Chronic bronchitis gk

2,995 views

Published on

0 Comments
14 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
2,995
On SlideShare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
0
Comments
0
Likes
14
Embeds 0
No embeds

No notes for slide

Chronic bronchitis gk

  1. 1. Chronic Bronchitis Obstructive Airway DiseasesSlide 1
  2. 2. Emphysema Bronchitis Asthma  Chronic obstructive pulmonary disease.  Bronchitis, emphysema, and asthma may present alone or in combination.Slide 2
  3. 3. Chronic Bronchitis Chronic bronchitis. Inset, Weakened distal airways in emphysema, a common secondary anatomic alteration of the lungs.Slide 3
  4. 4. Anatomic Alterations of the Lungs  Chronic inflammation and swelling of the peripheral airways  Excessive mucus production and accumulation  Partial or total mucus plugging  Hyperinflation of alveoli (air-trapping)  Smooth muscle constriction of bronchial airways (bronchospasm)Slide 4
  5. 5. Etiology  Cigarette smoking  Atmospheric pollutants  Infection  Gastroesophageal reflux diseaseSlide 5
  6. 6. Figure 9-11. Excessive bronchial secretions clinical scenario.Slide 6
  7. 7. Figure 9-10. Bronchospasm clinical scenario (e.g., asthma).Slide 7
  8. 8. Clinical Data Obtained at the Patient’s Bedside Vital signs  Increased respiratory rate  Increased heart rate, cardiac output, blood pressureSlide 8
  9. 9. Clinical Data Obtained at the Patient’s Bedside  Use of accessory muscles of inspiration  Use of accessory muscles of expiration  Pursed-lip breathing  Increased anteroposterior chest diameter (barrel chest)  Cyanosis  Digital clubbingSlide 9
  10. 10. Figure 2-36. The way a patient may appear when using the pectoralis major muscles for inspiration.Slide 10
  11. 11. Figure 2-41. A, Schematic illustration of alveolar compression of weakened bronchiolar airways during normal expiration in patients with chronic obstructive pulmonary disease (e.g., emphysema). B, Effects of pursed-lip breathing. The weakened bronchiolar airways are kept open by the effects of positive pressure created by pursed lips during expiration.Slide 11
  12. 12. Digital Clubbing Figure 2-46. Digital clubbing.Slide 12
  13. 13. Clinical Data Obtained at the Patient’s Bedside Peripheral edema and venous distention  Distended neck veins  Pitting edema  Enlarged and tender liverSlide 13
  14. 14. Distended Neck Veins Figure 2-48. Distended neck veins (arrows).Slide 14
  15. 15. Figure 2-47. Pitting edema. From Bloom A, Ireland J: Color atlas of diabetes, ed 2, London, 1992, Mosby-Wolfe.Slide 15
  16. 16. Clinical Data Obtained at the Patient’s Bedside  Cough, sputum production, hemoptysis  Chest assessment findings  Hyperresonant percussion note  Diminished breath sounds  Diminished heart sounds  Decreased tactile and vocal fremitus  Crackles/rhonchi/wheezingSlide 16
  17. 17. Figure 2-12. Percussion becomes more hyperresonant with alveolar hyperinflation.Slide 17
  18. 18. Figure 2-17. As air trapping and alveolar hyperinflation develop in obstructiveSlide 18 lung diseases, breath sounds progressively diminish.
  19. 19. Clinical Data Obtained from Laboratory Tests and Special ProceduresSlide 19
  20. 20. Pulmonary Function Study: Expiratory Maneuver Findings FVC FEVT FEF25%-75% FEF200-1200     PEFR MVV FEF50% FEV1%    Slide 20
  21. 21. Pulmonary Function Study: Lung Volume and Capacity Findings VT RV FRC TLC N or    N or  VC IC ERV RV/TLC ratio  N or  N or  Slide 21
  22. 22. Arterial Blood Gases Mild to Moderate Chronic Bronchitis  Acute alveolar hyperventilation with hypoxemia pH PaCO2 HCO3- PaO2    (Slightly) Slide 22
  23. 23. Time and Progression of Disease Disease Onset Alveolar Hyperventilation 100 90 Point at which PaO2 declines enough to 80 stimulate peripheral oxygen receptors 70 PaO2 or PaCO2 60 PaO2 50 40 30 20 10 0 Figure 4-2. PaO2 and PaCO2 trends during acute alveolar hyperventilation.Slide 23
  24. 24. Arterial Blood Gases Severe Chronic Bronchitis  Chronic ventilatory failure with hypoxemia pH PaCO2 HCO3- PaO2 Normal  (Significantly) Slide 24
  25. 25. Abnormal Laboratory Tests and Procedures  Hematology Increased hematocrit and hemoglobin  Electrolytes  Hypochloremia (chronic ventilatory failure)  Increased bicarbonate (chronic ventilatory failure)  Sputum examination  Increased white blood cells  Streptococcus pneumoniae  Haemophilus influenzae  Moraxella catarrhalisSlide 25
  26. 26. Radiologic Findings Chest radiograph  Translucent (dark) lung fields  Depressed or flattened diaphragms  Long and narrow heart  Enlarged heartSlide 26
  27. 27. Figure 11-2. Chest X-ray film of a patient with chronic bronchitis. Note the translucent (dark) lung fields, depressed diaphragms, and long and narrow heart.Slide 27
  28. 28. Radiologic Findings Bronchogram  Small spikelike protrusionsSlide 28
  29. 29. Figure 11-3. Chronic bronchitis. Bronchogram with localized view of left hilum. Rounded collections of contrast lie adjacent to bronchial walls and are particularly well seen below the left main stem bronchus (arrow) in this film. They are caused by contrast in dilated mucous gland ducts. (From Armstrong P, Wilson AG, Dee P: Imaging of diseases of the chest, St. Louis, 1990, Mosby.)Slide 29
  30. 30. General Management of Chronic Bronchitis  Patient and family education  Behavioral management  Avoidance of smoking and inhaled irritants  Avoidance of infections  Respiratory care treatment protocols  Oxygen therapy protocol  Bronchopulmonary hygiene therapy protocol  Aerosolized medication protocol  Mechanical ventilation protocolSlide 30
  31. 31. GOLD Standards Global Initiative for Chronic Obstructive Lung DiseaseSlide 31
  32. 32. Figure 11-4. Acute exacerbation of COPD (AECOPD): Guideline algorithm (ACCP/ACP-ASIM). CXR, Chest X-ray; NPPV, noninvasive positive pressure ventilation; PEFR, peak expiratory flow rate; URI, upper respiratory infection. (From GUIDELINES Pocketcard: Managing Chronic Obstructive Pulmonary Disease. Baltimore, 2004, Version 4.0, International Guidelines Center.)Slide 32
  33. 33. Figure 11-4. (Close-ups). (From GUIDELINES Pocketcard: Managing Chronic Obstructive Pulmonary Disease. Baltimore, 2004, Version 4.0, International Guidelines Center.)Slide 33
  34. 34. Figure 11-4. (Close-ups). (From GUIDELINES Pocketcard: Managing Chronic Obstructive Pulmonary Disease. Baltimore, 2004, Version 4.0, International Guidelines Center.)Slide 34
  35. 35. Figure 11-4. (Close-ups). (From GUIDELINES Pocketcard: Managing Chronic Obstructive Pulmonary Disease. Baltimore, 2004, Version 4.0, International Guidelines Center.)Slide 35
  36. 36. Figure 11-4. (Close-ups). (From GUIDELINES Pocketcard: Managing Chronic Obstructive Pulmonary Disease. Baltimore, 2004, Version 4.0, International Guidelines Center.)Slide 36
  37. 37. Figure 11-4. Acute exacerbation of COPD (AECOPD): Guideline algorithm (ACCP/ACP-ASIM). CXR, Chest X-ray; NPPV, noninvasive positive pressure ventilation; PEFR, peak expiratory flow rate; URI, upper respiratory infection. (From GUIDELINES Pocketcard: Managing Chronic Obstructive Pulmonary Disease. Baltimore, 2004, Version 4.0, International Guidelines Center.)Slide 37

×