PTHA 1321 - Human Diseases: A Systemic Approach - Zelman book and Miele lecture - Exam 3

- oral/nasal cavity
- pharynx (throat)
- larynx (entry to trachea)
- trachea (windpipe)
- right/left bronchi that enter the lungs and branch into
- bronchioles before terminating at
- alveoli (small air sacs surrounded by capillaries)

smooth muscle

respiratory epithelium (mucous membrane)

protective lining which traps dust and bacteria

numerous cilia line this mucosa, sweeping dust and foreign particles out before they reach the lungs

pleura

- double membrane covering
- inner membrane covers lungs
- outer membrane lines chest wall
- contain a lubricant which decreases friction with lung expansion and contraction and also reduces surface tension to help keep lungs expanded

- provides oxygen to the circulatory system/tissue
- removes CO2 from the system
- exchanges gases at alveolar/capillary level
- controls respiration

in the medulla

- via the cranial/spinal nerves

- phrenic nerve innervates diaphragm

by the level of CO2 in the blood (when the level increases, the center is stimulated and inspiration occurs)

- diaphragm
- external intercostals

- sternocleidomastoid (SCM)
- scalenes
- levator scapulae
- upper trapezius

when the body is working under increased O2 demands (such as strenuous exercise) additional muscles are activated to help meet the demand

passive

relaxation of muscles and recoil of elastic components

- abdominals
- internal intercostals

disease

- smooth muscle
- supporting cartilage
- respiratory epithelium
- lamina propria (connective tissue)

- higher concentration of CO2 in the bloodstream capillaries diffuses into alveolus

- higher concentration of alveolar O2 diffuses into capillaries of bloodstream

a disease of the nasal cavities, pharynx, and/or larynx

- disease of the trachea, primary bronchi, bronchioles/lungs, and/or alveoli

only the upper respiratory tract

(i.e., nasal cavity, pharynx, larynx)

the entire respiratory tract, upper and lower

- cold
- sinusitis
- hay fever (seasonal allergic rhinitis)
- tonsillitis, pharyngitis, laryngitis
- influenza (but also can, and usually does, affect lower respiratory system as well)
- nasal polyps
- snoring and obstructive sleep apnea

- a relatively contagious, acute inflammation of mucous membrane lining upper respiratory tract
- of viral origin (over 200 strains of adenoviruses, rhinoviruses, paramyxoviruses)
- no cure, must run its course

bacterial infections such as strep, staph, or pneumococci

- sinusitis
- pneumonia
- pharyngitis

a.k.a. seasonal allergic rhinitis

an allergic disease that is a histamine reaction due to hypersensitivity to certain foreign proteins/antigens (pollen, mold)

yes

it is a disturbance in the homeostasis of the body; a disorder of structure or function

with antihistamines

desensitization is also an option

- inflammation of lymph tissue in throat (tonsils)
- caused by strep infection
- treated with antibiotics
- tonsillectomy for repeated infections to prevent them leading to rheumatic fever (heart damage) and/or glomerulonephritis (kidney damage)

tonsils

- rheumatic fever (which can damage the heart and its valves)

- glomerulonephritis (kidney damage)

viral infection causing sudden onset of chills, fever, cough, sore throat, runny nose, chest pain, muscle aches, and/or GI problems

- destroys inner epithelial lining
- bacterial infections can occur (pneumococci, streptococci, staphylococci)
- pneumonia can develop
- can be fatal

- bronchitis
- asthma
- bronciectasis
- emphysema
- pneumothorax/atelectasis
- pneumonia (lobar, broncho, primary atypical, secondary)
- pneumoconiosis
- Legionnaires' disease
- adult respiratory distress syndrome (ARDS)
- pleurisy
- empyema
- tuberculosis
- bronchogenic cancer
- hyaline membrane disease
- cystic fibrosis
- pulmonary embolism
- chronic obstructive pulmonary disease (COPD)

inflammation of the bronchi resulting in constriction of the airway

can be acute or chronic

- viruses
- bacteria
- air pollutants

Type 1 = acute
- often follows a URI
- sx of dyspnea, chest pains, fever and cough
- sputum may contain pus

Type 2 = chronic
- results from repeated acute attacks
- lasting several months for 2 consecutive years

- long-term heavy smoking
- exposure to environmental irritants (dust, chemicals)
- complication of another respiratory infection

- chronic cough
- hypoxia
- tachypnea
- susceptibility to bacterial infections

chronic inflammation of the bronchi and bronchioles that has ramifications throughout the lung tissue

attacks caused by
- constriction/spasms of the smooth muscle of the bronchi and bronchioles narrows the lumen (due to lack of cartilaginous rings),
- swelling of mucous membranes, and
- excessive mucus secretions
- make breathing, especially exhalation, very difficult

results in
- narrowing of airways,
- difficulty breathing
- wheezing (sound of air trying to pass through the narrowed tubes)

predisposition for hypersensitivity to:
- allergens
- overexertion
- anxiety/stress
- exercise
- respiratory infections
- bronchitis
- air pollutants (smoke, perfume, aerosol sprays)

- bronchodilators
- nebulizers
- inhaled glucocorticoids (long-term prophylaxis)
- oral glucocorticoids for short-term therapy or acute, severe attack
- cortisone drugs for prevention and inflammation reduction, but negative side effects with long-term use
- omega-3 for natural anti-inflammatory

never, as it is a vasoconstrictor, and the last thing you want is to further constrict circulation

a severe attack may not respond to treatment

it is a medical emergency which can result in respiratory failure and death

dilation

permanent abnormal dilation of bronchioles due to destruction of small muscle/elasticity of walls

already existing respiratory disease that causes mucus plugs

the mucus plugs dilate the bronchi, bacterial infection develops, abscesses form, walls of bronchioles become necrotic and break down

leads to chronic dilation

- alveolar walls deteriorate
- bullae form
- lungs lose elasticity and airways narrow
- lungs lose ability to fully exhale and stale air (full of CO2) is trapped

it indirectly affects the heart

poor circulation through lungs causes obstruction of pulmonary artery, hypertrophy of right side of heart (Cor Pulmonale/right-sided CHF)

right ventricle struggles to meet body's demand for O2, leads to hypertrophy

- heavy smoking
- air pollutants, long-term chemical irritant exposure
- chronic bronchitis
- genetic form from deficiency in alpha-1-antitrypsin, which leaves lungs susceptible to alveolar destruction

- feeling of suffocation, SOB, tachypnea
- anxiety/distress due to inability to breathe unimpeded
- painful dyspnea
- cyanosis
- breakdown of alveolar walls damages capillaries; can cause pneumothorax/atelectasis
- chronic cough
- barrel chest (chest wall permanently expanded due to excess exertion of accessory respiratory muscles)
- rales (abnormal respiratory sounds)

- no cure
- medications to decrease mucus
- PT breathing exercises
- avoid smoking, air pollutants, dust, ozone

prognosis depends on age, severity, and general health; disease needs close monitoring

admission of air into the pleural cavity

less, otherwise the lung would not be able to expand

- weakened area of lung ruptures

- chest wall trauma (stabbing, GSW, fractured rib)

- deteriorated alveoli fuse and form larger, weaker air sacs (bullae)

- bullae can rupture and allow air to escape into pleural space

when air escapes into the pleural cavity and the subsequent pressure increase causes the lung to collapse

(Technically, decrease or loss of air in all or part of the lung, with resulting loss of lung volume itself.)

- sudden severe chest pain
- dyspnea
- weak, rapid pulse

yes, sometimes done therapeutically to rest the lung (e.g., after lung surgery; with TB)

depends on the cause
- spontaneous pneumothorax will heal itself
- if due to trauma or thoracocentesis, air will be drawn out of the pleural space with a chest tube (pleuracentesis)

collapse of all or part of a lung

- compression due to increased air pressure in pleural cavity; intrapleural pressure exceeds internal lung pressure (pneumothorax)

- compression due to accumulation of fluid/pus in pleural cavity

- obstruction of airway/major bronchus (mucous plug, inhaled object, chronic bronchitis, tumor) that prevents air from inflating the lung

- acute inflammation of a lung (alveoli, bronchioles) caused by a variety of viruses, bacteria, or foreign matter aspirated into lungs

- an inflammatory response in which exudate fills air spaces and solidifies

- other than the infirmed or indigent and vulnerable elderly, it typically runs in cyclical patterns, like the flu

- primary/"walking" (due to infection)
- secondary (following influenza, bronchiectasis, bronchitis, CHF)

- lobar pneumonia (inflammation of a section, often a whole lobe) usually caused by streptococcus pneumoniae, an opportunistic bacteria that is usually present in the respiratory tract, but that can infect the lungs during periods of reduced immunity

- bronchopneumonia - focused in small bronchi; commonly caused by inadvertent aspiration of gastric contents

a portion or all of a lung

may be unilateral or bilateral (double pneumonia)

can result in permanent lung damage, but not always

- illness/low resistance
- chronic bronchitis
- bronchiectasis
- immobilization
- old age
- youth
- chronic alcoholism

- dyspnea
- cough
- sputum production (thick, watery, or bloody)
- stabbing chest pain
- chills
- fever
- generalized weakness

- depends on cause
- antibiotics if bacterial
- bed rest
- postural drainage

poor if the patient is already debilitated (aged, chronically ill, etc.)

fifth leading cause of death in U.S.

inflammation of the pleural membranes secondary to lung infections, pneumonia, TB, injury, tumor, etc.

symptoms include cough, fever, chills, and sharp pain with each inhalation

1) dry - sharp pains and increased friction between pleura that often occurs with lobular pneumonia

2) pleurisy with effusion (excessive exudate in cavity) - can cause atelectasis; often occurs with TB and lung cancer

pus in the pleural cavity secondary to ruptured lung abscess or malignancy, lung infection, etc.

can cause atelectasis

rare due to availability/use of antibiotics

a chronic lung infection caused by mycobacterium tuberculosis

contracted by inhalation of infectious material (coughs, sneezes)

causes necrosis of lung tissue

there are primary and secondary stages of infection

it can lie dormant for years before reactivation to secondary stage

it starts when bacteria cause caseous (soft, cheeselike) lesions that heal as fibrous and calcified scars on the lungs in most cases, walling off bacteria in these pockets (tubercles) for months or years (likely asymptomatic)

secondary infection occurs with reinfection or when bacteria escape the tubercles; leukocytes now recognize bacteria and attack, leading to greater necrosis and destruction of lung tissue

it is primarily a disease of the lungs, but can spread via the bloodstream to other organs (kidney, brain, bone)

it has resurfaced as a serious health problem in the U.S. due to poor living conditions, overcrowding (prisons, etc.) and idiots not finishing the drug course

- drug-resistant bacteria
- homelessness
- (illegal) immigrants from infected countries
- HIV/AIDS

- often initially asymptomatic
- low-grade fever (evening)
- night sweats
- fatigue
- hemoptysis (spitting of blood from lungs due to hemorrage)
- wasting
- dyspnea
- chest pain

via TB (Mantoux) test - a subcutaneous injection of TB protein and, if positive, chest X-ray and sputum culture to determine if there is an active infection

long-term (up to 18 months) multiple drug therapy

(antibiotics specially designed for mycobacterium species, such as rifampin, isoniazid, ethambutol)

tumors arising in the bronchial tree (originated in bronchial tree, not a result of metastasis)

lungs are also a frequent site of metastases from the breast, GI tract, female reproductive system, and kidneys

easily via bronchoscopy; also x-ray, biopsy, sputum examination

treatment is often surgery to reduce the mass, then chemotherapy and/or radiation

poor

primary concern is blockage of airway by tumor as it grows into the lumen of a bronchus, collapsing the associated portion of the lung

- smoking (80% of cases)

- long-term exposure to air pollutants (second-hand smoke, asbestos, vinyl chloride, synthetic rubber)

metastasis from other areas

- occurs with premature infants
- hyaline-like membrane lining forms in alveoli, and there is a lack of surfactant to reduce the surface tension of the lungs
- alveoli collapse; atelectasis
- can result in respiratory failure and death

- administration of artificial surfactant
- positive pressure treatments
- intubation with mechanical ventilation

- chest PT
- bronchodilators
- antibiotics
- O2
- pancreatic enzyme supplements

- inability to digest and absorb nutrients
- difficulty breathing; lung collapse
- recurrent respiratory infections
- electrolyte imbalance

an obstruction of the pulmonary circulatory system caused by an embolism (dislodged thrombus from a leg vein, air, fat, tumor cells, other foreign material)

frequent complication of hospitalized patients (post-surgery, pelvic, abdominal, hip fractures)

approximately 50,000 deaths annually

infarction of lung tissue

life-threatening necrosis if the area is large

- severe chest pain
- tachycardia
- dyspnea

- anticoagulants
- occasionally surgery

a diagnosis given to any pathological process that permanently decreases ability of lungs to perform ventilation (exchange of O2--CO2)

includes
- chronic bronchitis
- chronic asthma
- emphysema
- cystic fibrosis
- pneumoconiosis

- emphysema
- chronic bronchitis
- asthma

- TB
- bronchiectasis
- cystic fibrosis

- where digestion of food begins
- mechanical breakdown of food
- salivation and enzyme secretion (initiates chemical breakdown of starches)
- swallowing

chewed food (bolus) passes down the tube via peristalsis and passes through the cardiac sphincter into the stomach

4-8 seconds

to prevent regurgitation

- secretes gastric juices (enzymes, HCl) to break down food proteins
- moistens and mixes food (chyme)
- food passes through pyloric sphincter into small intestine

3-4 hours

- chyme passes through via smooth, rhythmic muscular contractions (peristalsis)

20 feet

the greatest amount (about 80%) of breakdown/digestion of proteins, carbohydrates, and fats occur in this upper portion of the small intestine

the food joins digestive enzymes secreted from the pancreas, and bile from the gall bladder

villi in the intestinal walls enable nutrients from food to be absorbed into the blood capillaries and lymph vessels

X 600

- water and minerals are reabsorbed in the first part of the colon

- remaining matter excreted as feces through rectum

- salivary glands
- liver
- gall bladder
- pancreas

- secrete bile and enzymes to aid in breakdown of substances

- they are located near the mouth, stomach, and beginning of small intestine

cancer

it can develop in any area (gums, cheeks, palate, lip, tongue)

- cancer
- esophageal varices
- esophagitis/GERD
- hiatal hernia

- narrowing of the lumen
- dysphagia (principal symptom)
- vomiting
- weight loss
- bad taste in mouth/bad breath
- frequent metastasis (usually lungs and liver)
- poor prognosis (nearly always fatal)

- inflammation due to reflux (incompetent cardiac sphincter results in back flow of acidic contents from stomach)

- can cause chest pains resembling heart disease, hematemesis

- caused by incompetent cardiac sphincter, hiatal hernia, some medications

- protrusion of part of stomach through the diaphragm at a point where esophagus joins stomach

- causes indigestion, heartburn, shortness of breath after eating

- caused by congenital defect in diaphragm or increased intraabdominal pressure caused by obesity

- gastritis
- chronic atrophic gastritis
- ulcers

- inflammation of stomach

- frequently accompanied by hematemesis

- usually due to infection or irritating agents (caffeine, aspirin, and especially acute alcoholism)

- degenerative condition of the lining of stomach (wasting)

- no longer able to secrete intrinsic factor or HCl
- affects absorption of vitamin B12 and digestion of protein

- caused by stomach cancer, chronic alcoholism, chronic exposure to irritants (aspirin, alcohol, certain foods)

- necrotic tissue formed secondary to inflammation/lesion

- results in sloughing of dead tissue and a hole

- called peptic ulcers in the GI region

- bacterial (Helicobacter pylori) infection
- use of NSAIDs, caffeine, alcohol
- inherited condition of acid hypersecretion

peptic ulcer - of the stomach or small intestine
gastric ulcer - of the stomach
duodenal ulcer - of the small intestine

(peptic ulcers = gastric ulcers + duodenal ulcers)

- more common in men than women
- H. pylori infection appears to increase risk
- pain usually not an early symptom; anorexia, heartburn
- usually advances and spreads to liver and surrounding organs by time of diagnosis

- duodenal ulcers
- Crohn's disease
- appendicitis
- malabsorption syndrome
- diverticulosis
- diverticulitis
- chronic ulcerative colitis
- cancer of colon/rectum
- intestinal obstructions
- spastic colon/irritable bowel
- dysentery

may be stress related, resulting in overproduction of HCl, which irritates mucosal lining

- a.k.a. regional enteritis
- inflammation of intestine can lead to thickening of walls, obstruction
- periods of exacerbation (stress-related), remission and relapse

- cause unknown, but possibly allergies, immune disorders, stress
- alternating diarrhea and constipation; weight loss due to anorexia, nausea, vomiting; in severe cases hemorrhage or perforation
- flare-ups can manifest as rheumatoid arthritis
- pain like appendicitis

inflammation of the appendix due to infection (E. coli bacteria) or obstruction

can develop gangrene and result in rupture and peritonitis

- defective mucosal cells result in poor absorption of nutrients
- other diseases can result in secondary malabsorption syndrome (e.g., diseased pancreas, blocked pancreatic duct deprives small intestine of lipase needed to digest fat)

- lack of energy and inability to maintain weight
- fat-soluble vitamin K can't be absorbed; causes bleeding tendency

- mucosal membrane of intestines pushes into underlying muscle layer, forming small pouches

- usually asymptomatic

- increase with age (50% of older adults have it)

- pouches of diverticulosis become impacted with fecal material and/or bacteria, resulting in inflammation/abscesses and further complications

- causes low, cramplike pain, usually on left side
- as inflammation spreads, lumen narrows--can cause obstruction/abscess

- serious inflammation of colon w/extensive ulceration
- diarrhea with pus, blood, mucus; crampy low abdominal pain; anemia
- periods of exacerbation, remission, relapse

- high risk of colon cancer
- may require removal of portions of colon (hemicolonectomy) and/or colostomy

- signs include change in bowel habits, diarrhea, constipation, blood in stool, anemia, abdominal discomfort, obstruction
- mainly in rectum or sigmoid colon
- grows slowly, tends to remain localized

- predisposition to developing cancer is caused by ulcerative colitis and familial polyposis
- diet high in red meat and low in fiber also seems to be risk factor

classified as:
- organic (material blockages such as scarring, tumor, kinking/volvulus, adhesion, hernia, intussusception)
- paralytic (decrease in peristalsis due to peritonitis, sphincters can fail to open due to intense pain)

- severe pain with abdominal distention, vomiting, complete constipation (not even gas)
- serious condition if gangrene sets in at strangulated area

- acute inflammation of colon caused by bacteria, parasitic worms, or other microorganisms

- primary symptom is diarrhea containing pus, blood, and mucus; also severe abdominal pain

- treated with antibiotics or amebicides

- hemorrhoids
- cancer

from increased intraabdominal pressure, straining, constipation, pregnancy, heredity, poor dietary habits, inadequate fiber, overuse of laxatives, lack of exercise

growths lead to congestion of veins

- abdominal pain (dyspepsia); cramping, heartburn, indigestion; can be severe
- abdominal distention
- vomiting (caused by irritant or over distention due to obstruction)
- hematemesis
- diarrhea (nervous states, infection, inflammatory conditions)
- constipation (obstructions, poor diet)
- flatulence
- blood in stool; changes in stool color
- anorexia

- fluoroscopy
- endoscopy
- exploratory laparotomy
- stool examination

an X-ray following barium swallow or barium enema

shows tumors, malformations, obstruction of smooth muscle action

- flexible, fiber optic, hollow tube with lens/light on end to view inner wall of GI tract; threaded through mouth or anus

can take biopsies, analyze juices

invasive surgical procedure

incision into abdominal cavity when diagnosis is uncertain but symptoms are significant

check for presence of blood, which would indicate ulcers, cancer, polyps, etc.

malabsorption syndrome

- diet - restrict irritating agents
- antibiotics for bacterial infections
- surgery for excision of diseased tissue (appendix, polyps, malignancy) or obstruction (hernia, ulcer)
- colostomy - temporary or permanent opening from colon to outside; fecal contents empty through stoma and collect in bag; may require removal of colon

- stores glucose, amino acids, vitamins, iron (regulates blood glucose level)
- synthesizes proteins and enzymes for cellular activity
- detoxifies blood (alcohol, drugs, chemicals)
- secretes bile (digestion of fat)
- has regenerative powers (unless extensive damage)

- jaundice (icterus)
- viral hepatitis
- cirrhosis
- carcinoma

- yellow discoloration of skin, tissues, sclera
- caused by buildup of bilirubin in the blood
(bilirubin is usually secreted in bile and removed in feces)

caused by
- obstructed bile ducts in gallbladder
- liver damage
- hemolytic anemia

- inflammation of the liver caused by HAV and HBV

- formerly known as infectious hepatitis

- from contaminated water, food
- from feces/urine (poor sanitation)

- anorexia
- nausea
- mild fever
- jaundice
- tender liver

- usually mild in children, sometimes more severe in adults
- prognosis is good, and there is usually no permanent liver damage

- formerly called serum hepatitis
- most common form of hepatitis
- same symptoms as HAV, but slower developing (incubation of 2-6 months)

- more serious than HAV; can result in permanent liver damage (chronic hepatitis or cirrhosis) and a fulminating form can progress quickly to delirium, coma, and death
- transmitted by blood/bodily fluid (sex, contaminated needles, etc.)

HBV

Heptavax B

HCV

- chronic destruction of liver cells/tissue with nodular, bumpy regeneration
- caused by excessive alcohol, drugs, chronic hepatitis

- results in nodular, disorganized regeneration of liver tissue with lots of fibrous connective and scar tissue
- enlarged liver and obstructed portal vein
- circulation in liver is impaired, raises pressure in vessels of the abdomen; causes esophageal varices and even hemorrhage

- advanced cirrhosis can lead to death because liver cannot perform normal biochemical functions

- signs include hematemesis, jaundice, ascites, development of female sex characteristics, confusion/disorientation, stupor, tremor, somnolence

- hepatocarcinoma is a primary malignancy, usually due to hepatitis or complications of cirrhosis

- secondary carcinomas result from metastasis of cancer cells from other organs/tissues, especially colon, rectum, stomach, pancreas, esophagus, lung, or breast

- prognosis is usually poor

- store and concentrate bile

- secrete bile as required into duodenum for digestion of fats

inflammation of the gall bladder secondary to obstruction by gallstone, tumor, stricture, etc.

prolonged inflammation causes gallbladder to lose ability to concentrate bile; walls of gallbladder may thicken, preventing proper contraction

- severe pain under right rib, radiating to right shoulder
- fever/chills
- nausea
- vomiting
- belching and indigestion

- especially after eating fatty food, since the fat in the duodenum stimulates the gallbladder to contract and release bile and the contraction of the inflamed gallbladder causes pain

- can develop into infarction/gangrene
- can burst into abdominal cavity (peritonitis)
- can damage liver tissue (biliary cirrhosis)

treated by cholecystectomy to remove gallbladder

- endocrine - secreting hormones (e.g., insulin, glucagon) directly into the bloodstream

- exocrine - secreting digestive enzymes via ducts into duodenum for digesting carbohydrates, proteins, fats

very important for digestion

- pancreatitis
- pancreatic cancer
- cystic fibrosis

- severe, steady abdominal pain of sudden onset is first symptom
- pain radiates to back and resembles pain of perforated ulcer

- nausea and vomiting
- possibly jaundice if common bile duct is blocked
- greasy, foul stools due to lack of lipid enzymes
- secondary malabsorption syndrome

- if large area of pancreas is affected, endocrine AND exocrine/digestive functions are impaired

men
- excessive alcohol
- peptic ulcers

women
- gallstones in duct/gallbladder disease

both
- idiopathic causes
- local swelling
- necrosis
- hemorrhage
- trauma

- adenocarcinoma with high mortality rate
- more common in males

linked to smoking, high-protein/-fat diet, food additives, industrial chemicals, chronic alcohol abuse, chronic pancreatitis, diabetes mellitus

- malignancy in the head may show signs sooner, especially if it blocks common bile duct and causes jaundice and impaired digestion
- other signs/symptoms include weight loss; pain; metastasis to duodenum, stomach, and liver

- prognosis poor

- most common cause of chronic respiratory disease in children and adults
- hereditary disease affecting all exocrine glands (glands which secrete mucus, perspiration, digestive enzymes)
- causes excessively thick mucous secretions which block pancreatic ducts, air passages (trachea, bronchi) and causes excessive sweating; trapped bacteria cause lung infections
- results in inability to digest/absorb nutrients, respiratory complications/infections, electrolyte imbalance
- mortality rates decreased in children due to improved respiratory therapy techniques and use of antibiotics

not a friend

along with other redneck GI tract definitions:

Bacteria: Backdoor to cafeteria
Barium: What to do when treatment fails
Bowel: Letter like A E I O or U
Rectum: Dang near killed him

TB

- coughing
- sneezing
- talking and singing

none of which are required for O2 delivery or CO2 exchange

by ring structures called tracheal cartilages

Yes

No

the alveoli

stick together

an oily lubricant called surfactant bathes the inner surfaces to reduce surface tension and prevent them from collapsing/sticking together

- increase the volume of the chest cavity
- decrease pressure within the lungs

exhalation is passive
when the muscles relax
- volume of the chest cavity decreases
- pressure within the lungs increases
- air is pushed out

- pressure in the airtight space between lungs and chest wall
- pressure slightly less than that in lungs; acts as vacuum and prevents lungs from collapsing

- breathing irregularities (dyspnea, tachypnea, wheezing)
- coughs (dry, productive, hemoptysis)
- cyanosis
- fever
- fatigue (due to labored breathing and less sleep)
- pain (esp. sinuses, throat, chest)
- drainage (nasal and sinus)
- weakness (muscles and voice)

- vital capacity measurement (spirometer)
- one-second-forced-expiratory volume (FEV1)
- oscillometry
- arterial blood gases
- sputum examination
- imaging (bronchoscopy, chest X-ray, fluoroscopy, CT scan)

6000 ml or 6 liters

- vital capacity measurement

- one-second-forced-expiratory volume

- done via spirometry
- as much air as possible drawn in, then expelled
- volume expelled recorded

2250 - 4500 ml

depends on age, gender, height, and general health

- reveals maximum volume of air that can be expelled in one second

- impedances of air flow such as spasms, excess mucus, constriction should reduce FEV

- new means of testing
- patient breathes normally, it shoots sound waves into airways
- measures airway opening by measuring return echo of waves

- checks O2, CO2, blood pH (which is a key indicator of respiratory function)
- congestion, thickened respiratory membranes, alveolar destruction, etc reduce surface areas for gas diffusion
- invasive; requires blood draw

O2 - 98-100%
CO2 - 35-45 mm Hg

helps evaluate pneumonia, TB, and malignancies

gram-stained smears and cultures are useful in
- identifying causative organisms,
- determining antibiotic treatment, and
- diagnosing TB and fungal lung infections

bronchoscopy, chest X-rays, fluoroscopy, CT scans permit visualization of lungs and diaphragm during respiration

symptoms
- swelling of nasal mucous membrane and mucous secretion causing nasal congestion

no cure, but symptoms can be treated
- aspirin to lower fever
- antihistamines to relieve nasal congestion
- antitussives to control or suppress cough
(opiod or nonopiod)

secondary infections, if bacterial, treated with antibiotics

air-filled spaces that
- reduce weight of skull
- contribute resonance to voice

a.k.a. paranasal sinuses, because they are all connected to and drain secretions into the nasal cavity

by the skull bone in which they are found:
- frontal
- maxillary
- ethmoid
- sphenoid

1 in 7

33-37 million

inflammation of the mucous membrane linings which causes pressure, pain, and often headache

- viruses
- bacteria
- allergens
- nasal congestion accompanying the common cold and can reduce or block sinus drainage, thus causing sinusitis

environmental conditions such as
- changes in barometric pressure
- airplane flights
- swimming and diving activities
- dental work/tooth extraction
may precipitate sinusitis

diagnosed via
- physical exam
- patient history
- x-ray
- endoscopic sinuscopy

treated via
- decongestants
- antihistamines
- sinus tap if needed

- antibiotics
- antihistamines
- steroid regimens

many need IV antibiotics, or
balloon sinuplasty

noncancerous growths within the nasal or sinus passagway

cause is idiopathic, but certain chemicals found within the polyps themselves may be to blame

typically they form along with sensitivity or allergic response to aspirin and NSAIDs

5% of the population

especially noted in individuals with asthma and chronic rhinitis, as well as children with cystic fibrosis

- nasal sprays
- cortisone-like drugs
- surgery if polyps are troublesome (but they may recur)

exaggerated breathing sounds during sleep caused by
- nasal congestion
- postnasal drip
- inflamed sinuses

obstructive sleep apnea

obstructive sleep apnea

interruption or hesitation of the normal breathing cycle during the sleep period

blood oxygen levels fall to a point that alerts the system to the need for a new breathing cycle with such a jolt that a snore results

various blockage areas within the air passageways

primary sites of blockage are:
- nasal cavity (deviated septum, nasal polyps)
- base of tongue
- soft tissue like soft palate and enhanced uvula

- (mild/significant) 4-5 episodes per sleep hour
- severe - 20 episodes per hour
- extreme - 100-500 episodes in a night

heavy, long, and loud snoring and snorting

cerebral stroke

since in an estimated 75% of the cases, there is a decreased blood flow to the brain

highest among middle-aged overweight males

1 in 15 (6.62%) of population
70% of those have obstructive sleep apnea

via polysomnography, either in a clinical setting or with a home unit

brain waves, respiratory and auditory activities, and blood oxygen levels are monitored

depends on cause and severity, but can include:

- behavior therapy
- not sleeping on back
- alcohol/tobacco/tranquilizer cessation
- weight loss
- treating allergies or irritants
- C-PAP device
- surgical repair of misshapen/blocked sinuses and nasal cavities
- uvulo-palato-pharyngoplasty (trim uvula to prevent blockage)
- somnoplasty (RF procedure to shrink obstructive tissue)
- pillar procedure (contract palate)
- nasal valve procedure (sagging material stitched up)

hay fever

(it affects 1 in 6)

- palatine tonsils

- pharyngeal tonsils

masses of lymphatic tissue in the throat

- foreign objects
- hot liquids
- spicy foods
- breathing through mouth due to nasal congestion
- sleeping with mouth open
- strep throat (streptococci bacteria)
- other bacteria, pathogens, viruses

inflammation of the larynx or voice box

characterized by hoarseness or lost voice (aphonia)

- bacteria
- viruses
- allergies
- overuse of voice
- exposure to caustic chemicals or smoke
- croup in children

- antibiotics for bacterial infection
- resting the voice
- fluids
- steam inhalation

if recurrent fever, continued lethargy and symptoms do not improve rapidly, consider other respiratory conditions such as pneumonia

no cure
treatments are symptomatic and include
- rest
- fluids
- aspirin, etc. to reduce fever
- antibiotics for secondary bacterial infections

flu vaccine to prevent

- small children (bronchioles can easily become obstructed)

- elderly or chronically ill (secondary infection can develop)

- antibiotics don't work on viruses

- vapors, sprays, cough medicine (except in children under 6)

1 in 22 (4.4%)

more common in middle-aged men than women

same as acute bronchitis, but they persist
- excessive mucous secretion from bronchial mucosa
- mucous glands hypertrophy
- mucosa thickened and inflamed
- interference in air passages caused by swelling and mucus reduces ability to maintain blood O2 level properly (hypoxia)
- poor drainage of mucus sets up bacterial infection
- parts of respiratory tract can become necrotic and fibrous scarring follows

asthma

breathlessness or panting

- nocturnal
- exercise-induced
- occupational

increased dramatically since 1980 among all ages, genders, and ethnic groups (especially African Americans)

as of 2002, nearly 30 million Americans diagnosed

more aggressive in those under 18, estimated 7-10% of children have asthma and boys get it at a rate of 30-50% higher than girls

women have it 7% more than men

kills 15 people daily in the US

80% of asthmatic children
50% of asthmatic adults

have allergies

- no definitive test
- spirometry often used, but inconclusive if symptoms absent at time of testing
- obesity looked at as a cause of symptoms
- family history
- thorough questioning
- skin tests for allergic triggers

status asthmaticus

may require tracheotomy

if not treated, may result in respiratory failure and death

age 45-64 = about 1 million (1.5%)

over 65 = about 3 million (4.5%)

- spirometry
- X-rays in later stages (early stages do not show)
- identification of "barrel" chest
- auscultation reveals rales
- hypoxia/cyanosis

- dyspnea
- wheezing
- persistent cough
- thick sputum
- lung collapse

predisposition to developing bronchiectasis (weak/dilated bronchial tubing) as sequela of chronic inflammation and congestion

- excessive mucus blocks pancreatic ducts
- weight loss and malnutrition due to lack of digestive enzyme secretions
- large, bulky, foul-smelling stool as a result of lack of proper fat digestion
- secretory glands become dilated, develop into cysts containing thick mucus, then fibrous tissue develops

- sweat glands excrete excessive perspiration
- large amount of salt released
- susceptibility to heat exhaustion
- "sweat test" helps confirm CF

- a COPD caused by dust particles that seem to embed into lung tissue ("grit" in lungs)

- usually results from industrial mining, milling, asbestosis

- testing by x-ray, spirometry, and exercise

- bronchodilators and corticoid medications

- listening to lung activity
- chest x-ray
- analysis of sputum

by chest x-ray

since the infection has many foci of infection, the x-ray will show a diffuse pattern of inflammation

debilitated patients who are less mobile or bedridden from other diseases

- common in viral pneumonia
- denotes diffuse pattern seen on x-ray
- common in younger people due to crowding in schools and sharing facilities, contaminated items
- may not require doctor visit for those who are otherwise healthy and remain active
- complications more common in stressed/elderly individuals or those with diabetes, cirrhosis, sickle cell or cancer

initially flu-like with fatigue, fever, weakness, headache, sore throat, GI distress

unusual infectious agents like
- pneumocystis carini
- cryptococcus neofrmans

they may lack the ability to clear their lungs effectively

the one acquired as a complication of the flu

it was responsible for most of the estimated 20 million killed worldwide in the flu epidemic of 1918-1919

a lung infection caused by bacterium Legionella pneumophilia

by inhalation of droplets contaminated with the bacteria

often from large AC units, humidifiers, hot tubs, or other condition that produces contaminated aerosol droplets

flu-like symptoms, which sets it apart from other pneumonias and indicates another atypical form of pneumonia

it is serious, and potentially fatal, thus it is important to differentiate it from other forms of pneumonia via sputum culture and chest x-ray

treated with antibiotics, usually erythromycin

residual effects include long-term problems such as fatigue, coughing, shortness of breath, neuromuscular impairments

complications range from lung abscesses to lung collapse and respiratory failure

over 1 million cases per year

40,000-70,000 deaths

- antibiotics
- heat applications
- bed rest

via contaminated milk from infected cattle

because those in the secondary stage of the disease lose weight and become cachectic (wasting away)

tuberculosis

incidence is rising rapidly worldwide, but especially in Asia, Russia, and parts of Africa

one is the condition (pneumothorax=air in the chest)

the other is the result (atelectasis=collapse of the lung)

they often occur together, and are often considered to be the same thing

- newborns with stiff or inflexible lung (infant respiratory distress syndrome--IRDS)

- individuals using ventilators or CPAP machines

when there is a circulatory deficiency

pneumothorax/atelectasis may cause reduced blood pressure because the elevated internal chest pressure slows blood flow to the heart

respiratory difficulties (scarring of linings) caused by
- inhalation of food/vomit
- heavy smoke from burning structure
- toxic fumes

- O2 assistance
- respiratory therapy

few symptoms in early stages

persistent cough and coughing up of blood (hemoptysis) in later stages

also
- anorexia
- weight loss
- weakness due to poor oxygenation of blood
- difficulty breathing due to airway obstruction/compression

60

meaning that it's likely these cancers began years earlier

- later onset asthma persists, but attacks are less frequent/severe
- elastic tissue of lungs deteriorates and reduces lung capacity
- one square foot of respiratory membrane is lost each year after age 30
- even with cancer, the cause of death will likely be pneumonia (the final disease and actual cause of death)

d. emphysema

c. asthma

b. emphysema

c. tuberculosis

c. asthma

a. pneumonia

b. emphysema

d. bacteria

b. infant respiratory distress syndrome (IRDS)

c. pleurisy

True

False. No cure for common cold.

False. Tonsillitis is treated with tonsil removal in extreme cases.

True

False. Rates are rising and we don't have new drugs.

False. Hemoptysis is coughing of blood; dyspnea is SOB/difficulty breathing.

False. Atelectasis is collapse of a lung; bronchiectasis is chronic dilation of bronchi/bronchioles

True

False. Chronic Obstructive Pulmonary Disease

False

Mantoux skin test

atelectasis

smoking

spirometry

viruses

pleurisy

lobar

emphysema

somnoplasty

cystic fibrosis

- mouth
- pharynx
- esophagus
- stomach
- small intestine
- large intestine
- accessory organs (liver, gallbladder, pancreas)

because of a thick, protective mucosal lining

chyme

peristalsis

in the first part of the small intestine (duodenum)

- protein (trypsin and chymotrypsin)
- lipid (lipase)
- carbohydrate (amylase)

an alkaline solution for the neutralization of acid carried into the small intestine from the stomach

a liver secretion that is stored in the gallbladder

it passes through the common bile duct into the duodenum

no, it is an emulsifier that reduces large fat droplets into much smaller fat droplets, which allows the lipid enzymes to digest fat into small, absorbable units

cecum

vermiform appendix

no, they are disorders that are signs of a disease

book says "signs and symptoms" but these four look like signs to me

protective mechanism

- an irritant
- an infection
- a distention, or
- a blockage

sensory nerve fibers to deliver the message to the vomiting center in the medulla

in the medulla

activates motor impulses that stimulate the diaphragm and abdominal muscles to squeeze the stomach

nausea

frequent passage of watery stool

contents of small intestine are rushed through the large intestine

since colon is site of (re)absorption of water and minerals, rushing the material through via intensified peristalsis leaves no time to do so and stool remains watery

- poor habits of elimination,
- dehydration, and
- low-fiber diets

excessive water reabsorption

varicose veins in the lining of the rectum near the anus

may be internal or external, and
blue due to decreased circulation, or
red due to inflammation

oral inflammation

NOT stomach!
stoma = mouth

local infection of mouth by
- bacteria
- viruses
- fungi

or it may be a sign of a systemic infection

- patches
- ulcers
- redness
- bleeding
- necrosis

streptococci - bacterial oral/throat infection, canker sores
neisseria gonorrhea - ulcerations of mouth and throat
treponema pallidum - oral chancres and ulcerations
herpes simplex - cold sores
candida albicans - thrush

squamous cell carcinoma

floor of the mouth, tongue, and lower lip

but an aggressive form appears on the upper lip

dysphagia - difficult or painful swallowing

- varicose veins in the esophagus that can hemorrhage

- chief cause is cirrhosis of liver; impaired blood flow through cirrhotic liver elevates pressure in veins of abdomen

duodenal ulcers and occur most frequently in men aged 20-50

- bleeding that can produce anemia and hemorrhaging/shock
- perforation with spilling of contents into peritoneal cavity
- obstructions due to spasm of pyloric sphincter or scarring caused by ulcers

pepsin is a proteolytic enzyme that is partially responsible for causing ulcers

HCl and bile also irritate the gastric mucosa

heartburn and indigestion are frequently the first symptoms

nausea, vomiting, abdominal pain and occasionally massive GI bleeding

inflammation of the stomach and intestines

- anorexia
- nausea
- vomiting
- diarrhea

- bacteria/viral infection (E. coli, salmonella)
- chemical toxins
- lactose intolerance
- other food allergy

- fluid replacement
- electrolyte replacement
- antispasmodics

- poor nutrient absorption due to gluten intolerance

- diarrhea, gas, abdominal cramps, systemic signs of malnutrition

- biopsy of small intestine shows atrophy and flattening of villi

- seems to be a genetic immune dysfunction

- affects twice as many females as males

- more common among whites of European ancestry

- a.k.a. irritable bowel syndrome
- marked by diarrhea, constipation, abdominal pain, gas
- no lesions, tumors, or ulceration; functional disorder of motility
- pain caused by muscle spasm

irritants
- laxative abuse, caffeine, alcohol, spicy food, fatty food, OJ, beans, cabbage

treatments
- no cure, but suggest adding fiber and reducing stress

- receives oxygenated blood from hepatic artery
- receives blood rich in nutrients through the portal vein from the stomach, intestines, spleen and pancreas

- liver continuously secretes bile into hepatic duct
- hepatic duct carries bile to gallbladder
- gallbladder stores and concentrates bile
- when fats enter the duodenum, the gallbladder releases bile through the cystic duct to the common hepatic duct which carries it to the duodenum

- specialized cells that line the blood spaces within the liver
- they engulf and digest bacteria and other foreign substances, thus cleaning the blood

- water
- bile salts
- cholesterol
- bilirubin (from breakdown of hemoglobin)

- obstruction of bile flow from gallbladder
- hepatitis
- cirrhosis
- hemolytic anemia

- bile backs up and leaks into blood, causing dark urine and light stool
- infection or inflammation of gallbladder or bile ducts
- poor fat digestion
- poor fat-soluble vitamin absorption (bleeding issues with lack of vitamin K)
- liver damage

- initial symptoms are nonspecific, but similar to HAV and HBV
- persists for months or years
- 20% develop cirrhosis
- transmitted mainly through blood transfusions, but also IV drug use and sex
- treated with interferon injections and oral riavirin

- defective virus; cannot replicate in a cell unless that cell is also infected with HBV
- resulting disease is more serious and frequently progresses to chronic liver disease
- relatively uncommon

- very uncommon in the US; almost every case was due to foreign travels
- worldwide is the leading cause of infectious hepatitis outbreaks
- primarily caused by fecal-contaminated drinking water
- no evidence that it progresses to chronic disease

- ascites
- jaundice
- weight loss
- abdominal mass
- pain in right upper quadrant

- portal cirrhosis
- Laennec cirrhosis
- fatty nutritional cirrhosis

gallstones

a.k.a. biliary calculi
small stones are called gravel

- common, twice as common in women
- arise when bile composition changes or gallbladder muscle activity reduces such as in
- pregnancy, use of oral contraceptives, diabetes mellitus, obesity, cirrhosis, pancreatitis

- may be asymptomatic or cause excruciating pain if a small stone enters the common bile duct and causes obstruction
- may be one or several hundred - may be large or small

- cholesterol
- bilirubin
- calcium

surgical removal of the gallbladder

- serious inflammation of the pancreas that can result in death
- protein- and lipid-digesting enzymes activate within the pancreas and it digests itself
- severe necrosis and edema of pancreas; digestion severely impaired, hemorrhaging, can result in death

it diminishes with age

can lead to persistence of high blood levels of medications or toxins

b. inflammation of stomach mucosa

b. ulcerative colitis

b. celiac disease/malabsorption syndrome

d. diverticulitis

d. The prognosis is good, with an 85% cure rate

c. It is most often caused by diabetes

b. chronic alcoholism

a. cirrhosis

a. Candida albicans

c. cholecystitis

False

True

False

True

True

False

False

False

False

True

amoebic dysentery

Crohn's disease

hernia

endoscope

C

cholelithiasis

bile duct

ascites

mouth

large intestine