Pulmonary diseasDDDDDDDDDDDDDDDDDDes.ppt

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1. Diseases of Respiratory System
Li yonghuai
From the department of Respiratory medicine
of the first affiliated hospital of Anhui Medical
University
Pulmonary medicine

2. we have learned the basic medical courses
Now we are learning the clinic medical courses,
then we are on the way to become a true
doctor

3. Now let’s begin
The course have 8 weeksclass, every
time has 3 periods
We will learn some respiratory diseases
Pulmonary medicine is also linked to the
field of critical care medicine, so we
must work hard to study it.

4. Background
Pulmonary diseases are major contributors to
morbidity and mortality in the general
population.
Although advances in the diagnosis and
treatment of many common pulmonary
disorders have improved the lives of patients,
these complex illnesses continue to affect a
large segment of the global population.

5. Pulmonary diseases can be
divided into the following:
Respiratory infectious diseases
Airways diseases (reactive and no-reactive )
Interstitial lung diseases
Pulmonary vascular disease
Primary pulmonary tumors
Pleural diseases

6. Respiratory infectious diseases
Acute upper respiratory tract infection
(common cold and flu)
Acute tracheobronchitis
Pneumonia
Tuberculosis
Bronchiectasis
Lung abscess

7. Airways diseases
Asthma
COPD (chronic obstructive pulmonary
disease)
OSAHS (obstructive sleep apnea-
hypopnea syndrome )

8. Interstitial lung diseases
unknown cause
known cause

9. Pulmonary vascular disease
Pulmonary Embolism
Primary Pulmonary Hypertension

10. Primary pulmonary tumors
Non-small cell carcinoma
Squamous cell carcinoma
Adenocarcinoma
Large cell carcinoma
Small cell carcinoma

11. Pleural diseases
Pleural effusion
pneumothorax

12. How to diagnose
symptoms
physical examination
CHEST IMAGING (chest radiograph or
computer tomography)
pulmonary function testing
bronchoscopic examination
laboratory techniques

13. symptoms
Cough
Sputum
Hemoptysis
Apnea
Chest pain

14. physical examination
Inspect
palpate
percuss
auscultate

15. chest radiograph or computer
tomography

16. pulmonary function testing

17. bronchoscopic examination.

18. laboratory techniques
Gram’s Stain and Culture of
Sputum(a sputum sample must have
>25 neutrophils and <10 squamous
epithelial cells per low-power field)
Blood，Pleural effusion and so on
Routine Test

19. How to treat
Abandon smoking
Oxygen therapy
Expansion of bronchus

20. How to learn
What is the disease (definition, symptoms,
physical examination, assistant examinations)
What cause the disease (etiology,
pathogenesis, pathology)
How to diagnose the disease( diagnostic
reasons, differential diagnosis )
How to treat the disease (therapeutic
principle, chemotherapy, prevention)

21. The scientific basis of many pulmonary
medicine is rapidly expanding.
Novel diagnostic and therapeutic approaches
populate the published literature with great
frequency.
Maintaining updated knowledge of these
evolving areas is essential for the optimal
care of patients with lung diseases

22. Reference book
Clinic Diagnostics
Pathophysiology
Pharmacology
Harrison’sPulmonary and Critical Care
Medicine

23. You can do
You can do best

24. Let’s have a rest

25. Chapter 1
Respiratory Infections

26. Acute respiratory tract infection
Upper respiratory tract
Lower respiratory tract
Of the upper and lower airway boundary
is throat

27. The functions of respiratory
tract
Ventilatory flow
Defenceto infection

28. Respiratory tract defences
Cough
Mucociliary clearance mechanisms
Mucosal immune system
If the defense was broke up, respiratory
tract would be infected

29. Acute upper respiratory tract
infections
What is acute upper respiratory tract
infections? (definition)
It is a kind of acute inflammation of upper
respiratory tract (nasal cavity, pharynx, and
laryngeal)
Most of it caused by
viral infection, less with
bacteria involvment

30. Definition of a disease contains
the following elements
The aetiology of diseases or (and)
pathogenesis
Remarkable clinic features (symptoms,
signs, assistant examinations)

31. types of acute upper respiratory tract infections
The common cold
Acute pharyngitis and laryngitis
Herpangina
Pharyngoconjunctival fever
Acute pharyngitis and tonsillitis

32. The common cold
Definition
The common cold is a mind, self-limited, viral
infection of upper respiratory tract
A common cold is usually harmless, although it
may not feel that way.
it's a runny nose, sore throat , cough, watery
eyes, sneezing and congestion —or maybe all of
the above.

33. Due to any one of more than 200
viruses can cause a common cold,
symptoms tend to vary greatly.
Most adults are likely to have a
common cold two to four times a year.
Children, especially preschoolers, may
have a common cold as many as six to
10 times annually.

34. Most people recover from a common
cold in about a week or two.
If symptoms don't improve, maybe
there are complications.

35. Causes
Although more than 200 viruses can cause a common
cold, the rhinovirus is the most common culprit, and
it's highly contagious.
A cold virus enters your body through your mouth or
nose.
The virus can spread through droplets in the air
when someone who is sick coughs, sneezes or talks.
But it also spreads by hand-to-hand contact with
someone who has a cold or by using shared objects,
such as utensils, towels, toys or telephones.
Touch your eyes, nose or mouth after such contact or
exposure, and you're likely to "catch" a cold.

36. Symptoms
Symptoms of a common cold usually appear about one to three
days after exposure to a cold virus.
Signs and symptoms of a common cold may include:
Runny or stuffy nose
Itchy or sore throat
Cough
Congestion
Slight body aches or a mild headache
Sneezing
Watery eyes
Low-grade fever (sometime up to 39 ℃)
Mild fatigue

37. Complications
Acute ear infection (otitis media).
Ear infection occurs when bacteria or viruses infiltrate
the space behind the eardrum. It's a frequent
complication of common colds in children.
Typical signs and symptoms include earaches and, in
some cases, a green or
yellow discharge from the nose or the return of a
fever following a common cold. Children who are too
young to verbalize their distress may simply cry or
sleep restlessly.
Ear pulling is not a reliable sign.


38. Wheezing.
A cold can trigger wheezing in children with asthma.
Sinusitis.
In adults or children, a common cold that doesn't
resolve may lead to
sinusitis —inflammation and infection of the sinuses.
Other secondary infections. These include strep
throat (streptococcal pharyngitis), pneumonia,
bronchitis in adults and croup in children. These
infections need to be treated by a doctor.

39. Diagnosis
History
Clinic features
Assistant examinations

40. Differential diagnosis
Acute lower respiratory tract infections
(Acute tracheobronchitis)
Sputum or not
Influenza (flu)
See the next ppt

41. What is differential diagnosis
There are similar symptoms, physical
examinations, and assistant examinations
between the disease that will be diagnosed and
that other diseases
we will differentiate these diseases according to
symptom, physical examination, assistant
examination, then, we can find the differences
among those diseases, at last, we can detect the
right diagnosis

42. The Distinction
Influenza .VS. Common Cold

43. ·arunnyorstuffynose
·sneezing
·sorethroat
·wateryeyes
·afeelingthatyourearsareblocked
The symptoms of a common coldinclude:

44. · irritation in the throat or lungs
· headache
· high fever
· extreme fatigue
· severe muscle aches
· vomiting
· diarrhea
The symptoms of influenzainclude:

45. Symptoms Cold Flu
Fever
Sometimes, usually mild Typical,higher
（38.8-40°C，especiallyinyoung
children）persist3-4days
Headache Occasionally Common
General Aches Slight Usual; often and serious
General FatigueSometimes Usual; early；can last 2 to 3 weeks
Stuffy Nose Common Sometimes
Sneezing Usual Sometimes
Sore Throat Common Sometimes
Cough Mild to moderate; productive
cough
Common; even serious
Complications middle ear infection; generally
no serious complication.
bronchitis, ear infection, pneumonia; can
be life-threatening
Influenza .VS. Common Cold

46. Influenza .VS. Common Cold
↓
Treatment
Cold Flu
★There is no cure for the common
cold
★gettingplentyofrest
★drinking a lot of liquids
★gargling with warm salt water
★using cough drops, throat sprays,
or cold medicines.
★take medications such as
paracetamol .pain relievers, or fever
reducers are available over the
counter
★prescription antiviral drugs for flu
may be given in some cases
★avoid using alcohol and tobacco
★young children should avoid
taking aspirin during an influenza
infection

47. Influenza .VS. Common Cold
↓
Prevention
Cold Flu
★successfulimmunizationishighly
improbable
★washhandsregularly
★avoidclosecontactwithanyonewith
acold
★avoid touching the mouth and face
★sleep for 7-8 hours per night
★regular exercise
★GetVaccinated
Thesinglebestwaytopreventtheflu
istogetafluvaccinationeachfall.
Abouttwoweeksaftervaccination,
antibodiesdevelopthatprotectagainst
influenzavirusinfection.

48. Treatments and drugs
There's no cure for the common cold.
Antibiotics are of no use against cold viruses.
But the Other secondary infections. These
include strep throat (streptococcal
pharyngitis), pneumonia, bronchitis in adults
and croup in children. These infections need
to be treated

49. Acute tracheobronchitis
Definition
Is an inflammation of the tracheo-bronchial
tree
Usually in association with bacterial or viral
infection, but physical or chemical irritants,
antigens aspiration can also play a role
Cough and sputum are prominent
manifestation

50. Aetiology and pathogenesis
Infection
Can be caused by bacterial (such as
pneumococcus, hemophilies influenzae,
streptococcus, and staphylococci )
or viral (such as adenovirus, influenza virus,
respiratory syncytial virus, and parainfluenza
virus) infection
Is a commom complication of acute upper
respiratory tract infection

51. Physical or chemical factors
Aspiration of cold air, dust, irritant gas
or smoke (such as: haze, PM2.5)

52. Anaphylaxis
Varied allergens can produce the
inflammation
Such as: pollen, fungal spore, organic
dust, tropina, and the migration of
parasites in lung

53. Clinical manifestations
Cough and mucoid sputum (sometimes
is purulent sputum)
Rhonchi and coarse crackles
The symptoms will persist 2 to 3 weeks

54. Laboratory findings
White blood cell count and differential
count are normol but will be increased
in the severe bacterial infection
Sputum smear and culture may detect
the pathogenic organisms
Chest radiograph may present lung
marking increasein most cases

55. Diagnosis
The diagnosis can be established bases
on the history, clinical features, and
combined with the laboratory detections.
Sputum smear and culture may get the
pathogens.

56. Differential diagnosis
Acute upper respiratory tract infection
Sputum or not sputum
Nasopharynx symptoms or not
Physical examination and chest X-ray
are normal or abnormal

57. Bronchopneumonia (a type of pneumonia)
Chest x-ray shows the irregular patch
infiltration shadows go along with the lung
markings or just shows the lung
marking increase

58. Treatment
Most cases require measures directed only
at relieving cough, for it is self-limited
disease
For patients with fever or a predominant
tracheitis and purulent sputum, should give
antibiotic therapy and the sputum should be
Gram stained and cultured

59. Pneumonia
Infection of pulmonary
parenchyma with consolidation

60. Definition
Pathophysiology
Pathology
Community-Acquired Pneumonia
Etiology
Epidemiology
Clinical Manifestations
Diagnosis
Prognosis
Prevention .

61. Definition
Infection of pulmonary parenchyma
with consolidation

62. Definition
Gr. “disease of the lungs”
Infection involving the distal airspaces
usually with inflammatory exudation
(“localised oedema”).
Fluid filled spaces lead to consolidation

63. Classification of Pneumonia
By clinical setting
(e.g. community acquired pneumonia---
CAP；hospital acquired pneumonia----
HAP)
By organism
(e.g. pneumococcal ,mycoplasma, etc)
By morphology
(lobar pneumonia, bronchopneumonia,
interstitial pneumonia )

64. Organisms
Viruses –influenza, parainfluenza,
measles, varicella-zoster, respiratory
syncytial virus (RSV). Common, often
self limiting but can be complicated
Bacteria
Chlamydia[klə'mɪdɪə] ,
mycoplasma[,maɪko'plɑzmə]
Fungi['fʌŋgi:]

65. Lobar Pneumonia
Confluent consolidation involving a
complete lung lobe
Most often due to Streptococcus
pneumoniae (pneumococcus)
Can be seen with other organisms
(Klebsiella, Legionella)

66. Clinical Setting
Usually community acquired
Classically in otherwise healthy young
adults

67. Pathophysiology
Pneumonia results from
the proliferation of microbial pathogens at the
alveolar level
VS
the host’s response to those pathogens.
the host’s response
the proliferation
of microbial
pathogens

68. Microorganisms gain access to the lower
respiratory tract in several ways
The most common way : aspiration from the
oropharynx [,ɔro'færɪŋks] .
Small-volume aspiration occurs frequently during sleep
(especially in the elderly) and in patients with decreased
levels of consciousness
via hematogenous spread
Contiguous extension from an infected
pleural or mediastinal space

69. Pathological description of
pneumonia

70. Pathology
A classical acute inflammatory response
Exudation of fibrin-rich fluid
Neutrophil infiltration
Macrophage infiltration
Resolution
Immune system plays a part antibodies
lead to opsonisation, phagocytosis of
bacteria

71. Macroscopic pathology
Heavy lung
Congestion
Red hepatisation
Grey hepatisation
Resolution
The classical pathway

72. CAP
(Community-acquired
pneumona)

73. ETIOLOGY
bacteria (Streptococcus pneumoniae is most
common)
mycoplasma , chlamydia , legionella
fungi
Viruses
protozoa

74. The “typical”bacterial pathogens
includes :
S.pneumoniae,
Haemophilus influenzae,
S. aureus
gram-negative bacilli (such as Klebsiella
pneumoniae and Pseudomonas aeruginosa)

75. The “atypical”organisms
Include
Mycoplasma pneumoniae,
Chlamydophila pneumoniae,
Legionella spp.
respiratory viruses (such as influenza
viruses, adenoviruses, and respiratory
syncytial viruses (RSVs).

76. Anti-SARS

78. In the ∼10–15% of CAP cases that are
polymicrobial
the etiology often includes a combination
of typical and atypical pathogens.

79. Unfortunately, it is usually impossible to
predict the pathogen in a case of CAP
with any degree of certainty;
more than half ofcases, a specific
etiology is never determined.
So it is important to consider
epidemiologicand risk factorsthat
might suggest certain pathogens

83. EPIDEMIOLOGY
In USA, about 80% of the 4 million CAP
cases that occur annually are treated on
an outpatient ;about 20% are treated in
the hospital

84. Risk factors for CAP
Alcoholism
Chronic disease
Immunosuppression
An age of 70 years or older

85. CLINICAL MANIFESTATIONS
can vary from indolent to fulminant in
presentation
and vary from mild to fatal in severity

86. symptom
fever with a tachycardic response
may have chills or sweats
cough that is either nonproductive or
productive of mucoid, purulent, or
blood-tinged sputum.

87. Severity of infection, the patient may
not be able to speak in full sentences or
may be very short of breath.
If the pleura is involved, the patient
may be chest pain.
Up to 20% of patients may have
gastrointestinal symptoms such as
nausea, vomiting, or diarrhea.
Other symptoms may include fatigue,
headache, myalgias, and arthralgias.

88. physical examination
vary with
the degree of pulmonary consolidation
and the presence or absence of a
significant pleural effusion

89. An increased respiratory rate and use of accessory
muscles of respiration are common.
Palpation may reveal increased or decreased tactile
fremitus,
the percussion note can vary from dull to flat,
reflecting underlying consolidated lung and pleural
fluid, respectively.
Crackles, bronchial breath sounds, and possibly a
pleural friction rub may be heard on auscultation.
The clinical presentation may not be so obvious in
the elderly

90. DIAGNOSIS
When confronted with possible CAP
the physician must ask two questions:
Is this pneumonia?
and, if so, what is the etiology?

91. the former question is typically
answered by clinical and radiographic
methods
the latter requires the aid of laboratory
techniques

92. Whereas the former question is typically
answered by clinical and radiographic
methods,
the latter requires the aid of laboratory
techniques

93. Clinical Diagnosis
The newly emergence of cough, sputum, or
with chest pain ,hemoptysis
Fever
Related sings of pulmonary consolidation,
such as: decreased or increased fremitus,
the percussion note can vary from dull to
flat, Crackles ,etc

94. laboratory techniques
WBC > 10×10
9
or <4×10
9
standard postero-anteriorand lateral
chest radiography: localized alveolar
infiltrates and consolidation

95. Complications
Organisation (fibrous scarring)
Abscess
Bronchiectasis
Empyema (pus in the pleural cavity)

96. Viral pneumonia
Gives a pattern of acute
injury similar to adult
respiratory distress
syndrome (ARDS)
Acute inflammatory
infiltration less obvious
Viral inclusions
sometimes seen in
epithelial cells

97. The immunocompromised
host
Virulent infection with common
organism (e.g. TB) –the African pattern
Infection with opportunistic pathogen
virus (cytomegalovirus -CMV)
bacteria (Mycobacterium avium
intracellulare)
fungi (aspergillus, candida, pneumocystis)
protozoa (cryptosporidia, toxoplasma)

98. Diagnosis
High index of suspicion
Teamwork (physician, microbiologist,
pathologist)
Broncho-alveolar lavage
Biopsy (with lots of special stains!)

99. Immunosuppressed patient –fatal haemorrhage
into Aspergillus-containing cavity

100. HIV-positive patient CMV (cytomegalovirus) and
“pulmonary oedema”on transbronchial
biopsy….

101. Special stain also shows Pneumocystis