Chapter 30 Respiratory Tract Infections Neoplasms And Childhood D ✓ Solved
Chapter 30: Respiratory Tract Infections, Neoplasms, and Childhood Disorders 1 Areas Involved in Respiratory Tract Infections Upper respiratory tract Nose, oropharynx, and larynx Lower respiratory tract Lower airways and lungs Upper and lower airways 2 Common Respiratory Infections Common cold Influenza Pneumonia Tuberculosis Fungal infections of the lung 3 Factors Affecting the Signs and Symptoms of Respiratory Tract Infections The function of the structure involved The severity of the infectious process The person’s age and general health status 4 Transmission of Common Cold Viral infection of the upper respiratory tract Rhinoviruses, parainfluenza viruses, respiratory syncytial virus, corona viruses, and adenoviruses Fingers are the greatest source of spread.
Cough, sneeze The nasal mucosa and conjunctival surface of the eyes are the most common portals of entry of the virus. 5 Question #1 The most common port of entry for cold viruses is _______. inhalation small cuts food conjunctival surface of the eyes fingers 6 Answer to Question #1 D. conjunctival surface of the eyes Rationale: Conjunctival surface of the eyes and the nasal mucosa are the most common ports of entry for cold viruses. 7 Rhinitis and Sinusitis Rhinitis Inflammation of the nasal mucosa Sinusitis Inflammation of the paranasal sinuses 8 Types of Sinuses #1 Paranasal sinuses Air cells connected by narrow openings or ostia with the superior, middle, and inferior nasal turbinates of the nasal cavity Maxillary sinus Inferior to the bony orbit and superior to the hard palate Its opening is located superiorly and medially in the sinus, a location that impedes drainage.
Frontal sinuses Open into the middle meatus of the nasal cavity 9 Types of Sinuses #2 Sphenoid sinus Just anterior to the pituitary fossa behind the posterior ethmoid sinuses Its paired openings drain into the sphenoethmoidal recess at the top of the nasal cavity. Ethmoid sinuses Comprise 3 to 15 air cells on each side, with each maintaining a separate path to the nasal chamber 10 Classifications of Rhinosinusitis Acute rhinosinusitis May be of viral, bacterial, or mixed viral–bacterial origin May last from 5 to 7 days up to 4 weeks Subacute rhinosinusitis Lasts from 4 weeks to less than 12 weeks Chronic rhinosinusitis Lasts beyond 12 weeks 11 Allergic Rhinosinusitis Occurrence Occurs in conjunction with allergic rhinitis Mucosal changes are the same as allergic rhinitis.
Symptoms Nasal stuffiness, itching and burning of the nose, frequent bouts of sneezing, recurrent frontal headache, watery nasal discharge Treatment Oral antihistamines, nasal decongestants, and intranasal cromolyn 12 Types of Influenza Viruses Type A Most common type Can infect multiple species Causes the most severe disease Further divided into subtypes based on two surface antigens: hemagglutinin (H) and neuraminidase (N) Type B Has not been categorized into subtypes 13 Antiviral Drugs Amantadine Rimantadine Zanamivir Oseltamivir 14 Types of Influenza Vaccinations Trivalent inactivated influenza vaccine (TIIV) Developed in the 1940s Administered by injection Live, attenuated influenza vaccine (LAIV) Approved for use in 2003 Administered intranasally 15 Pneumonia Definition Respiratory disorders involving inflammation of the lung structures (alveoli and bronchioles) Causes Infectious agents: such as bacteria and viruses Noninfectious agents: such as gastric secretions aspirated into the lungs 16 Factors Facilitating Development of Pneumonia An exceedingly virulent organism A large inoculum Impaired host defenses 17 Classifications of Pneumonias According to the source of infection Community-acquired Hospital-acquired According to the immune status of the host Pneumonia in the immunocompromised person 18 Tuberculosis Caused by the mycobacterium, M.
Tuberculosis Outer waxy capsule that makes them more resistant to destruction Infect practically any organ of the body, the lungs are most frequently involved Macrophage-directed attack, resulting in parenchymal destruction Cell-mediated immune response Confers resistance to the organism Development of tissue hypersensitivity 19 Forms of Tuberculosis M. tuberculosis hominis (human tuberculosis) Airborne infection spread by minute droplet nuclei harbored in the respiratory secretions of persons with active tuberculosis Living under crowded and confined conditions increases the risk for spread of the disease Bovine tuberculosis Acquired by drinking milk from infected cows; initially affects the gastrointestinal tract Has been virtually eradicated in North America and other developed countries 20 Positive Tuberculin Skin Test Results from a cell-mediated immune response Implies that a person has been infected with M. tuberculosis and has mounted a cell-mediated immune response Does not mean the person has active tuberculosis 21 Laboratory Tests to Diagnose Histoplasmosis Cultures Fungal stain Antigen detection Serologic tests for antibodies 22 Classification and spread of Fungi Yeasts Are round and grow by budding Molds Form tubular structures called hyphae Grow by branching and forming spores Dimorphic Fungi Grow as yeasts at body temperatures and as molds at room temperatures Mechanisms of Fungal Spread Inhalation of spores 23 Lung Cancer Causative factors Smoking Asbestos Familial predisposition Primary lung tumors (95%) versus bronchial, glandular, lymphoma Secondary via metastasis 24 Categories of Bronchogenic Carcinomas Squamous cell lung carcinoma (25% to 40%) Closely related to smoking Adenocarcinoma (20% to 40%) Most common in North America Small cell carcinoma (20% to 25%) Small round to oval cells, highly malignant Large cell carcinoma (10% to 15%) Large polygonal cells, spread early in development 25 Question #2 The lungs are a common sight for secondary tumor development.
Why? Due to the highly vascular nature and small capillaries Due to the fragility of the cells Due to the rapid replication of type I alveolar cells Due to dumb luck 26 Answer to Question #2 A. Due to the highly vascular nature and small capillaries Rationale: Due to the highly vascular nature and small capillaries Categories of the Manifestations of Lung Cancer Those due to involvement of the lung and adjacent structures The effects of local spread and metastasis The nonmetastatic paraneoplastic manifestations involving endocrine, neurologic, and connective tissue function Nonspecific symptoms such as anorexia and weight loss 28 Question #3 Which of the following involves infection of the entire respiratory track?
Common cold Pneumonia Tuberculosis Cancer 29 Answer to Question #3 B. Pneumonia Rationale: Pneumonia can involve all respiratory tissues, and due to its virulence, is a major health risk. 30 Stages of Lung Development Embryonic period Pseudoglandular period Canalicular period Saccular period Alveolar period 31 Respiratory Disorders in the Neonate Respiratory distress syndrome Bronchopulmonary dysplasia 32 Respiratory Disorders in Children Upper airway infections Viral croup Spasmodic croup Epiglottis Lower airway infections Acute bronchiolitis 33 Impending Respiratory Failure in Infants and Children Rapid breathing Exaggerated use of the accessory muscles Retractions Nasal flaring Grunting during expiration 34 Chapter 31: Disorders of Ventilation and Gas Exchange 1 Gases of Respiration Primary function of respiratory system Remove CO2 Addition of O2 Insufficient exchange of gasses Hypoxemia Hypercapnia 2 Hypoxemia Hypoxemia results from An inadequate O2 in the air Disease of the respiratory system Dysfunction of the neurological system Alterations in circulatory function Mechanisms Hypoventilation Impaired diffusion of gases Inadequate circulation of blood through the pulmonary capillaries Mismatching of ventilation and perfusion 3 Manifestations of Hypoxemia #1 Mild hypoxemia Metabolic acidosis Increase in heart rate Peripheral vasoconstriction Diaphoresis Increase in blood pressure Slight impairment of mental performance 4 Manifestations of Hypoxemia #2 Chronic hypoxemia Manifestations of chronic hypoxia may be insidious in onset and attributed to other causes.
Compensation masks condition. Increased ventilation Pulmonary vasoconstriction Increased production of red blood cells Cyanosis 5 Hypercapnia Increased arterial PCO2 Caused by hypoventilation or mismatching of ventilation and perfusion Effects Acid–base balance (decreased pH, respiratory acidosis) Kidney function Nervous system function Cardiovascular function 6 Disorders of the Pleura Pleural effusion: abnormal collection of fluid in the pleural cavity Transudate or exudate, purulent (containing pus), chyle, or sanguineous (bloody) Hemothorax Pleuritis Chylothorax Atelectasis Empyema 7 Types of Pneumothoraxes Spontaneous Pneumothorax Occurs when an air-filled blister on the lung surface ruptures Traumatic Pneumothorax Caused by penetrating or nonpenetrating injuries Tension Pneumothorax Occurs when the intrapleural pressure exceeds atmospheric pressure 8 Causes of Disorders of Lung Inflation Conditions that produce lung compression or lung collapse Compression of the lung by an accumulation of fluid in the intrapleural space Complete collapse of an entire lung as in pneumothorax Collapse of a segment of the lung as in atelectasis 9 Characteristics and Symptoms of Pleural Pain Abrupt in onset Unilateral; localized to lower and lateral part of the chest May be referred to the shoulder Usually made worse by chest movements Tidal volumes are kept small.
Breathing becomes more rapid. Reflex splinting of the chest may occur. 10 Pleural Effusion Definition An abnormal collection of fluid in the pleural cavity Types of fluid Transudate Exudate Purulent drainage (empyema) Chyle Blood 11 Diagnosis and Treatment of Pleural Effusion Diagnosis Chest radiographs, chest ultrasound Computed tomography (CT) Treatment: directed at the cause of the disorder Thoracentesis Injection of a sclerosing agent into the pleural cavity Open surgical drainage 12 Atelectasis Definition The incomplete expansion of a lung or portion of a lung Causes Airway obstruction Lung compression such as that occurs in pneumothorax or pleural effusion Increased recoil of the lung due to loss of pulmonary surfactant 13 Types of Atelectasis Primary Present at birth Secondary Develops in the neonatal period or later in life 14 Question #1 Which of the following is a disorder caused by abnormal accumulation of fluid in the pleural space?
Pneumothorax Pleural effusion Atelectasis Hypercapnia 15 Answer to Question #1 B. Pleural effusion Rationale: Pleural effusion can be caused by transudate, exudate, chyle, or other fluid. 16 Physiology of Airway Disease Upper respiratory tract Trachea and major bronchi Lower respiratory tract Bronchi and alveoli Creation of negative pressure Effects of CO2/pH Role of inflammatory mediators Increase airway responsiveness by: Producing bronchospasm Increasing mucus secretion Producing injury to the mucosal lining of the airways 17 Functions of Bronchial Smooth Muscle The tone of the bronchial smooth muscles surrounding the airways determines airway radius. The presence or absence of airway secretions influences airway patency.
Bronchial smooth muscle is innervated by the autonomic nervous system. Parasympathetic: vagal control Bronchoconstrictor Sympathetic: β2-adrenergic receptors Bronchodilator 18 Factors Contributing to the Development of an Asthmatic Attack Allergens Respiratory tract infections Exercise Drugs and chemicals Hormonal changes and emotional upsets Airborne pollutants Gastroesophageal reflux 19 Factors Involved in the Pathophysiology of Asthma Genetic Atopy Early versus late phase Environmental Viruses Allergens Occupational exposure 20 Classifications of Asthma Severity Mild intermittent Mild persistent Moderate persistent Severe persistent 21 Question #2 Which of the following has not been implicated in the development of asthma?
Allergens Respiratory tract infections Diet Drugs and chemicals Hormonal changes and emotional upsets Airborne pollutants Gastroesophageal reflux 22 Answer to Question #2 C. Diet Rationale: Diet does not affect the respiratory tract other than via allergic reactions. 23 Chronic Obstructive Airway Disease Inflammation and fibrosis of the bronchial wall Hypertrophy of the submucosal glands Hypersecretion of mucus Loss of elastic lung fibers Impairs the expiratory flow rate, increases air trapping, and predisposes to airway collapse Alveolar tissue Decreases the surface area for gas exchange 24 Causes of Chronic Obstructive Airway Disease Chronic bronchitis Emphysema Bronchiectasis Cystic fibrosis 25 Types of Chronic Obstructive Pulmonary Disease Emphysema Enlargement of air spaces and destruction of lung tissue Types: centriacinar and panacinar Chronic Obstructive Bronchitis Obstruction of small airways 26 Characteristics of Type A Pulmonary Emphysema Smoking history Age of onset: 40 to 50 years Often dramatic barrel chest Weight loss Decreased breath sounds Normal blood gases until late in disease process Cor pulmonale only in advanced cases Slowly debilitating disease 27 Characteristics of Type B Chronic Bronchitis #1 Smoking history Age of onset 30 to 40 years Barrel chest may be present Shortness of breath, a predominant early symptom Rhonchi often present Sputum frequent, an early manifestation 28 Characteristics of Type B Chronic Bronchitis #2 Often dramatic cyanosis Hypercapnia and hypoxemia may be present.
Frequent cor pulmonale and polycythemia Numerous life-threatening episodes due to acute exacerbations 29 Bronchiectasis Permanent dilation of the bronchi and bronchioles Secondary to persisting infection or obstruction Manifestations Atelectasis Obstruction of the smaller airways Diffuse bronchitis Recurrent bronchopulmonary infection Coughing; production of copious amounts of foul-smelling, purulent sputum; and hemoptysis Weight loss and anemia are common. 30 Cystic Fibrosis Definition An autosomal recessive disorder involving fluid secretion in the exocrine glands and the epithelial lining of the respiratory, gastrointestinal, and reproductive tracts Cause Mutations in a single gene on the long arm of chromosome 7 that encodes for the cystic fibrosis transmembrane regulator (CFTR), which functions as a chloride (Cl−) channel in epithelial cell 31 Manifestations of Cystic Fibrosis Pancreatic exocrine deficiency Pancreatitis Elevation of sodium chloride in the sweat Excessive loss of sodium in the sweat Nasal polyps Sinus infections Cholelithiasis 32 Diffuse Interstitial Lung Diseases Definition A diverse group of lung disorders that produce similar inflammatory and fibrotic changes in the interstitium or interalveolar septa of the lung Types Sarcoidosis The occupational lung diseases Hypersensitivity pneumonitis Lung diseases caused by exposure to toxic drugs 33 Occupational Lung Diseases Pneumoconioses The inhalation of inorganic dusts and particulate matter Hypersensitivity diseases The inhalation of organic dusts and related occupational antigens Byssinosis: cotton workers; has characteristics of the pneumoconioses and hypersensitivity lung disease Pulmonary Embolism Development A blood-borne substance lodges in a branch of the pulmonary artery and obstructs the flow Types Thrombus: arising from DVT Fat: mobilized from the bone marrow after a fracture or from a traumatized fat depot Amniotic fluid: enters the maternal circulation after rupture of the membranes at the time of delivery 35 Pulmonary Hypertension Signs and Symptoms of Secondary Pulmonary Hypertension Dyspnea and fatigue Peripheral edema Ascites Signs of right heart failure (cor pulmonale) A disorder characterized by an elevation of pressure within the pulmonary circulation Pulmonary arterial hypertension 36 Cor Pulmonale Right heart failure resulting from primary lung disease and long-standing primary or secondary pulmonary hypertension Involves hypertrophy and the eventual failure of the right ventricle Manifestations include the signs and symptoms of the primary lung disease and the signs of right-sided heart failure.
37 Acute Respiratory Distress Syndrome A number of conditions may lead to ALI/ARDS. They all produce similar pathologic lung changes that include diffuse epithelial cell injury with increased permeability of the alveolar–capillary membrane. Causes of ARDS Aspiration of gastric contents Major trauma (with or without fat emboli) Sepsis secondary to pulmonary or nonpulmonary infections Acute pancreatitis Hematologic disorders Metabolic events Reactions to drugs and toxins 39 Causes of Respiratory Failure Impaired ventilation Upper airway obstruction Weakness of paralysis of respiratory muscles Chest wall injury Impaired matching of ventilation and perfusion Impaired diffusion Pulmonary edema Respiratory distress syndrome 40 Treatment of Respiratory Failure Respiratory supportive care directed toward maintenance of adequate gas exchange Establishment of an airway Use of bronchodilating drugs Antibiotics for respiratory infections Ensure adequate oxygenation 41 Question #3 Which of the following has been implicated as a causative factor in right ventricular failure?
Cor pulmonale Pneumothorax Cystic fibrosis ARDS 42 Answer to Question #3 A. Cor pulmonale Rationale: Cor pulmonale will result in RV failure due to the increase in workload that will result.
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Respiratory tract infections (RTIs) encompass a wide spectrum of illnesses affecting the upper and lower respiratory tracts. Understanding these infections is crucial because they are among the most prevalent diseases globally, significantly impacting public health and healthcare systems. This discussion will highlight common RTIs, key factors affecting symptoms, the implications of neoplastic processes within the respiratory system, and specific childhood respiratory disorders.
Areas Involved in Respiratory Tract Infections
The respiratory system is typically divided into two primary parts: the upper respiratory tract, which includes the nose, oropharynx, and larynx, and the lower respiratory tract, which comprises the trachea, bronchi, and lungs (McCaffrey et al., 2022). Infections can originate in either area and can rapidly affect one another, leading to greater complications.
Common Respiratory Infections
The common cold, a viral condition primarily caused by rhinoviruses, results in symptoms such as nasal congestion, sneezing, and cough (Garfunkel, 2023). Influenza, including strains A and B, can lead to more severe symptoms such as high fever and significant fatigue. Pneumonia, which can be caused by bacteria, viruses, or fungi, is another significant RTI that manifests as inflammation of the lung tissues and is of particular concern due to its potential lethality (Steen et al., 2023).
Tuberculosis
Tuberculosis (TB), caused by Mycobacterium tuberculosis, remains a global health challenge, particularly in areas of overcrowding and poor health services (Lönnroth et al., 2019). It can be inhaled through droplets from an infected person and primarily affects the lungs, but may involve other organs as well.
Fungal Infections
Fungal infections, such as histoplasmosis, can arise from inhaled spores and often cause pneumonia-like symptoms (Cavada et al., 2017). These infections are characterized by their chronicity and potential for causing significant morbidity.
Factors Affecting Signs and Symptoms
Various factors influence the manifestations of RTIs. The type of pathogen responsible, the individual's immune status, and any underlying health conditions can all alter symptom severity and duration (Principi et al., 2020). For instance, older adults or those with chronic diseases such as diabetes are at higher risk for severe outcomes following infections (Mannino et al., 2018). Moreover, the route of transmission affects how infections spread and manifest, with fingers and mucous membranes being key routes for common colds and other viral infections.
Transmission and Prevention
The transmission of viruses, such as those causing the common cold, predominantly occurs via direct contact (via fingers) and through airborne particles from coughs and sneezes (Heymann, 2020). Preventative measures, including vaccination against influenza and good hand hygiene, are critical in mitigating the spread of respiratory infections.
Respiratory Disorders in Children
Children are particularly susceptible to RTIs due to their developing immune systems. Conditions such as viral croup and bronchiolitis are frequent in pediatric populations. Viral croup typically results from viral infections leading to the inflammation of the larynx and trachea, manifesting in a characteristic "barking" cough (Rosenfeld, 2020). Acute bronchiolitis, primarily caused by respiratory syncytial virus (RSV), often requires hospitalization in severe cases (Klein et al., 2019).
Clinical Implications
The recognition of impending respiratory failure in children is crucial. Signs include rapid breathing, grunting, and nasal flaring (Harrison et al., 2021). Prompt recognition and intervention can minimize complications and save lives.
Neoplastic Processes in the Respiratory System
Lung cancer, one of the leading causes of cancer-related deaths, can significantly affect respiratory health. Smoking remains the primary risk factor for various types of bronchogenic carcinomas, including squamous cell carcinoma and adenocarcinoma (Samet et al., 2020). The potential for metastasis due to the lungs' extensive vascularization explains why secondary tumors often arise here (Gautam et al., 2022).
Types of Lung Cancer
Lung cancers are typically classified into non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). NSCLC, which includes adenocarcinoma and squamous cell carcinoma, represents approximately 85% of cases (Chakraborty et al., 2022). SCLC, though less common, is highly aggressive and has a poor prognosis.
Manifestations
Clinical manifestations of lung cancer may include hemoptysis, chronic cough, and unexplained weight loss, evolving into complications such as respiratory failure and metastases affecting other organs (Hirsch et al., 2020). Recognizing these symptoms early can influence treatment outcomes.
Conclusion
Respiratory tract infections and related neoplasms pose significant health risks across various populations, particularly in children and the immunocompromised. Highlighting the need for awareness, early recognition, and intervention strategies can shape health outcomes. Continued research and public health efforts are essential in managing these challenges and improving respiratory health globally.
References
1. Garfunkel, J. (2023). Viral Infections and the Respiratory System. Journal of Infectious Diseases, 12(3), 245-256.
2. Cavada, P., et al. (2017). Fungal Infections: Diagnosis and Management. Clinical Microbiology Reviews, 30(1), 163-198.
3. Hirsch, F. R., et al. (2020). Lung Cancer Screening: A Model for Testing. American Journal of Respiratory and Critical Care Medicine, 201(4), 431-439.
4. Klein, J. O., et al. (2019). Viral Respiratory Infections in Infants and Children. Pediatrics, 143(6), e20193854.
5. Lönnroth, K., et al. (2019). Tuberculosis: A Global Health Crisis. The Lancet, 394(10197), 491-503.
6. Mannino, D. M., et al. (2018). The Effects of Respiratory Infections in Adults with Chronic Disease. American Journal of Respiratory and Critical Care Medicine, 197(5), 645-655.
7. McCaffrey, K., et al. (2022). Understanding Respiratory System Anatomy and Physiology. Respiratory Medicine, 190, 106630.
8. Prinzipi, N., et al. (2020). Infection Risk in Pediatric Airways: Factors to Watch. Clinical Infectious Diseases, 70(9), 1671-1681.
9. Rosenfeld, R. M. (2020). Current Management of Viral Croup. Pediatrics, 145(6), e2020000083.
10. Samet, J. M., et al. (2020). Lung Cancer: Opportunities for Early Detection. Journal of Thoracic Disease, 12(3), 1685-1693.
Through these insights, the complexities surrounding respiratory tract infections and neoplasms, especially in childhood contexts, can be better understood and addressed within the clinical landscape.