse)
 Cyanosis (blue discoloration)Pulmonary Embolus (PE):
 Diagnostic tests for this condition are as follows:
 Arterial Blood Gas
 Pulse Oximetry
 Routine Chest X-ray
 Ventilation/Perfusion Scan in Nuclear Medicine
 Pulmonary Arteriogram
 CT Angiogram of the Chest
 Doppler Ultrasound to Detect DVT
 A variety of treatment options are available for a PE.
 The definitive choice is dependent upon the severity of the condition.
 Treatment options are as follows:
 Blood Thinners (heparin)
 Thrombolytic Therapy (streptokinase/urokinase) to
 Dissolve the Clot
 Insertion of an Inferior Vena Cava Filter
 Surgery
Lung Cancer:
 Lung cancer represents approximately 35% of all cancer deaths and it is the most common cause of death in both
men and women.
 The average onset is age 60.
 Smokers are 10 times more likely to develop lung cancer than non smokers.
 The most common symptoms of lung cancer are coughing, hemoptysis, dyspnea (SOB), and anorexia (weight loss).
 A biopsy is required to make a definitive diagnosis.
 Common treatments for lung cancer include surgery, radiation therapy, and chemotherapy.
Bronchogenic Carcinoma:
 This is a primary lung cancer that arises from the respiratory epithelium.
 It is divided into the following two broad categories:
1. Small Cell Lung Cancer (SCLC)
2. Non Small Cell Lung Cancer (NSCLC)
 Bronchogenic carcinoma has a poor prognosis with a 5-year survival rate of 12 to 14%.
Pulmonary Metastasis:
 Pulmonary metastasis (secondary lung cancer) is much more common than primary lung cancer.
 It primarily occurs via the lymphatic system or the circulatory system.
 It is common from the following types of primary cancer:
1. Breast Cancer
2. Colon Cancer
3. Prostate Cancer
 Treatment for pulmonary metastasis varies according to the type of primary cancer that is involved.
Pulmonary Edema:
 Pulmonary edema occurs when air within the lungs is replaced with fluid.
 It leads to a decrease in gas exchange and may cause respiratory failure.
 It often occurs secondary to congestive heart failure (CHF) or renal failure.
 Treatment includes the administration of oxygen and diuretics.
Atelectasis:
 Atelectasis refers to a condition where either a portion of or the entire lung has collapsed and is without air.
 It results from a bronchial obstruction that can be caused by any of the following conditions:
 Tumor
 Foreign Body
 Mucous Plug
 This is a common cause for acute atelectasis especially postoperatively following chest or abdominal surgery.
Pneumothorax:
 A pneumothorax is a condition occurs when air is introduced into the pleural space. The net result of this
phenomena is a collapsed lung.
 Common causes of a pneumothorax include the following:
1. Trauma
2. Ruptured Bulla from Emphysema
3. Spontaneous
4. Iatrogenic
 A tension pneumothorax is a life-threatening condition that is caused by a ball-valve type of fistula.
 Treatment for a pneumothorax often includes the insertion of a chest tube.
Subcutaneous Emphysema:
 Air escaping the patients lungs following a traumatic pneumothorax may enter the patients surrounding tissues.
 This condition is know as subcutaneous emphysema and if palpated, it will make a very distinct crackling or popping
noise that is referred to as crepitation.
 This air is eventually absorbed by the body.
Pleural Effusion/Hydrothorax:
 Excess fluid that accumulates within the pleural space is know as a pleural effusion.
 It can be caused by a myriad of conditions such as congestive heart failure (CHF) or pulmonary emboli.
 Large pleural effusions may require the insertion of a chest tube to remove the excess fluid.
 Another course of treatment would be the use of a needle to aspirate or remove the effusion.
This procedure is referred to as a thoracentesis.
Infant Respiratory Distress Syndrome:

 Respiratory distress syndrome (RDS) was formerly referred to as hyaline membrane disease.
 It is characterized by a lack of surfactant in premature infants.
This causes the alveoli to poorly aerate resulting in hypoxia.
 RDS has a very distinctive “ground glass” radiographic appearance on a chest X-ray.

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CHAPTER 3

1. Bronchopneumonia 14. Emphysema

Tuberculosis (TB) or Consumption:

Secondary or Reinfection TB:

Miliary or Hematogenous TB:

Multi-drug Resistant TB:

Chronic Obstructive Pulmonary Disease:

Pulmonary Embolus (PE):

Infant Respiratory Distress Syndrome:

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