Bronchogenic Carcinoma
The most common form lung cancer. These tumors arise in the bronchial epithelium & are malignant.
Squamous Cell Carcinoma
These tumors arise from the bronchial epithelium of the bronchus near the helium they project into the airways.
Adenocarcinoma
Found on the peripheral of the lung & are hard to detect due to lack of symptoms. These cancerous cells can sometimes secrete mucin.
Bronchoaveolar Cell Carcinoma
Found on the peripheral of the lung & are hard to detect due to lack of symptoms.
Oat Cell" Carcinoma
located near major bronchus in the central part of the lung. They are invasive & metastasize early
Large Cell Carcinoma
Found in the peripheral of the lung & consist of undifferentiated cells. They multiply rapidly & metastasize early.
What are common site of metastases of lung cancers?
Brain, bone, & liver
What are the effects of tumors of the lungs?
Obstruction of airflow, Inflamation, Infections, Pleural effusion, hemothorax, pneumothorax, & Pareneoplastic syndrome.
Pareneoplastic Syndrome
When tumors secrete hormones: also there may be neuromuscular disturbances & hematologic disorders E.g. DIC (clotting & hemorrhages)
Pleural effusion, hemothorax, pneumothorax are all common in what types of tumors & why?
They are seen in tumors found on the peripheral of the lungs. They cause inflammation & or erosion of the pleural membrane.
Why are infections common in lung cancer?
Inflammation around the tumor will stimulate coughs & dyspnea also secretions tend to accumulate & pool distal to the tumor: these conditions predispose one to secondary infections.
What is the etiology of lung cancers?
Smoking, second hand smoke, environmental factors, genetics, & predisposing factors E.g. COPD
What are the effects of smoke or smoking on the lung cells?
Smoke leads to chronic inflammation which in turns leads to meataplasia then to dysplasia. The mutations are a ciliated columnar epithelium cell becomes a squamas cell epithelium.
What is the onset of lung cancers?
Cancer has an insidious onset often it already has metastasized before diagnosis occurs.
What are the signs & symptoms of lung cancers?
Paraneoplastic syndrome, chest pain, any type of pleural disorder E.g. pneumothorax, A persistent cough dyspnea or wheezing, hemoptysis, pneumonia, headaches, hoarseness, facial & arm edema, dysphagia & atelectasis. Systemic signs include; malaise, weight
What is the cause of hoarseness in lung cancers?
Laryngeal nerve compression
What is the cause of dysphagia in lung cancers?
Compression of the esophagus
What is the cause of headaches, facial & arm edema in lung cancers?
Compression of the superior vena cava
What is the treatment for lung cancers?
Surgical resection, lobectomy, chemotherapy or radiation, photodynamic therapy, & supportive therapy.
What is Photodynamic Therapy?
A chemical is injected into the individual which migrates to the tumor cell. The chemical is activated by a laser light that destroys cancer cells.
What is the prognosis for lung cancers?
Very poor
Aspiration
The passage of food, fluid, vomitus, drugs, or any foreign material into the trachea & lungs.
Which lung is most often a victim of aspiration & why?
The lower lobe of the right lung. This is due to the fact that the right bronchus limb continues almost straight down & the left has more of a sharper turn.
What are the effects of aspirating solid objects?
They obstruct airways causing partial or total blockage or they can occlude the Trachea totally blocking airflow. This leads to inflammation & edema which can lead to bronchoconstriction.
What are the effects of aspirating fluids?
Severe inflammation, increased secretions, & narrowing of the airways. Also known as chemical or aspiration pneumonia.
What are some complications of aspiration?
Respiratory distress syndrome, pulmonary abscess, Chemical aspirated can be absorbed in the blood & cause systemic effects.
What are the signs & symptoms of aspiration?
Coughing, choking, dyspnea, strider, hoarseness, wheezing, nasal flaring, chest retractions, marked hypoxia.
What are the effects of aspiration when it causes total obstruction of the Larynx or Trachea?
No ability to talk or make sounds the person gestures to their chest or neck. Cardiac Arrest or Respiratory Distress ensues.
What are other treatments for aspiration?
Finger probe or a tracheotomy.
Patients who have widespread inflammation due to aspiration must be monitored for what?
ARDS, or Pneumonia.
What are supportive measures used for aspiration?
Oxygen therapy, supportive therapy, & prophylactic antibiotics.
Asthma
Periodic episodes of bronchial obstruction with hypersensitivity or hyperresponsive airways. Comes in the acute & chronic form.
What is the response of the bronchi tree during episodes of asthma?
1. Inflammation of the mucosa with edema
2. Bronchial constriction of the smooth muscle.
3. Increased secretions of thick mucus in the passages.
Extrinsic Asthma
Acute episodes that are triggered by a hypersensitivity 1 to an inhaled antigen. Commonly found in children. Resulting in inflammation & release of chemical mediators by the mast cells and Esinophils.
In extrinsic asthma what is the immunoglobulin reacts to the antigen?
IgE
Intrinsic Asthma
Onset that begins as an adult triggered by stimuli that targets hyperresponsive tissues of the airways.
What are examples of stimuli in Intrinsic Asthma?
Respiratory infections, exposure to cold weather, exercise, drugs (ASA), & inhalation of toxin (2nd hand smoke).
Partial Obstruction
Refers to the small bronchi & bronchioles which become obstructed by air trappings & hyperinflation of the lungs. Air passes through the partial obstruction but only part of it is exhales & RV is increased.
Total Obstruction
Mucus plugs completely block the passageways. This leads to atelectasis or non aeration of the tissue that is distal to the obstruction. Air is let out yet is not refilled that process causes the lung to collapse.
What are complications that arise due to total obstruction?
Respiratory and Metabolic Acidosis, Hypoxemia which causes further vasoconstriction in the pulmonary blood vessels reducing blood flow & increasing the workload.
Status Asthmatics
Presistant & severe attacks of asthma that do not respond to therapy. Owning to severe hypoxia, acidosis, & cardiac arrhythmias, or central nervous system depression. Often fatal.
What are the effects on the bronchus due to chronic asthma?
Bronchial walls become thick & fibrous this is caused by frequent infections that follow attacks in the atelectatic areas. Further complications can arise due to small mucus plugs that have not been removed.
What is the Etiology of Asthma?
Genetics, increased air pollutants, URI by viruses
What are the signs & symptoms of Asthma?
Cough, tight chest, dyspnea, wheezing, thick & tenacious mucus that is coughed up, tachycardia, pulsus paradoxus, hypoxia, respiratory alkalosis & acidosis, hypoxemia, respiratory failure.
Why does Respiratory Alkalosis occur in Asthma?
Due to Hyperventilation
Why does Respiratory Acidosis occur in Asthma?
Due to air trapping & fatigue the respiratory system decreases its effort. So Hypoxia sets in resulting in metabolic acidosis.
What is Pulsus Paradoxus?
A difference in the pulse during inspiration & expiration. Observed when the BP is taken during an asthma attack. There is a gap of about 10mm Hg. Between the two.
What are some treatments for Asthma?
Inhalers, breathing techniques, Glucocortoids, . prophylactic medications & hospitalization for status asthmatics.
What are some preventative measures one can take to avoid an Asthma attack?
Skin tests are useful in determining a stimulus that triggers attacks so you can avoid them. Swimming & walking improve the chest muscles, cardiovascular fitness, & reduce stress. Prophylactic medications after the signs of a developing cold begin.
Chronic Obstructive Pulmonary Disease (COPD)
A group of common chronic respiratory diseases that include Emphysema, chronic Bronchitis, & acute Asthma. They are characterized by tissue destruction & obstruction of airways.
What are the effects of COPD?
Reventually respiratory failure as a result of hypercapnia, & hypoxia. Core Pulmonale is common as well.
Emphysema
Destruction of the alveolar wall and septae by destructive enzymes known as Proteases E.g. Elastase. Elastase is released during inflammation by the netrophils. It breaks down the elastic fibers of the lung. Usually Alpha 1 antitrypsin (protein) inhibits
What is the etiology of Emphysema?
Cigarette smoking, genetic factor, or chronic lung diseases E.g. Cystic Fibrosis.
How does cigarette smoke cause Emphysema?
It increases Neutrophils in the alveoli which release Elastase. It also decreases the effect of alpha 1 antitrypsin.
What are the effects of Emphysema on the lungs?
Loss of surface space for gas exchange, loss of pulmonary capillaries, loss of elastic fibers the lung can no longer recoil, the lungs can no longer support the bronchi tree.
What is the onset of Emphysema?
Insidious
What are the signs & symptoms of Emphysema?
Dyspena, hyperventilation, Barrel Chest, anorexia, fatigue, secondary polycythemia, clubbed fingers.
As far as pulmonary volumes go what is seen in Emphysema?
Increase of RV & TLC, decrease of forced expiratory volume & VC
What are treatments for Emphysema?
Cessation of smoking, avoidance of irritants & infections, Immunization for the flu & pneumonia, pulmonary rehabilitation therapy, lung reduction surgery, & bronchodilators.
What is a "Pink Puffer"?
The facial appearance of an individual with Emphysema. There face appears to have a pink huse due; hyperventilation, overinflation, & dyspena.
Chronic Bronchitis
The effects of; smoking, exposure to pollutants, chronic coughs, repeated infections, & inflammation with obstructions will cause a change in the bronchus. This change is irreversible & progressive.
What are the effects of Chronic Bronchitis on the bronchus?
1. Mucosa is inflamed & swollen
2. Hypertrophy & hyperplasia of the mucus glands occurs & the glands secrete extra mucus.
3. Goblet cells are increased & a decrease of ciliated epithelialum.
4. Fibrosis of the bronchial wall
What are some of the things that cause obstruction in the bronchus?
Chronic inflammation & irritation, secretions of the mucus & goblet cells pool, Fibrosis of the bronchial wall.
What is the etiology of Chronic Bronchitis?
Smoking, Living in urban or industrial areas, & exposure to any inhaled irritants they cause frequent inflammation & infections.
What are the signs & symptoms of Chronic Bronchitis?
Constant productive cough with rhonci, tachypena, hypoxia, hypercapnia, secondary polycythemia, severe weight loss, cor pulmonale, & pulmonary hypertension.
When is a cough & rhonchi most frequent in COPD?
In the morning due to the pooling of secretions overnight.
What are the secretions of Chronic Bronchitis like?
Purlent & thick
What is the treatment for Chronic Bronchitis?
Influenza & pneumonia vaccine, avoid irritants, chest physiotherapy, bronchodialatiors, & prophylaxis antimicrobials.
What are the 2 most common outcomes of Chronic Bronchitis?
Cor pulmanle & pulmonary hypertension.
What is a "Blue Bloater"?
The facial appearance of a person who suffers from chronic bronchitis. Due to low levels of Oxygen & edema there face appears bloated & blue.
Bronchiectasis
A secondary condition in COPD & CF. An irreversible dilation of the medium sized bronchi ballooning of the bronchus becomes a breeding ground for microbes as fluid collect in it. Caused by inflammation & infection which weakens the elastic fibers & causes
What are the signs & symptoms of Bronchiectasis?
Cough, prulent sputum, rales & rhonchi, foul breath, dyspena, hemoptysis, malaise, & systemic effects (weight loss, anemia, & fatigue)
What are the treatments of Bronchiectasis?
Antibiotics, bronchodilators, chest physiotherapy
Restrictive Lung Disorders
2 groups of diseases where lung expansion is impaired & TLC is reduced
1.Diseases that impair expansion E.g. Scoliosis, botulism
2. Diseases affect the supporting tissues of the lungs E.g. Idiopathic pulmonary fibrosis.
Pneumoconioses
A group of chronic restrictive lung diseases caused by inhalation of irritants.
Anthracosis / Coal-Workers Diseases
The agent is coal dust & the occurrence is in coal miners
Silicosis
The agent is Silica & the occurrence is in; stone cutting, sand blasting, & mines
Asbestosis
The agent is Asbestos & the occurrence is in insulation & shipbuilding
Farmers lung
The agent is Fungal spores & the occurrence is in hay.
Pathophysiology of Pneumoconioses
Inflammation & fibrous tissue develops destroying the connective tissue. The destruction works its way into the alveoli & functional areas are lost. The damage is irreversible & can cause pleural effusions as well as caner. The diseases are aggravated & p
What are the signs & symptoms of Pneumoconioses?
It has an insidious onset with a productive or non productive cough dyspena occurs as inspiration worsens.
What are treatments for Pneumoconioses
Identifying & ending exposure to the agent will slow the disease.