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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 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 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 Co-ordinate the transition between inhalation and exhalation Pneumotaxic area 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 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? Inheritance How do they present??? Neonate? Failure to thrive Children and Young Adults Respiratory Recurrent Infectiond Pneumothorax GI – Symptoms Pancreatic Insufficiency Infertillity Diagnosis Test – Via the Sweat The MDT 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 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 Carcinoma of the Bronchus Cigarette Smoking Asbestos, Iron Oxides, Radiation Histology Small Cell Large Cell Oat Cell Squamous Adenocarcinoma Large Cell Most important division = SCLC & NSCLC Pathophysiology 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 Complications Local Metastatic 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
