Transcript Respiratory – Kaylea Clark

Respiratory
Kaylea Clark
4th Year medical Student
[email protected]
What to do today…
 Actually
manage to get through
everything
 Physiology of Breathing
 Pneumonia
 Eat Chocolate
 Lung Cancer
 Cystic Fibrosis
 Bronchiectasis
Medullary
Rhythmicity
Area
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Control the basic rhythm of respiration
There are inspiratory and expiratory areas
Inhalation lasts for about 2 seconds
Exhalation lasts for about 3 seconds
Nerve impulses generated in the inspiratory Area establish the basic rhythm of
breathing
The impulses propagate to:
External intercostal muscles via intercostal nerves
 Diaphragm via the phrenic nerves.
At the end of 2 seconds, the inspiratory area becomes inactive and nerve impulses
cease
With no impulses arriving, the diaphragm and external intercostal muscles relax for
about 3 seconds
Passive elastic recoil of the lungs and thoracic wall
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The neurons of the Expiratory Area remain inactive during quiet breathing
However, during forceful breathing nerve impulses from the inspiratory area
activate the expiratory area Impulses from the expiratory area cause
contraction of the internal intercostal and abdominal muscles
Respiratory Centre
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Co-ordinate the transition between inhalation and
exhalation
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Pneumotaxic area
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In the upper pons
Transmits inhibitory impulses to the inspiratory area
Help turn off the inspiratory area before the lungs
become too full
Shorten the duration of inhalation
Apneustic Area
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Transition between inhalation and exhalation
In the lower pons
Sends stimulatory impulses to the inspiratory area
Activate it and prolong inhalation
The result is a long, deep inhalation
When the pneumotaxic area is active, it overrides
signals from the apneustic area
Cystic Fibrosis
Commonest Autosomal
Recessive Condition
 Mutation in the CFTR Transmembane
conductance regulator gene
 Codes for a Cl- Channel
 Defective Cl- secretion and increased Na
absorption
 Making the Mucus Thick and Sticky
 Predisposing the lung to Infections and
Bronchiectasis
 What is Bronchiectasis?
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Inheritance
How do they present???
Neonate?
 Failure to
thrive
Children and Young Adults
 Respiratory
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Recurrent Infectiond
Pneumothorax
 GI
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– Symptoms
Pancreatic Insufficiency
 Infertillity
 Diagnosis
Test
– Via the Sweat
The MDT
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PATIENT AND FAMILY!!
Consultant
GP
CF Nurse
Dietician
Physio
Psychological Services
Social Services
School
Management
 Abx
 CREON
 DNA-ase
 Saline
Nebulisers
 Steroids
 High fat diet
 Vitamin AEDK
Bronchiectasis
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Abnormal permanently dilated
airways
Bronchial walls become
inflamed, thickened and
irreversibly damaged
he mucociliary transport
mechanism is impaired and
frequent bacterial infections
ensue
Cystic Fibrosis is the most
common cause
Splitting the Respiratory Tract
Pneumonia
 LRTI
 Changes
on X-Ray
Community
Hospital
Aspiration
Primary of
Secondary to
Disease
After 48 hours in
Hospital
Stroke, MG,
Oesophageal
Disease
Strep Pneumoniae
Enterobacteria
Staph Aureus
Volunteers to present?
Lung Cancer
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Carcinoma of the Bronchus
Cigarette Smoking
Asbestos, Iron Oxides, Radiation
Histology
Small Cell
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Large Cell
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Oat Cell
Squamous
Adenocarcinoma
Large Cell
Most important division = SCLC &
NSCLC
Pathophysiology
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Cigarette smoke contains carcinogens
Polycyclic Aromatic Hydrocarbons
Nitrosamines
Cytochrome P450 enzymes activate polycyclic
aromatic hydrocarbons and nitrosamines
Bind to DNA leading to DNA changes
Changes are mostly repaired
In chronic DNA change formation can lead to
mutations in genes such as p53
P53 – Tumour Supressor Gene
Symptoms and Signs
 What’s
the difference between a
symptom and a sign?
Symptom
Sign
Cough
Consolidation
Heamoptysis
Pleural Effusion
Dyspnoea
Clubbing
Chest Pain
Lymph Nodes
Tiredness
Anaemia
Weight loss
Cachexia
Red Flags
Persistent cough for more
than three weeks
 Pleuritic chest pain
 Dyspnoea
 Haemoptysis
 Persistent nocturnal cough
 Wheeze
 Recurrent chest infections
 Coughing up phlegm every morning for more
than three months of the year
 Unintentional weight loss
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Complications
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Local
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Metastatic
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Recurrent Laryngeal nerve Palsy
Horners Syndrome – Where is the tumour?
Brain
Bone
SCLC – Paraneoplastic – SIADH
What do we see?
Peak Flow Examination
 PEFR
– Maximum speed of exhalation
measured in 0.01 second (L/min)
 Should be over 80%
 Normal in Restrictive Disease
 Reduced in Obstructive
 Best of 3
What to do…
 Sit
up straight
 Put tip to 0
 Deep breath
 Hold horizontally – keep
fingers away
 Make a good seal
 Blow as hard and fast
 Record best of 3
Spirometry - Restrictive
 Normal
Peak flow
 Lung volume is reduced
 Fibrosing Alveolitis
 Scoliosis
Spirometry - Obstructive
 Reduced
Peak Flow
 Airways are obstructed by narrowings
 COPD
 Asthma
 CF