Title -An illustration depicting the heart & lungs.
Author -Bruce Blaus
Source -Own work
This note is for nursing students , Medical students All can read it , Pathology -1
So best of luck
What is Respiratory system?
Many organs Are involved in Respiratory system such as lungs , bronchi , trachia which help in taking breathing inside the body and removing carbon dioxide to outside of the body .
The diseases of Respiratory system are
1-Pulmonary infections
2-Pneumonia
3-Lung Abscess
4-Pulmonary tuberculosis
5-Chronic Obstructive lung disease
6-.Bronchial Asthma
7- Bronchiectasis
8-Tumors of Lungs
All diseases with pathological changes will discuss one by one .
RESPIRATORY SYSTEM
The respiratory system is a group of organs that help in breathing. It supplies oxygen to the body and removes carbon dioxide.
THE RESPIRATORY TRACT IN HUMAN IS MADE UP OF THE
FOLLOWING PARTS
1-External nostrils- For the intake of air to the lungs
2-Nasal chamber-It is lined with hair and mucus which trap dust and dirt from air .
3 -Pharynx It is present behind the nasal chamber and it is common passageway for both air and foods .
4- Larynx -Produces sound: It contains the vocal cords, which vibrate to create your voice.
5-Epiglottis– The epiglottis is a small, leaf-shaped flap of cartilage in the throat.
It covers the opening of the larynx during swallowing.
This prevents food and liquid from entering the airway and lungs.
6-Trachea- The trachea is a tube-like structure, also called the windpipe.
Its main function is to carry air to and from the lungs and keep the airway open.
7- Bronchi-The bronchi are two main air passages that branch from the trachea into each lung.
They carry air from the trachea into the lungs.
Inside the lungs, they further divide into smaller tubes called bronchioles.
8-Bronchioles- Bronchioles are very small air tubes inside the lungs.
They branch from the bronchi and carry air deeper into the lungs.
They end in tiny air sacs called alveoli, where gas exchange occurs.
9-Alveoli-Alveoli are tiny air sacs present in the lungs.
They are the place where oxygen and carbon dioxide are exchanged between air and blood.
Their thin walls help in easy and efficient gas exchange.
10-Lungs – The lungs are a pair of soft, spongy organs in the chest.
They help in breathing by taking in oxygen and removing carbon dioxide.
They contain tiny air sacs (alveoli) where gas exchange takes place.
RESPIRATORY SYSTEM FUNCTION
1-INHALATION AND EXHALATION–
1-Inhalation ( inhalation means when a person breath in)
Intercostal muscle and diaphragm work together during inhalation.
when the diaphragm contracts and moves downward, and the chest expands. This allows Air and oxygen enter into the lungs.
intercostal muscles also lift the ribs upward. The chest expands, Air and oxygen enter the lungs .
2-EXCHANGE OF GASES BETWEEN LUNGS AND BLOOD STREM
The Respiratory system help in exchange of gases bettewen lungs and blood stream. Such as alveoli.
3-The vibration of the vocal cord .
For voice production vibration of vocal cord is necessary
4– Regulation of blood pH – means maintaining acidity and alkalinity in blood , the normal blood pH is 7.35 to 7.45 . In Respiration blood pH maintain normal by controlling carbon dioxide.
5- Smelling Or Olfaction-
Olfaction means the sense of smell , it means smell different odours .
Example -Smelling flowers
WHAT IS PULMONARY INFECTION ❔
Lung infections also known as Pulmonary infections
Lung disease falls into three primary catagory.
1-Airway diseases-
Airway Diseases
Airway diseases are conditions in which the airways become narrowed, blocked, or inflamed, making breathing difficult. Examples:
1-Asthma
Airways become inflamed and narrow → causes wheezing and breathlessness
2-Chronic obstructive pulmonary disease
Long-term blockage of airways, usually due to smoking
3-Bronchitis means Inflammation of bronchi → causes cough with mucus
2-Lung tissue diseases-
What is Lung Tissue Disease❔
Lung tissue diseases are conditions that affect the lung tissue (alveoli and interstitium) rather than the airways.
These diseases damage the air sacs (alveoli) or lung tissue, so the lungs cannot exchange oxygen properly.
Examples: Pneumonia – infection fills alveoli with fluid or pus Tuberculosis – bacterial infection damaging lung tissue Pulmonary fibrosis– lung tissue becomes thick and stiff
3-Lung circulation diseases-
Lung circulation diseases are conditions that affect the blood vessels of the lungs, interfering with normal blood flow and gas exchange.
These diseases reduce or block the flow of blood in the lungs, so oxygen cannot reach the body properly. Examples:
1-Pulmonary embolism
A blood clot blocks blood flow in the lungs
2-Pulmonary hypertension
Increased pressure in lung blood vessels
Common features:
1-Shortness of breath
2-Chest pain
3-Fast heartbeat
4-Low oxygen levels
COMMON TYPES OF PULMONARY INFECTION
1-Empyema
2-Lung abscess
3-Tuberculosis
4- Chronic obstructive pulmonary disease
5-Cystic fibrosis
5- Asthma
CAUSES OF PULMONARY INFECTION
1-Pneumonia
2-COPD
3-Cystic fibrosis
SYMPTOMS OF INFECTION
Tightness in the chest
Body ache(( Myalgia)
Wheezing
Fatigue
Difficulty breathing
A crackling sound hear at the base of the lungs
DIAGNOSIS OF PULMONARY INFECTION
A throat swab
A blood culture
Imaging scans -Such as chest x-ray or CT scan
Spirometry-a device that measures air intake
Pulse oximetry -Which check blood oxygen level
TREATMENT OF PULMONARY INFECTION
Depending on etiology and symptoms different treatment for each pulmonary infection.
Antibiotic necessary for bacterial lung infections
Changes in lifestyle
Surgery may be necessary for chronic conditions like COPD
Next coming Pulmonary tuberculosis, pathogenesis, Histology and gross appearance.
For nursing students with pathogenesis and Gross appearance and Histology
Lung abscess is a pus filled cavity in the lungs due to infection and destruction of lung tissue.
CLINICAL FEATURES OF LUNG ABSCESS
1-Pleuritis
2-Empyema
3-Hemorrhage
4-Sepsis
5-Meningitis
6-Secondary amyloidosis
ETIOLOGY
1-Aspiration of infective material in to lungs may due to various types of disease condition like coma and epilepsy
2-.if patient had suffering previously pneumonia or any bacterial infection there is also chanse of destruction of lung tissue.and formation of lung abscess.
3-If patient suffering Recurrent tubercular infection there is also lung tissue destruction and formation of lung abscess occurs.
4- Septic embolism – Infected clot travel through blood stream by blood and bacteria spread to lung tissue so lung abscess occurs.
5-As a complication of malignancies where the tumor obstructs the air way leading growth of bacteria and infection,this infection spread to lung tissue and lungs abscess occurs.
Name of the Pathogenic organisms involved are
Anaerobic bacteria (most common)
Bacteroides
Peptostreptococcus
Fusobacterium Aerobic bacteria
Staphylococcus aureus
Streptococcus pneumoniae
Klebsiella pneumoniae
Pseudomonas aeruginosa
Escherichia coli (E. coli)
Others
Fungi
Mycobacterium tuberculosis may rarely cause abscess formation.
RISK FACTORS
1-Alcoholism
2-Seizure disorder
3-Neuromuscular disorder
4-Drug Overdose
5-General anaesthesia
6-Stroke
7-Immunocompromised patient
8- ICU patient
PATHOGENESIS
Due to Etiology may be tumor, pneumonia or aspiration
⬇️
Bacteria enter and grow in lung tissue.
⬇️
Develop infection and inflammation
⬇️
Pus formation occur
⬇️
A cavity filled with pus develops
⬇️
Forms lung abscess
COMPLICATION OF LUNG ABSCESS
1-Chronic abscess
2-Empyema
3-Bleeding
4- Bronchopleural fistula
Pathological changes
Gross appearance
Abscess vary in size ranging from a few mm to 6cm may be single and multiple.
HISTOLOGICAL CHANGES
Destruction of the alveolar space
DIAGNOSIS
Physical examination
Dullness to percussion
Decreased breath sound on Auscultation over the segment of lung involved
Pulmonary tuberculosis is an infectious disease that affects the lung tissue.
The Mycobacterium tuberculosis is the name of bacteria which is the main cause of pulmonary tuberculosis Disease
CLINICAL FEATURES OF PULMONARY TUBERCULOSIS
Pulmonary tuberculosis
1-Shortness of breath
2-Hemoptysis ( Blood in sputum)
3-Chronic cough with more sputum production
4-Loss of appetite
5-Weight loss
6-The patient has a mild fever in the evening or at night
7 -Fatigue
ETIOLOGY OF PULMONARY TUBERCULOSIS
1-Mycobacterium tuberculosis – ( This bacterium causes mainly tuberculosis in humans.)
2-Mycobacterium bovis – ( Due to this bacteria tuberculosis occurs in cows)
3-, Mycobacterium avium intracellularedue .-( Pulmonary tuberculosis occur in immunocompromised patient for weak immune system.
Mycobacterium tuberculosis is an aerobic bacterium. means Mycobacterium tuberculosis bacteria need oxygen to grow which is why it commonly affects the lungs
MODE OF TRANSMISSION OF PULMONARY TUBERCULOSIS.
1-INHALATION -when a person infected by Mycobacterium tuberculosis and when he or she sneezes or coughs, tiny droplets come out from the body that contain Mycobacterium tuberculosis.
When these droplets containing Mycobacterium tuberculosis from an infected person are inhaled by a healthy person’s lungs and cause infection.
2 -INGESTION –
Ingestion means eating or drinking by mouth
Any healthy person who ingests unpasteurized milk which contains Mycobacterium bavis that causes tuberculosis in humans.
and if also ingestion of infected sputum which contains Mycobacterium tuberculosis that causes tuberculosis infection in healthy women.
3 -TRANSPLACENTAL
( means through the placenta)
When a fetus is inside the womb he takes oxygen and nutrition through the placenta, if in pregnancy when the fetus is in the womb of the mother and the mother is affected by Pulmonary tuberculosis caused by Mycobacterium tuberculosis bacteria.
and this bacteria pass through the placenta and enters the blood circulation of the fetus. Then the fetus will also be affected by
Tuberculosis. This is called congenital TB (congenital means during pregnancy in the womb)
4-INOCULATION (INTO THE SKIN)
Mycobacterium tuberculosis enters through the broken skin, which is called inoculation into the skin It is rarely seen.
RISK FACTORS OF PULMONARY TUBERCULOSIS
1-Lower socioeconomic group
2-Poor hygiene
3-Immunosuppressed Individual
Normally when other bacteria enter our body our defense cells, macrophages first engulf those bacteria
After engulfing the bacteria is in a sac called a phagosome.
This phagosome joins with the lysosomes of the macrophages.
This is called phagolysosome, and due to this the digestive enzymes from lysosomes are released over the bacteria, and bacteria die ( Normally this occurs but in Mycobacterium tuberculosis phagolysosome does not occur and TB bacteria do not dye easily.
When Mycobacterium tuberculosis enters our body, macrophages engulf that microorganisms and engulf it and try to destroy but can’t destroy for their cell wall .( Their cell wall contain mycolic acid and glycolipid which protects Mycobacterium tuberculosis)this Mycobacterium tuberculosis stays inside the macrophages.and don’t dye
When our immune cells Macrophages, are unable to destroy Mycobacterium tuberculosis then our body starts type IV hepersensitivity reactions .
These infected macrophages breaks the small parts of Mycobacterium which is called antigen, and this small break parts ( antigen pieces ) attaches on MHC class 1 molecule on the surface of the macrophages so that Helper T cell can recognise and destroy it .
And infected macrophages also release cytokines which is protein called interleukins 12 .
This Interleukins 12 activate CD4 or T helper cell
Then T helper cell release two cytokines one is Interferon- gamma and other one is Tumor necrosis factor -alpha.
Interferon–gamma promotes the formation of a phagolysosome. So that lysosomes break down and digestive enzymes which is acid will come into contact with bacteria.
And this acidic environment is unfavorable for their existence.
Interferon gamma also produces nitric acid which has bactericidal action.
These two cytokines inform to other immune cells so other immune cell come and surround the bacteria ( Mycobacterium tuberculosis )so hat it will not infectious to other parts of body . This is called granuloma.
And also When a T helper cell is activated
Activated Macrophage change their shape and become Epithelioid cells.
These epitheloid cell Gather together at one place.
Around them more immune cell Colect
This forms a small wall-like structure called granuLoma
Granulomas form by Macrophages and other immune cell .
When infected person immune system is strong then the Mycobacterium tuberculosis bacteria will be inactive in that immune cell surrounding trap but if that patients immune system is not strong then the granuloma will break down and patient will be infected by Pulmonary tuberculosis.
TYPES OF TUBERCULOSIS
1-Primary tuberculosis
If any person who has no history of previous tuberculosis infection The person is affected for first time that is called primary tuberculosis.
In primary tuberculosis, the first lung lesion is usually single (Solitary) is called Ghon focus .
Commonly occurs in the lower part of the upper lobe.
anf the upper part of the lower lobe
2-Secondary tuberculosis
Secondary tuberculosis is tuberculosis that occurs due to reactivation of old dormant TB infection or reinfection in a person who was previously exposed to TB bacteria.
Secondary tuberculosis is also called post-primary pulmonary tuberculosis.
It occurs due to reactivation of old dormant TB infection present in the body.
The TB bacteria remain hidden in previously healed lesions (old foci).
When immunity becomes weak, the dormant bacteria become active again.
The bacteria spread through the blood (hematogenous spread) to the lungs.
They commonly affect the upper lobes of the lungs.
The upper lobes have higher oxygen levels, which help TB bacteria survive and multiply better.
This causes more severe and damaging lung lesions compared to primary TB.
MILIARY TUBERCULOSIS
When tuberculosis spreads from its original site to other organs by blood and lymph it is called Miliary tuberculosis.
In this type of tuberculosis, the TB lesion is seen as a small round seed like a millet seeds so it is called Miliary tuberculosis.
( Outcomes of primary tuberculosis)
1-Healing by fibrosis ( means healing of damage tissue by forming fibronous scar )
2-Calcification rarely Ossification (. TB lesion heals by forming scar tissue with calcium deposition and rarely bone formation.)
3-Persisting primary infection with an enlarging primary focus spreads to other lungs
4-Secondary tuberculosis
5- Miliary tuberculosis
(Outcomes of secondary tuberculosis)
1-Healing by scarring and calcification
2-Tubercular pneumonia
PATHOGENESIS OF PRIMARY TUBERCULOSIS
Inhalation of infected droplets containing Mycobacterium tuberculosis.
⬇️
Engulfment of bacteria by macrophages present in the alveoli
⬇️
Macrophages unable to kill Mycobacterium tuberculosis due to its cell wall.
⬇️
Persistence of Mycobacterium tuberculosis bacteria within the macrophages.
⬇️
Macrophage break down small pieces of bacteria and attach on her surface
⬇️
Macrophage release cytokine Interleukins 12
⬇️
Due to Interleukins 12 Helper T cell activated
Helper T cell release two cytokines one is Interferon gamma and another one is Tumor necrosis alpha
Communicate with other immune cell and form Granuloma .
Mycobacterium tuberculosis trapped in between granuloma immune cell .
If patients immune system is strong it is inactivate.
If patients immune system is weak then break granuloma and mycobacterium tuberculosis spread to other parts
Pulmonary tuberculosis infection occur.
PATHOGENESIS OF SECONDARY TUBERCULOSIS
Bacteria stay hidden in body will again reactivate due to weak immune system.
⬇️
Formation of Ghon complex ( Tuberculosis infection in the lungs along with infection in nearby lymph nodes)
⬇️
Protective layer of immune cell enclose the Mycobacterium tuberculosis breakdown due to weak immune system.
⬇️
Release of Mycobacterium tuberculosis and spread to outside of the granuloma
⬇️
Mycobacterium tuberculosis get activated and multiply
⬇️
Symptoms starts ( like chest pain , weight loss ,cough)
⬇️
Transmission by droplets and transmission by blood and lymph nodes from lungs to other organs of the body is called extra pulmonary spreads.
DIAGNOSIS OF PULMONARY TUBERCULOSIS
1-Mantoux test
2-Sputum for AFB
3-Sputum culture
4- Hemogram
5-Chest xray
6- FNAC
7- Gene X pert test
8-Drug sensitivity testing
9- CBNAAT
10- Rifampsin resistance detected
11-Line probe easy
PREVENTION OF PULMONARY TUBERCULOSIS
1- Early diagnosis and treatment –
Due to early diagnosis by sputum test after getting positive results start immidiately treatment to recover soon and prevent complication.
2-BCG vaccination-
Two scientists devlop BCG vaccine Albert calmette and Camille Guerin According these scientists Vaccine name devloped BCG ( full form OF BCG if Bacillus calmate Guerin)
In this vaccination live weak bacillus used . BCG vaccine should given at birth as early as possible.
3-Cover mouth and nose while coughing and sneezing.( Advice patient to cover mouth when talking and sneezing because it is droplet infection.and nurse should use mask ,gives ,gown during caring the patient to protect herself.
4-Use of Mask -Nurse should use mask when caring of the tuberculosis patient to protect herself.
5-Balanced nutrition – Balance nutrition necessary to recover from Pulmonary tuberculosis but High rich protein diet is necessary to recover soon.
6-Maintain personal hygiene -If we maintain personal hygiene then Pulmonary tuberculosis can be prevented example .Regular hand washing can reduce jerm from hand
Health education
8-Regular screening of close contact
TREATMENT OF PULMONARY TUBERCULOSIS
1- Rifampicin
2-Isoniazid
3- Ethambutal
4- Pyrazinamide
5-High rich protein diet such as egg , milk , paneer, soya chunks , chicken,fish ,meat ,Rajma ,chana , Dal , Almond
NURSING MANAGEMENT OF PULMONARY TUBERCULOSIS
1-check vital sign such as temperature,pulse , Respiration regularly to find out any abnormality.
2-Use mask and Gown at the time giving medicine to the patient.
3-Mode of transmission of Pulmonary tuberculosis is by inhalation so teach me patient to cover mouth and nose while coughing and sneezing.
4-Give antitubercular drug Such as Rifampsin, Isoniazid, Ethambutal, Pyrazinamide, according to Doctors order and doses.
7-Give information regarding antitubercular drugs effect in body such as during taking Rifampsin medicine patient pass red or orange colour urine which is normal.
8-Observ for any side effects of medicine.
9-Advice to take High rich protein diet to take so that patients will recover faster .
10-Advice patient to take antitubercular drug regularly ,not to miss or forgot the medicine.if the patient will forgot the medicine then the tubercular microorganisms ( Mycobacterium tuberculosis) Will resist and may be patient have to take medicine longer time , means duration of medicine will be increased due this small mistake,so please don’t forget to take antitubercular drugs regularly.
11- Advice to Avoid alcohol and smoking
11-Advice to take adequate rest and sleep is necessary.
14-Isolate the patient to prevent spread of infection to other patient.
Pulmonary Tuberculosis – Important MCQs
For AIIMS, NORCET, RRB, ESIC & Nursing Entrance Exams
1. Pulmonary tuberculosis is mainly caused by:
A. Streptococcus pneumoniae
B. Mycobacterium tuberculosis
C. Staphylococcus aureus
D. Klebsiella pneumoniae
Answer: B. Mycobacterium tuberculosis
2. The most common route of transmission of pulmonary TB is:
A. Blood transfusion
B. Fecal-oral route
C. Airborne droplets
D. Skin contact
Answer: C. Airborne droplets
3. Which organ is primarily affected in pulmonary tuberculosis?
A. Liver
B. Kidney
C. Lungs
D. Brain
Answer: C. Lungs
4. A characteristic histological feature of tuberculosis is:
A. Fat necrosis
B. Granuloma formation
C. Hemorrhage
D. Fibrosis only
Answer: B. Granuloma formation
5. The central area of a tuberculous granuloma commonly shows:
A. Liquefaction necrosis
B. Caseous necrosis
C. Fat necrosis
D. Coagulative necrosis
Answer: B. Caseous necrosis
6. Which cells are commonly seen in tuberculous granuloma?
A. Plasma cells
B. Giant cells
C. Mast cells
D. Basophils
Answer: B. Giant cells
7. The confirmatory test for pulmonary tuberculosis is:
A. Urine examination
B. Sputum examination for AFB
C. ECG
D. Blood glucose test
Answer: B. Sputum examination for AFB
8. Which stain is commonly used to identify tubercle bacilli?
A. Gram stain
B. Ziehl–Neelsen stain
C. PAS stain
D. Leishman stain
Answer: B. Ziehl–Neelsen stain
9. Which symptom is most commonly associated with pulmonary TB?
A. Sudden blindness
B. Persistent cough
C. Severe diarrhea
D. Joint deformity
Answer: B. Persistent cough
10. Night sweats and weight loss are commonly seen in:
A. Asthma
B. Tuberculosis
C. Hypertension
D. Migraine
Answer: B. Tuberculosis
11. The vaccine used for prevention of tuberculosis is:
A. OPV
B. DPT
C. BCG
D. MMR
Answer: C. BCG
12. BCG vaccine is usually given:
A. At birth
B. At 10 years
C. During pregnancy
D. At old age
Answer: A. At birth
13. Which investigation is useful for screening tuberculosis?
A. CT brain
B. Mantoux test
C. EEG
D. Colonoscopy
Answer: B. Mantoux test
14. Pulmonary tuberculosis mainly affects which part of the lungs?
A. Lower lobes only
B. Apex of lungs
C. Middle lobe only
D. Pleura only
Answer: B. Apex of lungs
15. Which of the following is a risk factor for tuberculosis?
A. Good nutrition
B. Strong immunity
C. Malnutrition
D. Regular exercise
Answer: C. Malnutrition
16. Which drug is commonly used in anti-tubercular therapy?
A. Penicillin
B. Rifampicin
C. Paracetamol
D. Cetirizine
Answer: B. Rifampicin
17. DOTS therapy is related to:
A. Malaria treatment
B. TB control program
C. Diabetes management
D. Hypertension control
Answer: B. TB control program
18. Hemoptysis in a TB patient means:
A. Vomiting blood
B. Blood in urine
C. Coughing blood
D. Bleeding gums
Answer: C. Coughing blood
19. Which of the following is NOT a common symptom of pulmonary TB?
A. Fever
B. Chronic cough
C. Weight loss
D. Increased appetite
Answer: D. Increased appetite
20. Untreated pulmonary TB may lead to:
A. Lung destruction
B. Improved immunity
C. Hair loss only
D. Cataract
Bronchiectasis is the permanent abnormal dilatation of the bronchi caused by destruction of the bronchial wall due to chronic infection and inflammation.
CLINICAL FEATURES
1-Persistent productive cough ( chronic cough )
Cough continue for long time with sputum .
The patient experience cough because in infection of bronchi more mucus secreted and our body tried to remove from our body by coughing.
2-Large amount of thick , purulent,foul smelling sputum is produced.
3-Blood may appear in sputumdue to damage of bronchial blood vessels ( hemoptysis)
4-Dyspnea-Bronchiectasis occur due to infection so the bronchi become dilated and filled with mucus and blood.
This mucus and blood causes Blockage of airway and reduce oxygen entry from outside to the lungs.so the breathing becomes difficult.
5-Fever during infection
Due to bronchiectasis or infection in bronchi develop fever in patient.
6-Chest pain-Repeated infection cause chest pain happened in bronchiectasis.
COMPLICATION
1-Hemoptysis-
In bronchiectasis, repeated infection and inflammation damage the bronchial wall.
Small blood vessels present in the bronchi may rupture.
Blood mixes with mucus and comes out during coughing.
2- Amyloidosis-
When bronchiectasis continues for many years, infection and inflammation also continue for a long time.
Because of this, the body produces an abnormal protein called amyloid.
This protein slowly collects in organs like the kidney, liver, and spleen.
The collected amyloid can damage these organs.
This condition is called amyloidosis.
3-Septicemia
In bronchiectasis, repeated bacterial infection occurs in the bronchi.
Sometimes bacteria spread from the lungs into the bloodstream.
When bacteria enter and multiply in blood, it causes a serious infection called septicemia (blood infection).
4-Septic shock
In severe bronchiectasis, repeated lung infection may spread into the blood and cause septicemia.
The infection then produces a strong body reaction, causing blood pressure to fall suddenly.
Due to low blood pressure, organs do not get enough oxygen and blood supply.
This serious condition is called septic shock.
5-Lung abscess
In bronchiectasis, mucus collects inside the dilated bronchi.
Bacteria grow in this mucus and cause severe infection.
Sometimes the infection spreads into the lung tissue and destroys it.
This leads to formation of a cavity filled with pus in the lung.
This pus-filled cavity is called a lung abscess.
6-Pneumonia
In bronchiectasis, bronchi become dilated and filled with mucus.
Bacteria grow in this mucus anhd cause repeated infection.
The infection may spread to the alveoli (air sacs) of the lungs.
This causes inflammation and consolidation of lung tissue, leading to pneumonia.
7-Pleurisy
In bronchiectasis, repeated infection and inflammation occur in the lungs.
Sometimes the infection spreads to the pleura (covering of lungs).
This causes inflammation of the pleura, leading to chest pain during breathing.
This condition is called pleurisy.
8-Empyema
In bronchiectasis, repeated bacterial infection occurs in the bronchi.
Sometimes the infection spreads from the lungs to the pleural cavity (space around the lungs).
Pus then collects in the pleural cavity.
This collection of pus is called empyema.
9-Fibrosis
In bronchiectasis, repeated infection and inflammation damage the lung tissue.
During healing, scar tissue forms in the lungs.
Repeated damage and healing over many years increase scar formation.
This leads to fibrosis.
10-Cor pulmonale
In bronchiectasis, repeated infection and lung damage reduce oxygen in the blood.
Low oxygen causes narrowing of pulmonary blood vessels.
This increases pressure in pulmonary circulation (pulmonary hypertension).
The right side of the heart has to work harder to pump blood.
Over time, the right side of the heart enlarges and fails.
This condition is called cor pulmonale.
GROSS APPEARANCE
1-Lungs becomes hard and scarred
2-Many small holes and cyst are formed and look like honey comb .
3-The lungs become smaller and damaged
4-The cyst may contain pus
5-Mostly seen near the outer surface of the lungs
HISTOLOGY OF BRONCHIECTASIS
1-Bronchial wall shows chronic inflammation.
2-Many inflammatory cells like neutrophils are present.
3-Destruction of bronchial wall occurs.
4-Elastic tissue and smooth muscle are damaged.
5-Bronchi become dilated permanently.
6-Ulceration of bronchial lining may be seen.
7- Surrounding lung tissue shows fibrosis (scar formation).
8-Sometimes mucus and pus are present inside bronchi.
PATHOGENESIS OF BRONCHIECTASIS
Airway obstruction / Infection
↓
Accumulation of mucus in bronchi
↓
Bacterial growth and repeated infection
↓
Chronic inflammation of bronchial wall
↓
Destruction of smooth muscle and elastic tissue
↓
Weakening of bronchial wall
↓
Permanent dilatation of bronchi
↓
Collection of pus and mucus
↓
Bronchiectasis develops.
Bronchial Asthma and COPD Nursing Notes , pathology
Chronic obstructive pulmonary disease (COPD)
There are four types chronic obstructive pulmonary disease.
1-Emphysema
2-Bronchiectasis
3-Chronic bronchitis
4-Bronchial asthma
What is Bronchial asthma❔
Bronchial asthma is a condition where due to allergy airway becomes narrow and making breathing difficulties.
CLINICAL FEATURES OF BRONCpHIAL ASTHMA
1-Cough –in bronchial asthma due to any condition like dust , pollen , first inhale by a person if same person any allergic condition for this then airway becomes irritated swollen and filled with mucus .This irritution stimulates cough receptor so the body produces cough as a protective reflex .
2-Shortness of breath -In asthma airway become narrow due to inflammation so breathing difficulties occur .
3-Chest wheeze– In Asthma airway becomes narrow ,so air has to pass through tight space so whistling sound come out during respiration .
ETIOLOGY
1-Pollen
2-Air pollutants
3-Noxious chemical
4-Viral infection of the upper respiratory tract
5-Stress
6-Exercise
PATHOGENESIS OF BRONCHIAL ASTHMA
During first contact the antigen enter inside the body through airway.
⬇️
Antigen is captured by antigen presenting cell ( APC eats and breaks the antigen into small fragments .APC keep that antigen on its outer surface.
Interleukins 4 causes activation of B cell ( Activate B lymphocytes)
⬇️
Activated B lymphocytes transform plasma cell that produce IgE antibody .
⬇️
IGE antibody production
⬇️
IgE antibody Bind to the FC receptor present on the mast cell
⬇️
Mast cell fully sensitized for next event ( After binding mast cell ready to react with same antigen in next event.)
⬇️
During the second contact with same antigen
⬇️
Antigen bind with IGE antibody on the surface of the mast cell activated.
⬇️
Mast cell Lysis
⬇️
Degranulation of mast cells ( mast cell contain leukotrienes which came out by mast cell break down)
⬇️
Leukotrienes ( Leukotrienes receptor are present in trachia and bronchial wall so these leuKotrienes attached with their receptor causes bronchospasm.
⬇️
Bronchospasm
⬇️
Asthma
TYPES OF ASTHMA ( Two broad types of asthma)
1-Extrinsic asthma or atopic Asthma
Extrinsic asthma or atopic asthma is a condition which occurs due to allergic reactions. Such as ,dust and pollens
Sensitization phase -Sensitization phase means body becomes ready or sensitized so that next time when Antigen enters the body strong asthma attack happens (Because our body here try to protect from allergens such as dust and dirt )
When allergen enters the body such as dust ,pollen and smoke .
Our immune system get activated
Th2 type of lymphocyte get activate and release chemicals interleukin-4 , Interleukin -5 .
These chemicals tells B cell to make antibodies.
B- cell produced IgE antibodies
IgE attach mast cell in the lungs
Re -exposure phase –
Allergen enters again
It binds IgE attach which is already present on mast cell
Then mast cell break open ( degranulation)
These mast cell releases its stored chemicals histamine into surrounding tissues.
When mast cell release histamine smooth muscle of airway contract and this is called
2-INTRINSIC OR NON ATOPIC ASTHMA
Intrinsic or non atopic asthma is a type of bronchial asthma is not caused by allergic reactions or not family history of allergic reactions.
In nonatopic asthma IgE is normal so it is not allergy.then why asthma happens
When a person inhale dust or pollen etc , then dust and pollens enter to airway then vagal receptor ( Nerve ending).
and vagus nerve get stimulated and airway muscle contract.Bronchospasm occur .
Drug induced asthma
Drug induced asthma is a condition which occurs due to certain medicine,
COMPLICATION OF ASTHMA
1-Emphysema ( is a lung disease in which alveoli becomes enlarged and damaged .
2-Recurrent infection -Frequent chest infection due to excess Accumulation of mucus and blocked airway.
GROSS APPEARANCE ( means you can see in naked eye)
1 -Narrowed lumen of the airway
2-Increased weight and size of the lungs
2-Atelectasis (/Lung collapse)
4-The walls of the bronchi are thickened and are filled with mucus plugs .
HISTOLOGICAL CHANGES
1-Smooth muscle cell hyperplasia
( due to bronchoconstriction and inflammation In the walls of airway smooth muscle cells number increase/)
2-Bronchial gland hyperplasia (Increase number of mucus secreting glands in walls of airway )
3-Submucosal edema (fluid accumulate in the submucosal
4-Inflammation including eosinophils ( A type of white blood cell Eosinophils you can see under microscope)
5-Mucous plugs and mucous gland hyperplasia ( Due to mucous gland hyperplasia, mucous secrete more than normal and form mucus plugs and obstruct airway.
6-Increased vascularity-Due to inflammatory reaction increased blood flow )
7- The presence of charcot -Leyden crystals– If asthma due to allergic condition then Immediately a type of white blood cell eosinophils run that site to fight.and after fighting some eosinophils died and breakdown down and release protein
one of these proteins form charcot -Leyden crystals- which we can see by microscope.
Charcot-Leyden_crystal_-_Asthma.jpg
8-Curschmann spirals – Due to inflammation in airway mucus secretion increases and collect in bronchi and bronchioles,when patient cough ,this sputum expelled out with form of spiral shape is called curschmann spirals.we can seen in sputum of the bronchial asthma patients in microscope.
9-Creola bodies– In bronchial asthma due to inflammation damage epithelial lining .and epithelial cells looses and detach from wall of airway and come out in sputum as a cluster called creola bodies.
Chronic Bronchitis in COPD: Causes, Symptoms & Treatment Guide
What is chronic Bronchitis❔(COPD)
Chronic obstructive pulmonary disease
There are four types chronic obstructive pulmonary disease.
1-Emphysema
2-Bronchiectasis
3-Chronic bronchitis
4-Bronchial asthma
What is chronic Bronchitis❔
It is a disease characterized by chronic continuous cough with sputum production for atleast 3 month every year for a minimum of two consecutive years .
RISK FACTORS
1-Pollution
Long term exposure to dust ,smoke and industrial pollutants can cause chronic Bronchitis.
2-Older age
Immunity decreases in old age and due to weak immune system older age are more prone to recurrent infection and due to recurrent infection airway will be damage.
3-Smoking
Due to smoking -wall of the bronchioles injured and increase mucus production and this mucus accumulate in lumen of Trachea cause chronic inflammation (Due to inflammation swelling occur in trachia ) cause blocking of the airway.
4- Recurrent Respiratory infection –
Recurrent Respiratory infection in child and old age cause chronic bronchitis.
5-CLOSE AND FREQUENT EXPOSURE TO STRONG CHEMICAL
Continue breathing of strong chemical can cause chronic bronchitis.
Clinical Features of chronic Bronchitis
1-Chronic cough
2-Sputum production
3-Dyspnea
4-Fatigue
5- Cyanosis
6-Frequent Respiratory infection
7- Cor pulmonary ( Right sided heart failure
PATHOGENESIS
Due to any cause ,may be due to polution ,dust , chemical , Airway irritation occur
⬇️
Hypertrophy of submucosal bronchial glands
⬇️
Increase mucus secretion
⬇️
Accumulation of. Mucous in lumen of airway
⬇️
Inflammation of airway due to obstruction by mucus.
⬇️
Obstruction of airway
COMPLICATION
1-Frequent bacterial infection
2-Cor pulmonary ( Right side heart failure)
CHANGES SEEN IN NAKED EYE
Thick bronchial wall due to infection
Red and edematous mucosa due to infection
Excess mucus in bronchi
Some times pus due to infection
HISTOLOGICAL PATHOLOGY
1-Hypertrophy and hyperplasia of mucus gland.
2-Increased Reid index
3-Increased goblet cells
4-Due to chronic inflammation there may be neutrophil, macrophages,Lymphocytes
5-Loss of cilia -Impaired mucociliary clearance
6-Narrowed airway lumen
PREVENTION OF CHRONIC BRONCHITIS
1- Cessation of smoking
2- Early Diagnosis and Early treatment
3-Avoid, dust ,dirt and industrial pollutants.
4-Maintain hygiene
5-vaccination to prevent Respiratory infection.
TREATMENT
1-Bronchodilator to open airway.
Example -Salbutamol
2- Corticosteroids -This medicine reduce airway inflammation.
RESPIRATORY SYSTEM DISEASES(Chronic Obstructive pulmonary disease, EMPHYSEMA, FROM PATHOLOGY -BSC NURSING 3rd SEM SYLLABUS.
Respiratory disease means which affects the respiratory system.and the organs involved in Respiratory system.such as nose , Trachea , bronchi ,Alveoli .
Chronic obstructive pulmonary disease, Emphysema
There are four types chronic obstructive pulmonary disease.
1-Emphysema
2-Bronchiectasis
3-Chronic bronchitis
4-Bronchial asthma
What is emphysema
Emphysema is a Respiratory disease in which walls of the alveoli permanently enlarged and destroyed causing patients fell difficulty in breathing out.
TYPES OF EMPHYSEMA
1- Centriacinar
In this emphysema central part of the acinus damaged .
Acinus is the functional unit of lung. It includes
1-Respiratory bronchioles
2-Alveolar ducts
3-Alveoli
If central part of acinus which is Respiratory bronchiole involved then it called centriacinar emphysema
2- Panacinar–
If all total acinus is involved in called paracinar emphysema
3- Paraseptal-
If distal part is affected such as. Alveolar sac is affected called paraseptal emphysem
4-IRREGULAR EMPHYSEMA –
it is characterised by uneven destruction of alveoli..
CLINICAL FEATURES EMPHYSEMA
Shortness of breath
Tachypnea
Laboured breathing
Barrel shaped chest
Cough
Less sputum
Weight loss
Pink buffer
X ray chest show hyperinflated lungs with small heart .P
PATHOLOGICAL CHANGES
GROSS APPEARANCE
Destruction of the alveoli
STUDY OF TISSUE UNDER MICROSCOPE (Histological changes)
Large , distended abnormal alveoli
Large pores of kohn
Alveolar wall destroyed
Scaring in the small area of central part of the lungs.
Swelling and narrowing of bronchioles due to infl
Capillary may be thin
PATHOGENESIS
Smoking
Inflammation in lungs
Release of enzymes ( protease)
Damage of alveolar wall.
Loss of ilastic tissue
Alveoli enlarges
Air gets trapped in lungs
Reduced surface area for gas exchange
Breathlessness
Protease antiprotease theory
-protease means enzymes that break down lung tissue.
When a person smoke and inflammation occur at that time neutrophil come and release enzyme elastase.
This enzyme destroy bacteria and remove damage tissue.
Alpha -antitrypsin antiprotease is a protective substance which
When a person smoke this alpha-trypsin antiprotease inactivate and elastase become uncontrolled and destroy elastic fibers of alveolar wall .
Diagnosis of pregnancy(symptoms of first trimester in pregnancy/)
SECOND TRIMESTER OF PREGNANCY SYMPTOMS
Signs and symptoms in second trimester of pregnancy
13 to 28 weeks of gestation is called second trimester
Symptoms are in second trimester of pregnancy in a woman ( symptoms means which woman can feel )
1-Amenorrhoea
Women will experience amenorrhoea from first trimester of pregnancy but it will continue also in second trimester of pregnancy and will continue till end of the delivery.
2-MORNING SICKNESS
Some pregnant woman may experience morning sickness means feeling Nausia and vomiting in morning. These
symptoms reduce in second trimester but some of women is there who experienced these symptoms in second trimester also due to ongoing hormonal changes.
3-Quickening(Quickning means first perception of the fetal movement by the mother is called quicking)
In primigravida ( means in first pregnancy) Mother can fill movement of the fetus around 18 to 20 weeks of gestation.
In Multigravida ( a woman who has been pregnant more than Once ) feels quickning around 16 to 18 weeks of gestation.)
Signs are seen in second trimester of pregnancy.( Doctor can find it after examination )
Breast signs
Breast size will be increase due to growth of glandular tissue and fat deposits in the breast .
Areola of the breast become darker , prominent veins, Enlargement of montogomerys tubercle, and colostrum secreation may begin .
Many Changes occur in skin of the pregnent woman .
1- Cloasma – It is the 34 hyperpigmentation of the skin Specialy on the face during pregnancy due hormonal changes.
2-Linea nigra-
Lineanigrra
You can see a pigmented line between symphysis pubis to umbilicus . means a pigmented lines extending from symphysis pubis to umbilicus is called Linea nigra .
3-Striae gravidarum
Striae gravidarum
In simple you can remember when devlopment of fetus occur in uterus, uterus enlarged and it extends into abdominal cavity , and this cause abdomen stretches .
This stretch Mark is called Strai gravidarum .
UTERINE SIGN
1-Braxton Hicks contraction
Painless irregular uterine contraction during pregnancy is called Braxton Hicks contraction.
SIGNS OF THE FOETUS
1-Internal ballottement
It occurs around 16 to 20 weeks of pregnancy,this is probable sign of pregnancy. Here examiner insert two fingers into vagina and pushed cervix upward .
Due to this fetus also pushed upward and rebound and felt by the examiners is called internal ballottement.
2-External ballottement
Means if a examiner will keep her hand on the abdomen of pregnent woman and push the fetus will go away and again return and touch with external examiner hands .This coming back is called external ballottem
3-Palpation of foetal parts and movement
In second trimester of pregnancy you can palpate fetal part and movement also .
4-Foetal heart sound
In second trimester of pregnancy Nurse or Doctor can check fetal heart sound to detect any abnormality of fetus health status .
In pregnancy in second trimester we can not see the fetus because fetus is in the wombs of the mother but we can find out if fetus suffering any abnormality in the mother’s womb by Auscultation of fetal heart .the normal fetal heart rare is 120 to 160 beats per minute .if below 120 drops or above 160 drops per minute then may be therevis any problem to fetus immediately inform to doctor.
INVESTIGATIONS
1-Pregnancy test
Rapid urine pregnancy test -By this method examiner or mother can find out result rapidly by detecting hCG hormone in the urine.
In this procedure
Collect urine sample from mother,put 2 to 3 drops of urine in test card
. after putting urine drops in card wait for a minutes then result will come out .
If two lines appear C+T , then result positive .
If only one line appear on the card which is C ( control line ) then it is nagative .
2-Ultrasonography
Ultrasound is necessary in second trimester to find out presentation of the fetus ,to find out placenta privia , to find out normal or abnormal amniotic fluid amount ,to confirm gestational age , to detect congitital anomalis
