Chapter 008resp

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Chapter 8
The Respiratory System
Copyright 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.
Normal Respiratory System
Sagittal Section of Pharynx
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Coronal Section of Larynx
Histology of Bronchi & Alveoli
Air Exchange in Lungs
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Overview of Major Lung Diseases

z z z z z
Infectious diseases Immune diseases Environmentally induced diseases Circulatory diseases Tumors
Acute Upper Respiratory Infections
Acute Inflammation of Larynx
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Pneumonia
10
Bronchopneumonia
11
Lobar Pneumonia
12
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Interstitial Pneumonia
13
Common Causes of Pneumonia

z
Bacteria

Streptococcus pneumoniae Haemophilus influenzae Staphylococcus aureus Mycobacterium tuberculosis Influenza Aspergillus flavus Candida albicans Pneumocystis jiroveci Mycoplasma pneumoniae
Copyright 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 14
Vi Viruses
Fungi

Bacteria-like organisms
Pathogenesis of Pulmonary Infections

z z
z z
Inhalation of aerosol particles Aspiration of infected secretions from upper respiratory tract Aspiration of regurgitated gastric contents Hematogenous spread
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Histologic Appearance of Bronchopneumonia
16
Complications of Pneumonia
17
Clinical Features of Pneumonia

z
z z
Systemic signs of infection: fever, chills, prostration Local signs of irritation: cough Airway obstruction: shortness of breath (dyspnea), rapid breathing (tachypnea) Inflammation & tissue destruction: expectoration of rusty sputum, hemoptysis
18
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Causes of Atypical Pneumonia

z z z
Viruses Mycoplasma pneumoniae Pneumocystis carinii
19
Pulmonary Tuberculosis
z z z
Primary infection Secondary infection Extrapulmonary dissemination
20
Ghons Complex
21
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Tuberculosis: Lymphatic Spread
22
Tuberculosis: Hematogenous Spread
23
Tuberculosis: Spread Through Airways
24
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Chronic Obstructive Pulmonary Disease (COPD)

z z z
Chronic bronchitis Bronchiectasis Emphysema
25
Bronchiectasis
26
Emphysema
27
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COPD: Emphysema (Pink Puffer)
28
COPD: Chronic Bronchitis (Blue Bloater)
29
Expiratory Air Obstruction & Air Trapping

An interactive video titled Expiratory Airway Obstruction and Air Trapping in COPD can be viewed by clicking Student Resources/Prepare for Class, Clinical or Lab/Animations. Instructors can click Instructor Resources/Prepare for Class, Clinical or Lab/Animations.
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10
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Comparison of Chronic Bronchitis & Emphysema
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Immune Diseases
z z z z
Allergic rhinitis Asthma Sarcoidosis Hypersensitivity pneumonitis
32
Asthma
z z
Extrinsic Intrinsicattacks precipitated by:

Physical factors Exercise P h l i stress Psychologic t Chemical irritants, air pollution Bronchial infection Aspirin
33
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Pathogenesis of Asthma
34
Histopathology of Asthma
35
Allergy & Asthma

An interactive video titled Allergy and Asthma can be viewed by clicking Student Resources/Prepare for Class, Clinical or Lab/Animations. Instructors can click Instructor Resources/Prepare for Class, Clinical or Lab/Animations.
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12
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Sarcoidosis
37
Hypersensitivity Pneumonitis
38
Pathogenesis: Hypersensitivity Pneumonitis
39
13
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Pneumoconioses
z
z z
Coal-workers lung disease Silicosis Asbestosis
40
Asbestosis
z z z z
Pulmonary fibrosis Pleural fibrosis, pleural plaques Lung cancer Mesothelioma
41
Asbestosis (Contd)
42
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Causes of Dyspnea
43
Disturbances of Ventilation
z z z
Suffocation Drowning Ventilatory failure

Loss of neural control Failure of respiratory muscles Chest wall diseases Airway obstruction
44
Causes of Adult Respiratory Distress Syndrome (ARDS)
45
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Pathogenesis: ARDS
46
Atelectasis
47
Neoplasms
z z
Carcinoma of the larynx Lung cancer
48
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Carcinoma of the Larynx
49
Lung Carcinoma
z
z z
Most common malignant tumor of internal organs in U.S. Most often related to cigarette smoking Rare before age of 40, but incidence rises with age Poor prognosis
50
Effects of Smoking
An interactive video titled Effects of Smoking can be viewed by clicking Student Resources/Prepare for Class, Clinical or Lab/Animations. Instructors can click Instructor Resources/Prepare for Class, Clinical or Lab/Animations.
51
17
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Histogenesis of Lung Carcinoma
52
Lung Cancer
53
Histopathology of Lung Tumors

Squamous cell carcinoma Adenocarcinoma z Large-cell undifferentiated carcinoma z Small-cell carcinoma z Tumors of mixed pattern z Carcinoid z Mesothelioma __________________________________
z z
Note: Tumors can be central (hilar) or peripheral (subpleural)
54
18
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Clinical Features of Lung Cancer

z z
z z z
Bronchial irritation Local extension into mediastinum or pleural cavity: pleural effusion Distant metastases Systemic effects of neoplasia Paraneoplastic syndromes
55
Metastatic Cancer in Lungs

z z
Most common malignant tumor of lungs May present as:

Solitary lesion Multiple lesions (cannonballs on x-ray films) Diff Diffuse i involvement l t of fl lungs
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Metastases of Lung Carcinoma
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Metastases of Lung Carcinoma (Contd)
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Pleural Diseases
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Mesothelioma
60
20

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1/27/2011

Copyright 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.

Normal Respiratory System

Copyright 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.

Sagittal Section of Pharynx

Copyright 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.

Coronal Section of Larynx

Copyright 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.

Histology of Bronchi & Alveoli

Copyright 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.

Air Exchange in Lungs

Copyright 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.

Overview of Major Lung Diseases

Copyright 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.

Acute Upper Respiratory Infections

Copyright 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.

Acute Inflammation of Larynx

Copyright 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.

Copyright 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.

Copyright 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.

Copyright 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.

Copyright 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.

Common Causes of Pneumonia

Pathogenesis of Pulmonary Infections

Copyright 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.

Histologic Appearance of Bronchopneumonia

Copyright 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.

Copyright 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.

Clinical Features of Pneumonia

Copyright 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.

Causes of Atypical Pneumonia

Viruses Mycoplasma pneumoniae Pneumocystis carinii

Copyright 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.

Primary infection Secondary infection Extrapulmonary dissemination

Copyright 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.

Copyright 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.

Tuberculosis: Lymphatic Spread

Copyright 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.

Tuberculosis: Hematogenous Spread

Copyright 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.

Tuberculosis: Spread Through Airways

Copyright 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.

Chronic Obstructive Pulmonary Disease (COPD)

Chronic bronchitis Bronchiectasis Emphysema

Copyright 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.

Copyright 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.

Copyright 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.

COPD: Emphysema (Pink Puffer)

Copyright 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.

COPD: Chronic Bronchitis (Blue Bloater)

Copyright 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.

Expiratory Air Obstruction & Air Trapping

Copyright 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.

Comparison of Chronic Bronchitis & Emphysema

Copyright 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.

Allergic rhinitis Asthma Sarcoidosis Hypersensitivity pneumonitis

Copyright 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.

Extrinsic Intrinsicattacks precipitated by:

Copyright 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.

Copyright 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.

Copyright 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.

Allergy & Asthma

Copyright 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.

Copyright 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc.