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Chapter 23 Notes Essay

1932 words - 8 pages

Chapter 2
Restrictive Resp. Disorders
* Resulting from basically a collapsed lung - Alterations in lung parenchyma, pleura, chest wall, or neuromuscular function
* Decrease in vital capacity (VC), lung capacity (TLC), functional residual capacity (FRC), residual volume (RV)
* The greater the decrease in lung volume, greater the severity of disease

Fibrotic Interstitial Lung Disease
* Immune reaction
* Begins with injury to alveolar epithelial or capillary endothelial cells
* Interstitial and alveolar wall thickening
* Increased collagen bundles in interstitium
* lung tissue becomes infiltrated
* Persistent alveolitis leads to obliteration of alveolar ...view middle of the document...

5/100,000)
* Northern European whites (10.9:100,000)
* Acute or chronic systemic disease of unknown cause
* Immunologic
* Activation of alveolar macrophage to unknown trigger

Sarcoidosis
* Affects multiple organs
* Lymph nodes, lung tissue (most common)
* Skin, eyes, spleen, liver, kidney, bone marrow
* Fibrotic and surrounded by large histiocytes
* May occur in bronchial airways
* Abnormal T-cell function
* Malaise, fatigue
* Weight loss
* Fever
* Dyspnea of insidious onset
* Dry, nonproductive cough
* Erythema nodosum
* Macules, papules, hyperpigmentation, and subcutaneous nodules
* Hepatosplenomegaly, lymphadenopathy
* Leukopenia, anemia
* Increased eosinophil count, elevated sedimentation rate
* Increased Ca++ levels (5%)
* Elevated liver enzymes
* Anergy (70%)
* Elevated angiotensin-converting enzyme in active disease (40%-80%)
* Gallium-67 scan
* Localize areas of granulomatous infiltrates
* Pleural effusion noted in 10% of cases
* PFTs
* Normal or show evidence of restrictive disease and/or obstructive disease
* Bronchoalveolar lavage
* Monitors cell content
* Fluid has increased lymphocytes and high CD4/CD8 cell ratio
* Transbronchial lung biopsy
* Noncaseating granulomas (definitive diagnosis)
* Chest x-ray
* Differentiates stages
* Stages
* Stage 0
* Normal
* Stage 1
* Good prognosis
* Hilar adenopathy alone
* Stage 2
* Hilar adenopathy and bilateral pulmonary infiltrates
* Stage 3
* Pulmonary infiltrates without adenopathy
* Stage 4
* Advanced fibrosis with evidence of honeycombing, hilar retraction, bullae, cysts, and emphysema
* Corticosteroids
* Immunosuppressive agents

Hypersensitivity Pneumonitis
* Known as extrinsic allergic alveolitis
* Restrictive and occupational disease
* Predominant in nonsmokers (80%-95%)
* Genetic predisposition
* Agent suggested by patient history
* Agent confirmed by precipitating antibodies in serum
* Antigen combines with serum antibody in alveolar walls; leads to type III hypersensitivity reaction
* Antigen-antibody complexes then elicit granulomatous inflammation leading to lung tissue injury
* Must have delayed hypersensitivity (type IV) reaction to antigen to develop pneumonitis
* Acute
* Symptoms start 4-6 hr after exposure and resolve in 18-24 hr
* General symptoms
* Chills, sweating, shivering
* Myalgias
* Nausea
* Malaise, lethargy
* Headache
* Chest x-ray
* Acute/subacute
* Transient, bilateral pulmonary infiltrates
* Increased bronchial markings with alveolar nodular infiltrates
* Chronic
* Diffuse reticulonodular infiltrates
* Fibrosis
* Skin testing with causative antigen
* Red, indurated hemorrhagic...

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