Restrictive Lung Diseases

& Bronchogenic
Carcinoma
By Dr Muhammad Waseem

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Bronchogenic Carcinoma

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Lung Cancer (Cont.)
Lung tumor effects
Obstruction of airflow into a bronchus
Causes abnormal breath sounds and dyspnea
Inflammation and bleeding surrounding the tumor
Cough, hemoptysis, and secondary infections
Pleural effusion, hemothorax, pneumothorax
Para neoplastic syndrome
Occurs wen tumor cell secretes hormones or hormone-like substances
Usual systemic effects of cancer

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Lung Cancer (Cont.)
Early signs
Persistent productive cough
Detection on radiograph
Hemoptysis
Pleural involvement
Chest pain
Hoarseness, facial or arm edema, headache, dysphagia, or
atelectasis

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Lung Cancer (Cont.)
Systemic signs
Weight loss, anemia, fatigue
Paraneoplastic syndrome
Indicated by signs of an endocrine disorder
Related to the specific hormone secreted
Signs of metastases
Bone pain
Cognitive deficits, motor deficits

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Lung Cancer (Cont.)
Diagnostic tests
Specialized helical CT scans and MRI
Chest radiography
Bronchoscopy
Biopsy and mediastinoscopy

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Aspiration
Passage of food, fluid, emesis, other foreign material into
trachea and lungs
Common problem in young children or individuals laying
down when eating or drinking
Result may be:
Obstruction
Aspirate is a solid object.
Inflammation and swelling
Aspirate is an irritating liquid.
Predisposition to pneumonia

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Aspiration (Cont.)
Potential complications
Aspiration pneumonia
Inflammationgas diffusion is impaired.
Respiratory distress syndrome
May develop if inflammation is widespread
Pulmonary abscess
May develop if microbes are in aspirate
Systemic effects
When aspirated materials (solvents) are absorbed into blood

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Aspiration (Cont.)
Signs and symptoms
Coughing and choking with dyspnea
Loss of voice if total obstruction
Stridor and hoarseness
Characteristic of upper airway obstruction
Wheezing
Aspiration of liquids
Tachycardia and tachypnea
Nasal flaring, chest retractions, hypoxia
In individuals with severe respiratory distress
Cardiac or respiratory arrest

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Emergency Treatment for
Aspiration

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Obstructive Sleep Apnea
Result of pharyngeal tissue collapse during sleep
Leads to repeated and momentary cessation of breathing
Men are affected more often than women.
Obesity and aging are common predisposing factors.

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Restrictive Lung Disorders
Group of disorders with impaired lung expansion and reduced
total lung capacity
First group
Abnormality of chest walllimits or impairs lung expansion
Kyphosis or scoliosis, poliomyelitis, amyotrophic lateral sclerosis, botulism,
muscular dystrophy
Second group
Diseases affecting the supporting framework of lungs
Idiopathic pulmonary fibrosis, occupational diseases

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Pneumoconioses
Chronic restrictive diseases resulting from long-term
exposure to irritating particles
Inflammationgradual destruction of connective tissue
Functional areas of the lungs lost
Onset insidious
Dyspnea develops first
Treatmentending exposure, treatment of infection

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Pneumoconioses (Cont.)

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 Vascular Disorders: Pulmonary
Edema
Fluid collecting in alveoli and interstitial area
Can result from many primary conditions
Reduces amount of oxygen diffusing into blood
Interferes with lung expansion
May develop when:
Inflammation in lungs is present.
Increases permeability of capillaries
Plasma protein levels are low.
Decreases osmotic pressure of plasma
Pulmonary hypertension develops.

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Pulmonary Edema (Cont.)
Signs and symptoms
Cough, orthopnea, ralesin mild cases
Hemoptysis
Frothy, blood-tinged sputum

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Pulmonary Edema (Cont.)

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Vascular Disorders

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Pulmonary Embolus

Blood clot or mass that obstructs pulmonary artery or any of

its branches
Effect of embolus depends on material, size, and location
Small pulmonary emboli might be silent unless they involve
a large area of lung.
Large emboli may cause sudden death.
90% of pulmonary emboli originate from deep vein
thromboses in legs; are preventable

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Pulmonary Embolus (Cont.)
Signs and symptoms
Transient chest pain, cough, dyspneasmall emboli
Larger emboliincreased chest pain with coughing or deep
breathing; tachypnea and dyspnea develop suddenly.
Laterhemoptysis and fever
Hypoxiacauses anxiety, restlessness, pallor, tachycardia
Massive emboli
Severe crushing chest pain, low blood pressure, rapid weak pulse, loss
of consciousness

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Pulmonary Embolus (Cont.)
Diagnosis
Radiography, lung scan, MRI, pulmonary angiography

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Pulmonary Embolus (Cont.)

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Expansion Disorders

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Atelectasis
Nonaeration or collapse of lung or part of a lung
Leads to decreased gas exchange and hypoxia
Alveoli become airless.
Collapse and inflammation or atrophy occur.
Process interferes with blood flow through the lung.
Both ventilation and perfusion are altered.
Affects oxygen diffusion

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Atelectasis (Cont.)
Mechanisms that can result in atelectasis
Obstructive or resorption atelectasis
Caused by total obstruction of airway
Compression atelectasis
Mass or tumor exerts pressure on part of the lung.
Increased surface tension in alveoli
Prevents expansion of lung
Fibrotic tissue in lungs or pleura
May restrict expansion and lead to collapse
Postoperative atelectasis
Can occur after surgery

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Atelectasis (Cont.)

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Atelectasis (Cont.)
Signs and symptoms
Small areas are asymptomatic.
Large areas
Dyspnea
Increased heat and respiratory rates
Chest pain

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Pleural Effusion
Presence of excessive fluid in the pleural cavity
Causes increased pressure in pleural cavity
Separation of pleural membranes
Exudative effusions
Response to inflammation
Transudate effusions
Watery effusions (hydrothorax)
Result of increased hydrostatic pressure or decreased osmotic
pressure in blood vessels

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Pleural Effusion (Cont.)
Signs and symptoms
Dyspnea
Cyclic chest pain
Increased respiratory and heart rates

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Pneumothorax
Air in pleural cavity
Closed pneumothorax
Air can enter pleural cavity from internal airwaysno opening in
chest wall
Simple or spontaneous pneumothorax
Tear on the surface of the lung
Secondary pneumothorax
Associated with underlying respiratory disease
Rupture of an emphysematous bleb on lung surface or erosion by a
tumor or tubercular cavitation

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Types of Pneumothorax

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 Pneumothorax (Cont.)
Open pneumothorax
Atmospheric air enters the pleural cavity though an opening in the
chest wall.
Sucking wound
Large opening in chest wall
Tension pneumothorax
Most serious form
Result of an opening through chest wall and parietal pleura or from a tear in
the lung tissue and visceral pleura
Air entry into pleural cavity on inspiration but hole closes on expiration
Trapping air leads to increased pleural pressure and atelectasis

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Emergency Treatment for
Pneumothorax

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Flail Chest
Results from fractures of ribs, which allow ribs to move
independently during respiration
During inspiration
Flail or broken section moves inward rather than outward.
Inward movement of ribs prevents expansion of affected lung.
Large flail section can compress adjacent lung tissue.
Pushing air out of that sectionup the bronchus
Air (stale) from damaged lung crosses into the other lung with newly
inspired air.

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Flail Chest (Cont.)
During expiration
Unstable fail section pushed outward by increasing intrathoracic
pressure.
Large flail section
Paradoxical movement of ribs alters airflow during expiration.
Air from unaffected lung moves across into affected lung.
Hypoxia results from limited expansion and decreased
inspiratory volume.

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Flail Chest Injury

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Infant Respiratory Distress
Syndrome
Usually related to premature birth
Lack of surfactant in alveoli
Poorly developed alveoli are difficult to inflate.
Diffuse atelectasis results.
Decreased pulmonary blood flowpulmonary vasoconstriction
severe hypoxia
Poor lung perfusion and lack of surfactant
Increased alveolar capillary permeability
Fluid and protein are leaking into the interstitial area and alveoli,
hyaline membrane formation

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Infant Respiratory Distress
Syndrome (Cont.)

Signs and symptoms

Respiratory difficulties may be evident at birth or shortly thereafter.
Respirations rapid and shallow, with chest retractions and flaring of
nares.
Frothy sputum and expiratory grunt
Blood pressure falls.
Cyanosis and peripheral edema
Severe hypoxemia and decreased responsiveness
Irregular respirations with periods of apnea
Decreased breath sounds

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Adult Respiratory Distress
Syndrome

Results from injury to the alveolar wall and capillary membrane

Causes the release of chemical mediators
Increases permeability of alveolar capillary membranes
Increased fluid and protein in interstitial area and alveoli
Damage to surfactant-producing cells
Diffuse necrosis and fibrosis if patient survives
Multitude of predisposing conditions
Often associated with multiple organ dysfunction or failure

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Adult Respiratory Distress
Syndrome (Cont.)
Signs and symptoms
Dyspnea
Restlessness
Rapid, shallow respiration
Increased heart rate
Combination of respiratory and metabolic acidosis

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Adult Respiratory Distress
Syndrome (Cont.)

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Acute Respiratory Failure
May result from acute or chronic disorders
Emphysema
Combination of chronic and acute disorders
Acute respiratory disorders
Many neuromuscular diseases
Signs may be masked or altered by primary problem

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