Patho Exam 3

Respiratory – Nasal cavity, Pharynx, Larynx, Trachea, Bronchi, Bronchiole – to

alveoli ( composed of alveolus) - where gas exchange takes place. Elastic Fibers.

1. COPD- Chronic bronchitis is defined as hyper secretion of mucus and

chronic productive cough for at least 3 months of the year (usually the winter
months) for at least 2 consecutive years.

Chronic bronchitis – History of smoking, Productive cough , cyanosis , chronic

hypoventilation , cor pulmonale.

Treatment for chronic bronchitis – Bronchodilators and expectorants are

prescribed as needed to control cough and reduce dyspnea. Chest physical therapy
may be helpful and includes deep breathing and postural drainage. During acute
exacerbations (infection and bronchospasm) , individuals require treatment with
antibiotics and steroids and may need mechanical ventilation.

2. Emphysema – COPD ( diseases in which air exchanged is impaired)

Centriacinar Emphysema- Focal enlargement and destruction of respiratory

bronchioles. (only at the earlier part of the bronchi’s) inflammation where
neutrophils make elastase= common in smokers.

Panacinar Emphysema- Destruction and enlargement of all portions of the

acinus
deficiency in alpha-1-antitrypsin- Unchecked elastase
Paraseptal Emphysema – Bronchioles are unaffected but there is an enlargement of airspaces and
destruction of the alveoli
Paracicatrical Emphysema- Association with fibrosis

Emphysema is abnormal permanent enlargement of gas-exchange airways

accompanied by destruction of alveolar walls without obvious fibrosis.
(destruction of the Alveoli, walls and elasticity) Obstruction results from changes in
lung tissues, rather than mucus production and inflammation as in chronic
bronchitis. The major mechanism of airflow limitation is loss of elastic recoil.

Emphysema - Loss of elasticity, abnormal enlargements of the airspaces and destruction

of the alveolus. Immune cells secrete protease and increase in protease results in
destruction of the elastic fibers and collagen. Resulting in permanent enlargement and
destruction of the alveoli spaces. Ultimately, Increases mucus which narrows the airways
which makes= shortness of breath( bronchitis) = Smokers or pollution

Symptoms of emphysema: 1. Dyspnea (abnormal breathing), wheezing , coughing,

history of smoking, Prolonged expiration, weight loss

Diagnosis - Barrel chest- muscle wasting, Chest X-Ray , Pulmonary function test with
a spirometry – measures how fast and much air you breathe out.

Treatment – Chronic management of emphysema begins with smoking cessation.

The pharmacologic management is titrated to the severity of the disease. Inhaled
anticholinergic agents and beta agonists should be prescribed. Inhaled
corticosteroids are indicated for severe COPD, although long term therapy with oral
steroids should be avoided.

3. alpha 1- antitrypsin- compound made in the liver – regulates the

amount of Elastin

Alpha-1 antitrypsin deficiency (AAT deficiency) is an inherited condition that raises

your risk for lung and liver disease. Alpha-1 antitrypsin (AAT) is a protein that protects
the lungs. The liver makes it. If the AAT proteins aren't the right shape, they get stuck
in the liver cells and can't reach the lungs.

Symptoms of AAT deficiency include = Shortness of breath and wheezing, Repeated

lung infections, Tiredness, Rapid heartbeat upon standing, Vision problems, Weight loss

4. Respiratory distress
5. blood transfusions

6. Asthma- It is a chronic inflammatory disorder of the bronchial mucosa that

causes hyperresponsiveness and constriction of the airways. Narrowing of
the airways is usually reversible but in some patients with chronic asthma
the inflammation may lead to irreversible airflow obstruction.

Obstructive lung disease is characterized by airway obstruction that is worse with

expiration. Asthma is one of the most common lung disorders in the United States.

Symptoms are usually intermittent , and may consist of episodic breathlessness ,

wheeze , recurrent or paroxysmal cough. This breathlessness , cough and/or
wheezing may be clearly identified by the patient as being triggered by a particular
event of factor. The patient may complain of chest tightness , and commonly there
is a strong element of anxiety in the patient.
Severe asthma presents with the flowing signs:

Tachycardia , tachypnea , wheeze , chest tightness and pain. The patient may be too
breathless to complete whole sentences. In some cases wheezing may be heard
without the aid of a stethoscope.

Immediate Care – ABCDE ,Oxygen Brochodilators , Steriods , Adrenaline for

anaphylaxis and Magnesium (causes bronchiole relaxation)

IgE aallergic response

nosocomial pneumonia

Tuberculosis - risk factors.

A client has active TB. Which of the following symptoms will he exhibit?-  Chills,
fever, night sweats, and hemoptysis
TB Spreads through - A. person to person, through airborne droplets, with coughing,
sneezing by inhaling infected, aerosolized sputum
RF: close-contact situations, alcohol and IV drug abuse, and certain diseases (for
example, diabetes, cancer, and HIV) and occupations (for example, health-care
workers).

GI –

Melena

Hematochezia

GERD

Hiatal Hernia

Paralytic ileus

Diverticulitis

Appendicitis

Hepatitis A

Hepatitis B
Hepatitis C

Cholelithiasis

GI pain

Gastric Cancer

Ulcerative Colitis

Cholecycstitis

Vomiting

Intestinal Obstruction

Crohns disease

Liver failure

Ammonia

Drug used in Liver failure.

Renal –

Cystitis

Renal Failure and causes of Prerenal,

Intrarenal,

Postrenal.

Pylonephritis

Blood results for renal failure,

Glomerulonephritis

Renal Calculi

Genito –

Endometrioisis
Cervical Cancer

Benign Prostatic Hypertrophy

Pelvic Oragn Prolapse

Pre-Menstrual Dysphoric Disorder

Polycystic Ovary Syndrome. (Listen to the recording)

Endocrine- SIADH and normal lab values,

HbA1C

Diabetes Mellitus type 1

Diabetes Mellitus type 2,

Hypothyroidism,

Cushings Syndrome,

DKA,

Hypoparathyroidsim,

Graves disease,

Addisons Disease,

Diabetes Insipidus, 

Acromegaly/Gigantism,