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Respiratory System - Coggle Diagram

- - - - A bronchial obstruction leading to infection with inflammation (distal to the obstruction)
      - In UK, usually caused by CF
      - Other causes
        
        Bordetella pertussis (Whooping Cough) can cause bronchiectasis later in life
        
        Ciliary dysfunction syndromes
        
        Primary hypogammaglobuminaemia
        
        Congenital abnormalities (usually rare ones)
        
        TB – most common cause worldwide
    - - Chronic cough
        
        usually worse in morning, may be brought about be changes in posture
      - Production of large amounts of foul smelling sputum, which may also contain flecks of blood
      - Finger clubbing may be present
      - Recurrent RTI’s
      - Haemoptysis
    - - Coarse crackles (numerous) over areas containing large amounts of sputum
      - Possible collapse (no breath sounds)
      - Reduced or absent breath sounds at areas distal to places of obstruction
    - - CXR
      - CT
        
        Signet ring appearance
      - Sputum sample
      - CF testing (genotyping, sweat electrolyte test, etc)
    - - TB
      - Bordetella pertussis
      - CF
    - - Antibiotics
      - Steroids
      - Postural drainage (physio)
      - Bronchodilators
  - - - Increased heart rate in acute severe episode
      - Hyper-resonant lungs in moderately severe episode
      - Rhonchi (chronic asthma)
    - - Obs
      - Nasal examination (to rule out allergic rhinitis)
      - Peak flow
    - - Expiratory wheeze
      - Use of accessory muscles in severe episode
      - Coughing
      - Tight chest
      - Breathlessness
    - - 1st line: Inhaled short-acting beta₂ agonist (SABA) - salbutamol
    - - Airway bronchoconstriction caused by inflammation, most often due to allergic stimuli
    - - Other atopic conditions (eczema, hay fever)
  - - - Hospital acquired
        
        Staphylococcus aureus
      - Community acquired
        
        Streptococcus pneumonia
        
        Hameophilius influenza
    - - SOB
      - Cough productive of sputum
      - Fever
      - Haemoptysis
      - Pleuritic chest pain
      - Delirium
      - Sx of sepsis
        
        Tachypnoea
        
        Tachycardia
        
        Hypoxia
        
        Hypotension
        
        Fever
        
        Confusion
    - - Bronchial breath sounds
      - Focal coarse crackles
      - Dullness to percussion
    - - CXR
        
        Consolidation
      - FBC (raised white cells)
      - U&Es (for urea)
      - CRP
    - - Cigarette smoking
      - Bronchiectasis (i.e. in CF)
      - Immune supression
    - - Keep oxygen saturation >92%, using oxygen therapy as required
      - 6 week follow up CXR
      - If severe and/or vomiting, IV antibiotics
      - If not vomiting, and CURB65 score ≤2, oral antibiotics (amoxicillin or macrolide)
    - - C – Confusion – use the abbreviated mental test (score ≤8)
      - U – Urea – >7mmol/L
      - R – Respiratory rate – ≥30/min
      - B – Blood Pressure <90 systolic, or <60 diastolic
      - 65 – age >65 years
      - Score of ≤2 = hospitalisation
  - - - Strongly associated with smoking
      - Chronic inflammation of bronchi & bronchioles (chronic bronchitis) / alveolar air sacs (emphysema)
    - - Frequent chest infections
      - Persistent wheeze
      - Productive cough
      - Cyanosis
      - Increasing breathlessness
      - Fatigue
    - - Barrel chest
      - Use of accessory muscles
      - Proximal muscle wasting
      - Polyphonic wheeze
    - - Peak flow
      - Spirometry
      - Pulse oximetry
      - CXR
      - ECG (check for right ventricular hypertrophy, A fib, ischaemia, etc.)
    - - Smoking
      - Occupation with exposure to smoke, dust, other irritants
    - - Long acting bronchodilator (LABA/LAMA +/- ICS)
      - Flu vaccination
      - Oxygen therapy if SaO₂ ≤88% twice in 3 weeks
  - - - Exudative (protein >3g/dL)
        
        Inflammation
        
        Lung cancer
        
        Pneumonia
        
        Rheumatoid arthritis
        
        Tuberculosis
        
        Post CABG
      - Transudative (protein <3g/dL)
        
        Congestive cardiac failure
        
        Hypoalbuminaemia
        
        Hypothroidism
        
        Meig’s syndrome
    - - SOB
      - Chest pain
      - Dry, non-productive cough
    - - Stony dull percussion over the effusion
      - Reduced breath sounds
      - Tracheal deviation away from the effusion if it is massive
      - Reduced chest expansion unilaterally (if large)
      - Displaced apex beat (if large, away from effusion)
    - - CXR
        
        Blunting of the costophrenic angle
        
        Fluid in the lung fissures
        
        Larger effusions will have a meniscus
        
        Tracheal and mediastinal deviation if it is a massive effusion
      - Pleural fluid aspiration
        
        protein count, cell count, pH, glucose, LDH and microbiology testing
    - - Treat underlying cause (in smaller effusions)
      - Pleural aspiration
      - Chest drain
    - - Infected pleural effusion
      - Suspect an empyema in a patient who has an improving pneumonia but new or ongoing fever
      - Pleural aspiration shows pus, acidic pH (pH < 7.2), low glucose and high LDH
      - Mx: chest drain to remove pus + antibiotics
  - - - Inflammation and infection of the bronchioles, usually caused by a virus
        
        Most common: Respiratory syncytial virus (RSV)
    - - Coryzal symptoms
      - Signs of respiratory distress
        
        Use of accessory muscles
        
        Head bobbing
        
        Nasal flaring
        
        Tracheal tugging
        
        Intercostal and subcostal recessions
      - Dyspnoea
      - Tachypnoea
      - Poor feeding
      - Mild fever (under 39ºC)
      - Apnoeas
    - - Signs of respiratory distress
      - Wheezing
      - Grunting
      - Stridor
    - - Basic obs
      - Nasal swab for RSV
      - Blood gases if admitted
    - - Saline nasal drops & nasal suctioning
      - Ventilation in v. severe cases
      - Oxygen (if O2 sats remain <92%)
      - Prevention
        
        Palivizumab (monoclonal antibody)
        
        Given to high risk infants
      - Hospital admission (if severe i.e. not feeding adequately)
    - - .>1 year
      - Most common in >6 months
- - - - 1) Trachea
      - 2) Right/left primary bronchus
      - 3) Lobar/secondary bronchi
      - 4) Segmental/tertiary bronchi
      - 5) Terminal bronchioles
      - 6) Respiratory bronchioles
      - 7) Alveolar ducts
      - 8) Alveolar sacs
      - (nasal cavity -> pharynx -> glottis)
    - - Left
        
        Upper lobe
        
        (separated by oblique fissure)
        
        Lower lobe
      - Right
        
        Upper lobe
        
        (separated by horizontal fissure)
        
        Along 4th rib
        
        Middle lobe
        
        (separated by oblique fissure)
        
        Lower lobe
    - - Parietal
        
        Innervation: somatic nerves (phrenic & intercostal nerves)
      - Visceral
        
        Innervation: autonomic nerves (pulmonary plexus)
      - Inferior borders of pleural cavity
        
        Mid-clavicular line - 8th rib
        
        Mid-axillary line - 10th rib
        
        Mid-scapular line - 12th rib
    - - Mid-clavicular line - 6th rib
      - Mid-axillary line - 8th rib
      - Mid-scapular line - 10th rib
  - - - Location: posterior wall of nasopharynx
    - - Location: on each side at the base of the tongue, in the oropharynx
    - - Location: lateral walls of fauces in oropharynx
  - - - C3-C6
    - - 2 main groups
        
        Longitudinal (elevators)
        
        Circular (constrictors)
      - Innervation
        
        All supplied by the vagus nerve
        
        Except the stylopharyngeus which is supplied by the glossopharyngeal nerve
    - - Innervation
        
        All supplied by inferior laryngeal nerve (branch of vagus nerve)
        
        Except the cricothyroid which is innervated by the superior laryngeal nerve
    - - Superior and inferior laryngeal arteries
    - - True
        
        Inferior portion of thyroarytenoid muscles
        
        Involved in phonation (abduct & adduct to change sound)
        
        Relatively avascular -> white in colour
      - False
        
        Superior portion of thyroarytenoid muscles
        
        Not involved in phonation
        
        More vascular -> red in colour
  - - - Nasopharynx
      - Oropharynx
      - Laryngopharynx
      - Between nasopharynx & oropharynx: Soft palate
      - Between oropharynx & laryngopharynx: Epiglottis
    - - Attaches to the hyoid bond, continuous with the trachea posteriorly
      - Ends at C6
    - - Nasopharynx: Maxillary nerve (CN V2)
      - Oropharynx: Glossopharyngeal nerve (CN IX)
      - Laryngopharynx: Vagus nerve (CN X)
    - - External carotid artery