Diseases of the Respiratory System

Pendahuluan

Penyakit & KelainanKongenital/ Herediter

AsthmaHernia diafragmatikaTracheoeosophageal fistule

DidapatInfeksi (TB, Bronchitis, empisema, PPOK/COPD, N5A1,

SARS, dll)Kanker ParuSkeleosis, Kiposis

TraumaKontusio paruFraktur costaRuptur trachea

Obstructive Lung DiseaseAliran udara terbatasRate ekspirasi lambatVolume umumnya

normal

Restrictive Lung Disease

Pengembangan paru yang terbatas

Terbatasnya volume & flow rate

Major Determinants of DiseaseDiseases of one lung compartment tend to affect the

othersThe lungs are open to the environment, exposing

them to infectious agents, allergens, irritants, & carcinogens

Most lung disease is caused by inhalation of material; the most common exception is autoimmune lung disease

Lost pulmonary membrane is not recoverableSmoking is a major cause of lung diseaseThe heart & lungs are a functional unit; lung disease

usually affects the heart; & heart disease usually affects the lungs

Upper Respiratory InfectionsAllergic rhinitis

“hay fever” nasal mucosal edema nasal discharge sneezing allergic conjunctivitis

“Colds” transmitted through respiratory droplets clear nasal discharge low grade fever if nasal discharge becomes colorful, it is

an indication of secondary bacterial infection

Acute pharyngitis “sore throat” usually viral bacterial infections more serious red, swollen tonsils

Carcinoma of the LarynxCommonMostly in male

smokers over 40Alcohol abuse

increases the riskPresents with

hoarsenesspaincoughdysphagiahemoptysis

AsthmaChronic inflammatory disease of small bronchi &

bronchiolesCharacterized by bronchospasm & air trappingAirflow out is impairedTriggered by inhaled irritants & classified by irritantAllergic

type I hypersensitivityOccupationalExercise-inducedInfectiousOthers

drug reactionsemotional stresssevere air pollution

Hyperplastic mucous glands in bronchi, hypertrophied smooth muscle, edema, & marked inflammation

AtelectasisCollapse of a lung or part

of a lungResorption

bronchial obstruction air below obstruction

completely absorbed obstructions are

mucous plug asthma bronchitis tumors

Compression pressure exerted from

pleural space or upward pressure on diaphragm

Contraction scars cause constriction

& collapse TB

Chronic Obstructive Pulmonary Disease (COPD)

Related diseasesChronic bronchial

outflow obstructionOverlapping

features

EmphysemaDestruction of

alveolar walls, alveoli merge to form large air spaces

Loss of surface area affects diffusion

90% of cases are smokers

Cigarette smoke irritates lung & causes inflammation

Inflammatory cells release digestive enzymes

These enzymes normally inhibited by alpha-1 antitrypsin

AAT inhibited by smoke & so enzymes digest lung tissue

Shortness of breath

Wheezing & coughing

Weight lossBarrel-chestedExhibits

“tripoding”

Chronic BronchitisChronic cough that

produces sputum for 3 consecutive months 2 years in a row

Primary cause is cigarette smoking

Chronic inflammation of bronchi

Simple chronic bronchitisChronic asthmatic

bronchitisObstructive chronic

bronchitis

Most patients have chronic bronchitis & emphysema in varying degrees

“pink puffers” emphysema usually thin barrel-chested short of breath but well

oxygenated“blue bloaters”

obstructive chronic bronchitis

wheezing, coughing sputum production cyanotic no lost pulmonary

membraneAll at risk of chronic

hypoxia

BronchiectasisMarked, permanent dilation of small bronchiDestruction of smooth muscle & elastic

supporting tissueMust have obstruction & infection

obstruction causes mucus retentioninfection damages bronchial walls which causes

excess mucus productionNot a primary conditionTypically involves lower lobesPersistent cough

Restrictive Lung DiseaseChronic inflammation

making lungs stiff & inelastic

Affects diffusionScar tissue accumulates

in the interstitiumMostly cause is

unknownEqual decline in FEV1 &

FVCUsually presents with

shortness of breathCan lead to pulmonary

HTN

Interstitial Fibrosis without Granulomatous InflammationUsually middle-aged

men at time of diagnosis

Shortness of breath; may progress to cor pulmonale, hypoxia

Pneumoconiosesblack lung diseasesilicosis

most common chronic occupational disease

asbestosis mesothelioma

Interstitial Fibrosis with Granulomatous InflammationSarcoidosis

cause unknownaffects many

tissues but mostly lungs

present with shortness of breath, cough, chest pain, hemoptysis

Pulmonary EdemaFluid in alveoliIncreased BP in lung

normal is 25/8 mmHg with average at 15 mmHg

Microvascular injurydue to

toxic fumes hot gases septicemia IV drug abuse

Main symptom is SOB

Pulmonary ThromboembolismAbout 50,000 deaths

annuallyMostly from DVT Inflammation predisposes

you to itPromoted by

CHF pregnancy birth control pills prolonged bed rest metastatic cancer genetics

Most associated with no symptoms but some cause lung infarcts chest pain & dyspnea death

Adult Respiratory Distress Syndrome ARDS Alveolar or pulmonary capillary

damage Pathogenesis

injury to endothelium or alveoli neutrophils infiltrate protein-rich fluid exudes into alveolar

space SOB occurs with rapid breathing

which dries the fluid into a thick membrane

stiffens lungs limits airflow & interferes with

diffusion hypoxia

50% fatality Causes

sepsis smoke inhalation near drowning O2 toxicity burns DIC fat embolism endotoxic shock

PneumoniaInflammation of the

lungsUsually caused by

bacteria80,000 deaths/yrAlveolar pneumonia

usually acutefill with inflammatory

exudatemost common

Bronchopneumoniapatchy inflammationinvolves alveoli of more

than 1 lobeusually in basilar parts

Lobar pneumoniaconsolidation of an

entire lobealmost always caused

by S. pneumoniae

Pulmonary Hypertension Sustained systolic pressure over

30 mmHg or average in excess of 25 mmHg

Vicious cycle Most common cause is

increased pulmonary vascular resistance

Usually secondary to COPD heart disease collagen vascular diseases recurrent pulmonary

thromboemboli With R heart failure is cor

pulmonale Thickening of arteriolar walls SOB

chest pain fatigue

Interstitial PneumoniaInflammation in

septaDiffuse &

bilateralUsually viral

Etiologymostly bacterial

S. pneumoniae Haemophilus

influenzae Staph E. coli Pseudomonas

Pathogenesisinhalation of

droplets, aspiration of gastric contents, blood-borne spread

those susceptible include immune deficiency decreased cough

reflex impaired cilia accumulated

secretions pulmonary congestion

Community-acquiredacute pneumoniabronchopneumonia lobar pneumoniaLegionnaire’s diseaseatypical pneumonia

Mycoplasma

NosocomialCommonly S. aureus &

E.coliSeen in

People with severe disease

Prolonged antibiotic therapy

People with internal mechanical devices

Aspiration Inflammatory reaction

due to corrosive effectsThose who are comatose

or those with a strokeHi mortality rate

Terjadi pada usia muda & orang tuaHypoxia & deathBacterial

high fever & chillspurulent sputumincreased neutrophilscoughSOB

Interstitialless severeincreased lymphocytescoughSOB

Lung AbscessPurulent inflammation

with tissue necrosis & liquefaction

Usually have several types of bacteria with anaerobic

Most commonly due to aspiration of gastric contents

Foul-smelling sputum

TuberculosisMycobacterium tuberculosisChronic granulomatous inflammation with

caseous necrosis

Pathogenesis

Affects about 2 billion worldwideKills about 2 million/yr2nd only to AIDSAssociated with poverty, crowding,

malnourishment, & chronic diseasePPD

Low-grade feverNight sweatsMalaiseWeight loss anorexia

MycosesHistoplasmosisCoccidiomycosisCryptococcus

Lung NeoplasmsMostly due to metastasisBronchogenic carcinoma is the most common

most common of all cancers#1 cancer deathabout 90% are cigarette smokers

Bronchogenic Carcinoma

Mostly caused by cigarettesDirect relationship between incidence of cancer &

number of cigarettes smokedDirect relationship between precancerous changes

in bronchial mucosa & number of cigarettes smoked

Small cell carcinoma20% of casesarise from specialized

neuroendocrine cells of the bronchus

strongest relationship to cigarettes

aggressively malignantSquamous cell

carcinoma30% of casesbronchial epithelium that

has undergone metaplasiaarises centrallymost common in men who

smokegrows slower so better

prognosis

Adenocarcinomas30% of casesmost well-differentiatedsomewhat better

prognosismore peripheral in

smaller bronchi less associated with

smokingLarge cell carcinoma

15% of casespoor prognosismetastasizes early

Bronchial Carcinoid Tumor5% of lung cancersArise from bronchial neuroendocrine cellsMuch less aggressiveGrows slow

PneumothoraxAir in pleural spaceCauses atelectasisMay occur spontaneouslyMore frequent in people with emphysema

who have large blebs near pleuraTraumatic penetrationCan be fatalTension pneumothorax

air in but not out

Pleural EffusionFluid in pleural spaceTransudate from CHF most commonIf blood, called hemothorax

PleuritisInflammationPleurisy with each breathMostly caused by pneumonia

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