Respiratory diseases nur124 – session 5

1. Respiratory diseases nur124 – session 5 Nadeeka Jayasinghe

2. OBJECTIVES Discuss pathophysiology, symptoms, diagnosis, treatment of: • Respiratory Failure • Pleural Effusions • Lung Cancer • Bronchiectasis • Occupational Lung Disease • Traumatic Disorders Of The Lung

3. RESPIRATORY FAILURE • A process where the respiratory system fails in one or both of its gas exchange functions 1. Oxygenation 2. Carbondioxide elimination • Hypoxic(Type 1) or Hypercapneic (Type 2)

4. HYPOXIX RESP FAILURE (TYPE 1) • Arterial oxygen tension (PaO2) <60mmHg with low or normal arterial carbon dioxide tension (PaCO2). • Most common form of respiratory failure • Can be associated with most lung diseases which involve fluid overload or alveloar collapse • Examples : Cardiogenic/non-cardiogenic pulmonary edema, pneumonia

5. HYPERCAPNEIC RESP FAILURE • Arterial carbondioxide tension (PCO2) higher than 50mmHg. (Hypercapniea) • Can lead to hypoxemia if they are breathing in room air • Blood pH will be less than 7.35 • Can develop over minutes to hours • The pH levels depend on the bicarbonate levels in the body which in turn is depedant

6. RESP FAILURE - CAUSES • Abnormalities in any of the components of the respiratory system including the airway, alveoli, central nervous system (CNS), peripheral nervous system, respiratory muscles and chest wall. • Pharmacological, structural and metabolic disorders of the CNS may lead to respiratory depression. This leads to hypoventilation or hypercapnea. (tumors in brain stem, sedatives, overdoses)

7. RESP FAILURE - CAUSES • Disorders of the peripheral nervous system

8. RESP FAILURE - DIAGNOSIS • Arterial Blood Gases • Chest xray • ECG (not essential but can rule out possible cardiac causes ) • Pulmonary function tests

9. PLEURAL EFFUSIONS • WHERE IS THE PLEURAL SPACE OF THE LUNG? • Definition?

10. PLEURAL EFFUSIONS • The pleura is the thin membrane that lines the surface of the lungs and inside the chest wall outside the wall. • A pleural effusion is an abnormal amount of fluid around the lung. • Normally, 5-10ml of fluid is in the pleural space allowing the lungs to move smoothly during respiration.

11. CAUSES OF PLEURAL EFFUSIONS • Congestive heart failure • Pneumonia • Liver disease (cirrhosis) • End stage renal disease • Nephrotic syndrome • Cancer • Pulomonary embolism • Lupus and other autoimmune conditions

12. Why does excessive fluid accumulate? • Due to fluid overload – congestive heart failure, renal and hepatic disease. • Inflammation – pneumonia, autoimmune disease

13. SYMPTOMS • Shortness of breath • Chest pain upon breathing (pleuritic) • Fever • Cough • Decreased chest movement and breath sounds on affected side • Bronchial breathing

14. Diagnosis • Auscultation and percussion (very difficult to rule out) • Chest xray – (white space at the base of lungs) • CT scan • Ultrasound – assists with drainage of fluid

16. TREATMENT – Pleural effusions • Thoracentesis – a needle is inserted into the chest wall between the 6/7/8th intercostal space on mid-axillary line into the pleural space and fluid is drained out. • Pleural tap may be left in for a few hours to drain fluid over time • Fluid can be used to determine – protein content, cell count, infection (via culture), fungus, gram stain, lipids etc.

17. LUNG CANCER • Pulmonary carcinoma • Small cell carcinoma vs non small cell carcinoma • 80-90% of lung cancers are from long term tobacco smoke exposure • 10%-15% occur in patients who have never smoked (genetics, pollution, asbestos exposure, second hand smoking)

18. SYMPTOMS • Respiratory : coughing, hemoptysis, wheezing, shortness of breath • Systemic: weight loss, fever, clubbing of the fingernails, fatigue • Symptoms due to the mass pressing on adjecant structures: chest pain, bone pain, superior vena cava obstruction, swallowing difficulty

19. DIAGNOSIS • CT SCAN • LUNG BIOPSY (via brochoscope and/or CT guided biopsy)

21. Treatment • Surgery : Pulmonary function tests must first reveal that the patient is well for surgery. Lobectomy, wedge resection and pneumonectomy are options. • Radiotherapy: Can be given with chemotherapy. For patients who are not suitable for surgery • Chemotherapy: Improves survival but has severe side effects.

22. BRONCHIECTASIS • A disease where the lung is abnormally widened due to mucus blockage • Can develop at any age. But common at birth (congenital bronchiectasis) • Infection - TB, influenza, pneumonia, cystic fibrosis • Due to a blockage in your airway: due to a mass, or an inhalation of a solid (food etc)

24. BRONCHIECTASIS • Mucus to build up causes bacteria growth and severe infection. Over time, the airways loses it’s ability to ventilate adequately. • Can lead to respiratory failure, heart failure and collapsed lung.

25. Symptoms • Shortness of breath • Hemoptysis • Wheezing • Chest pain • Fatigue • General lethargy and feeling unwell

26. Diagnosis • Chest CT scan • Chest xray – will show airway abnormalities • Blood tests – infection, other conditions that may be contributing factors • Lung function tests – capacity of lungs, if breathing volumes are affected • Bronchoscopy – blockages of airway, bleeding etc.

27. Treatment • Treatment of underlying conditions • Antibiotic therapy • Chest Physiotherapy • Bronchodilators, steroids, oxygen • Surgery

28. OCCUPATIONAL LUNG DISEASES • Broad group diagnosis • Inhalation of dust, chemical and proteins • “Pneumoconiosis” – diseases associated with inhaling mineral dust • The exposure of different particles result in different diseases Asbestos exposure - Asbestosis Silicon exposure – Silicosis Coal / mineral dust - Pneomoconiosis

29. OCCUPATIONAL LUNG DISEASE 1. ASBESTOSIS: • Asbestos – used for industrial work – breaks into fibers when shattered • Industrialization exposed large communities to asbestosis but symptoms did not develop till later in life • Asbestosis causes scarring, fibrosis, lung cancer, pleural effusions, plaques. • Dyspnoea

30. OCCUPATIONAL LUNG DISEASE 2. SILICOSIS: • Develops decades after exposure • Silica nodules in the lungs • Acute (higher mortality) vs chronic silicosis (silicotic nodules develop into lesions) • Silicosis increases risk of TB and immune related diseases (systemic arthritis and SLE) • Associated with increased risk of lung cancer

31. OCCUPATIONAL LUNG DISEASES 3. PNEMOCONIOSIS (CWP): • Long term exposure to coal dust • Also known as black lung – small spots in upper lungs that reflect coal inhalation • Progresses into fibrosis. Similar to Silicosis – destroys lung architecture • Exposure to coal dust – airflow obstruction, chronic bronchitis, rheumatoid arthritis • Stomach cancer has been associated with coal ingestion

33. TRAUMATIC DISORDERS OF THE LUNG • PNEUMOTHORAX: • An abnormal collection of air or gas in the pleural space that separates the lung from the chest wall • Spontaneous pneumothorax – occurs without an apparent cause in the absence of lung disease • Secondary pneumothorax – occurs in the presence of significant lung pathology

34. TRAUMATIC DISORDERS OF THE LUNG • In a minority of cases, the amount of air in the chest increases markedly when a one-way valve is formed by an area of damaged tissue, leading to a tension pneumothorax. This condition is a medical emergency.

35. Causes (Pneumothorax) • Physical trauma to the chest wall • Blasts • Complication from a medical or surgical intervention • Long term mechanical ventialation

36. Signs and symptoms • Shortness of breath • Chest pain (mild to severe – depending on stage) • Hypoxia – leads to cyanosis • Hypercapnia – confusion

38. DIAGNOSIS • Chest xray • CT scan • Auscultation • Observation and assessment of changes in patient condition (tracheal deviation, changes to the shape of chest wall)

39. Management • Not all pneumothoraces require treatment • Immediate needle decompression (if in an emergency setting) • Chest tube insertion • Pleurodecis (