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Sylvia is out of breath, depend on, occur through, ventilation there…
Sylvia is out of breath
COPD
↑ RV, ↑ FRC, ↑ TLC
↓↓ FEV1, ↓ FVC
↓ FEV1/FVC ratio
Chest X-Ray findings
Flattened diaphragm
Hyperinflation
Decreased vascular markings
Chronic obstructive pulmonary disease
Refer to a group of progressive diseases that cause airflow blockage & breathing-related problems
Emphysema
structural changes of the alveoli
Chronic bronchitis
clinical changes that involve chronic coughing with mucus
COPD exacerbation/ flare-up
a worsening state of COPD that indicates the patient needs a medical interfere at the hospital
Bacteria & viruses
more severe symptoms
more wheezing than normal
more coughing
Change of the color of mucus
more fatigue
chest pain
Causes
Smoking
alpha-1 antitrypsin deficiency
Other obstructive diseases
Bronchiectasis
abnormal permanent dilatation of bronchial wall
repeated severe infections & inflammation
underlying diseases
Cystic fibrosis
Primary ciliary dyskinesia
Anatomy
Bony Thorax
sternum
Manubrium
Body
Manubriosternal joint (Sternal angle of Louis)
Important landmark
IV disc between T4 and T5
Inferior limit of superior mediastinum
Bifurcation of trachea
Arch of aorta begins and end
Thoracic duct crosses from right to left mediastinum
Xiphoid process
thoracic vertebrae
intervertebral discs
12 pairs of ribs
Classification
True ribs
1-7
False ribs
8-10
Floating ribs
11&12
Muscles of respiration
Internal intercostal muscle
Fibre direction
inferoposteriorly
Action
Depress ribs
Innermost intercostal muscle
Fibre direction
inferoposteriorly
Action
Depress ribs
Transversus thoracic
Fibre direction
Four of five slips radiating superiolaterally
External intercostal muscle
Fibre direction
inferoanteriorly
Action
Elevate ribs
Diaphragm
Thoracic Apertures:
Superior thoracic aperture
Inferior thoracic aperture
blood supply
Arteries of Thoracic Wall:
Subclavian artery
Internal thoracic artery
Anterior Intercostal artery
Posterior intercostal artery
Venous drainage of anterior thoracic wall:
anterior intercostal veins
Internal thoracic vein
brachiocephalic vein
Venous drainage of posterior thoracic wall
Posterior intercostal vv.
Left upper thorax drain into accessory hemizygous
azygous
Left lower thorax drain into hemizygous
Right hemithorax drain into azygous
Histology of Respiratory Tract
Conducting portion lined by
respiratory epithelium.
Respiratory Portion:
Bronchioles lined by
simple columnar to the cuboidal epithelium
Alveoli lined by
thin squamous epithelium.
Emphysema
Abnormal permanent enlargement of the air spaces
Imbalance between proteases and anti-proteases
Smoking
Alpha-1 anti-trypsin deficiency
Destruction of the alveolar septa
Reduced surface area for gas exchange
Hypoxia
Loss of elastic recoil of the lunge
Airflow obstruction
Site of damage
Paraseptal
Panacinar
Centriacenar
Irregular
Clinical features
Prolong expiration
Weight loss
Dyspnea
Increased AP diameter of the chest
Hypoxemia
Complications
Chronic respiratory failure
advanced stages of COPD
progressive emphysematous changes
loss of diffusion surface area
Acute exacerbation
acute worsening of respiratory symptoms in a patient with COPD
infections
viral
Rhinovirus
bacterial
Haemophilus influenzae
drugs
beta blockers
symptoms
Increased frequency and severity of cough
Worsening of dyspnea
Increased purulence of sputum
Cor pulmonale
Altered structurer impaired function of the right ventricle
pulmonary hypertension
Chronic cor pulmonale
Slow progression
diseases of the airway
COPD
Kyphoscoliosis
Bronchiectasis
Acute cor pulmonale
Sudden overload of the right ventricle
pulmonary embolism
Life-threatening condition
Management
cor pulmonale
Diuretics
thiazide dierutices
hydrochlorothiazide
chlorothalidone
loop diuretics
Furosemide
Bumetanide
Torasemide
K + sparing diuretics
spironolactone
eplerenone
vasodilators
COPD
β2 -adrenergic agonists
short acting
Albuterol
Levalbuterol
long acting
Formoterol
Salmeterol
hypokalemia
tachycardia
bronchodilator
muscarinic antagonists
Ipratropium Bromide
Pulmonary infections
Respiratory syncytial virus
Syncytial is formed by fusion of infected cells with neighbouring cells
Symptoms
Dry cough
Difficulty breathing
Fever
RSV virion
Spherical
Filaments
RSV genome
Negative sense
Single stranded RNA
10 genes encoding 11 proteins
Structural proteins
NS1
NS2
Non-structural proteins
F and G glycoproteins
SH protein
Pathogenesis
The virus replicate in the epithelial lining nasopharynx
The virus will start spreading to the lower respiratory tract
Increase in the mucus production and narrowing the airway
Coronavirus
Appearance of a crown prompting the name
Genome
Positive sense RNA
Enveloped
Largest single stranded RNA
Proteins
Non- Structural
rep 1a
rep 1b
Structural
Envelope
Membrane
Spike
lung diffusion & gas exchange
compositon of air
atmospheric air
humidified air
alveolar air
alveolar PCO2
CO2 production
alveolar PO2
O2 consumption
rate of ventilation
respiratory membrane
fluid & surfactant layer
alveolar epithelium
epithelial BM
interstitial space
capillary BM
capillary endothelium
factors
FIck's law
pressure gradient (△P)
Net diffusion = △P x A x d / T
surface area (A)
membrane thickness (T)
diffusion coefficient (d)
V/Q ratio
normal range 0.8~1.2
ventilation
perfusion
3 models
normal V/Q
V/Q = 0
shunted blood
V/Q = ⚯
dead space
depend on
occur through
ventilation there depend on
in
controlled by
controlled by
composed of
affected by
can be determined by
include variables
calculated by
has
directly proportional with
inversely proportional with
include
consist of
result in
result in
then
causing
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has an
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Leads to
Defined as
Into
As a result of
Characterized by
Due to
Causing
Classified according to
Causing
Includes
Causing
between them
include
is characterized by
leading to
give rise to
give rise to
autosome with
drain into
drain into
drains into
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includ
due to
such as
such as
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