9.DISORDERS AND /OR ADVERSE REACTIONS - RESPIRATORY SYSTEM -SUMMARY
 

Refer - other information

Contents

1.Evidence Based Medicine

2.Facts on Finger Tips

3. Disorders and/or Adverse Reactions                                                                                Items 1 to 20

9.DISORDERS AND /OR ADVERSE REACTIONS - RESPIRATORY SYSTEM-SUMMARY

( Ref- Harrisons - Priniciples of Internal Medicine Ninth Edition )

1. Nasal Obstruction (1254)
2. Respiratory distress Syndrome (1276)
3. Asthma (1202/1207)
4. Infiltration (1241)
5. Pulmonary edema (165)
6. Dyspnea (162)
7. Cough ( 159)
8. Wheezing (1207)
9. Pneumonia (1223)
10.Bronchiectasis (1230)
11.Broncholithasis (1232)
12.Cystic Fibrosis (1233)
13.Chronic Bronchitis (1235)
14.Emphysema and Chronic obstructive lung disease (1235)
15.Primary Pulmonary Hypertension (1247)
16. Pulmonary Thromboembolism (1249)
17. Rhinitis and Nasal Obstruction (1254)
18. Ozena (1255)
19. Acute Pharyngitis (1255)
20. Acute Sinusitis (1257)

1. Nasal Obstruction (1254)

Acute or self limited nasal obstruction is usually associated with upper respiratory tract infections
the most commonly viral. Hypertrophy and inflammation of the tubinates leading to nasal obstruction,
with or without persistent nasal discharge, may be caused by allergic reactions. A common  reason
for difficulty in breathing through the nose is a deviated septum.

    Nasal congestion ( 387 )
     Adverse reaction - drug
       1.Reserpine
       2. Guanethedine
       3. Isoproterenol
       4. Oral contraceptives
       5. Decongestat abuse

2. Respiratory Distress Syndrome (1276)

Adult respiratory distress syndrome is a descriptive term that has been applied to many acute,diffuse,
infiltrative lung lesions of diverse etiologies when accompanied by severe hypoxemia. The term was
chosen because of several clinical and pathological similarities between  such illness in adults and
the neonatal respiratory distress syndrome

Respiratory depression ( 387 )
    Adverse reaction - drug
      1. Aminoglycosides
      2. Polymixins
      3. Trimethaphan
      4. Opiates
      5. Sedatives
      6. Hypnotics

3. Asthma (1202/1207)

Asthma is a disease of airways that is characterstized by increased responsiveness of the
trachebronchial  tree to a multiplicity of stimuli. Asthma is manifested physiologically by a
widespread narrowing of the air passages which may be relieved spontaneously or as result of
therapy. Asthma is manifested  clinically by paroxysms of dyspnea, cough, and wheezing.

Attacks often occur at night, for reasons which are not clear but relate to circadian variation in
airway receptor threshold. attacks may also abruptly follow exposure to a specific allergen,
 physical excertion, a viral respiratory infection, or emotional excitement. At the onset
the patient experience s a sense of constriction in the chest, often with a nonproductive cough.
Respiration becomes audibly harsh and wheezing in both both phases of respiration become
prominent. Patients frequently have tachypnea, and expiration becomes prolonged.

The lungs rapidly become overinflated  and the anterior -posterior diameter of the throax
increases. If the attack is severe or prolonged the accessory  muscles becomes visibly active.
Termination of the episode is frequently marked by a cough producing thick mucus which often
takes the form of casts of the distal airways 

Airway obstruction ( bronchospam, asthma, also anaphylaxis ) ( 387 )
   Adverse reaction - drug
     1. Betablockers
     2. NSAIDs eg.aspirin, indomethacin,
     3. Cholinergic drugs
     4. Tartrazine ( drugs with yellow dye )
     5. Penicillins
     6.Cephalosporins
     7.Streptomycin
     8. Pentozocaine

4. Infiltration (1241)

Infiltration means the diffusion into. accumulation in, a tissue of substances not normal to it.  Infiltrates
of the lung are usually cellular (eg. inflammatory or neoplastic infiltration) or noncellular
(eg. infiltration of edema fluid, collagen, or other substances).  Numerous clinopathologic entities,
therefore , are associated with diffuse infiltration of the lung. Although these disorders differ
considerably in their pathogenesis- which is obsure in many instances- they share the common
features of widespread structural involvement and characterstic alterations in pulmonary function.

 Pulmonary infiltrates ( 387 )
   Adverse reaction - drug
    1. Nitrofurantoin
    2. Methysergide
    3. Chlorambucil
    4. Procarbazine
    5. Busulfan
    6. Melphalan
    7. Cyclophosphamide
    8. Azothioprine
    9. Bleomycin
    10. Methorexate
    11. sulfonamides

5.  Pulmonary edema (165)

An increase in pulmonary venous pressure , which results in initially in the enlargement of the
pulmonary vasculature is most common in most instances of dyspnea in association with
congestive heart failure. The lungs become less compliant, the resistent of small airways increases
and there is an increase in lymphatic flow which apparently serves to maintain pulmonary
extravacular fluid volume

Pulmonary edema ( 387 )
   Adverse reaction - drug
    1.Heroin
    2. Methadone
    3. Hydrochlorthiazide
    4. Propoxyphene
    5. Constrast media

6. Dyspnea (162)

As a cardinal symptom of diseases affecting the cardiorespiratory system , dyspnea is defined
as an abnormally uncomfortable awareness of breathing. Although dyspnea is not painful in the
usual sense of the word, it is, like pain, involved in both the perception of a sensation and reaction
to that perception. Thus, since it is a symptom, dyspnea is present whenever a patient experience
it.

Patients experience and use an even larger number of verbal expressions to describe these
sensations such as - cannot get get enough air-, - air does not go all the way down-, -smothering
feeling in the chest-, -tightness in chest-, - fatigue in the chest- , and a -choking sensation-. 

7. Cough ( 159)

Cough, one of the most frequent cadiorespiratory symptoms is an explosive expiration which
provides a means of clearing the trachobronchial tree of the secretions and foreign bodies.
Coughing may be initiated  voluntarily or reflexly. As a defensive reflex it has both afferent and
efferent pathways. The afferent limb includes cough receptors within the sensory distrubution of
the trigeminal, glossopharyngeal. 

8.Wheezing (1207)

The symptoms of asthma consist of a triad of dyspnea, cough, and wheezing, the latter being
regarded as qua non. In its typical form  asthma is an episodic disease, and all three symptoms
coexist. Attacks often occur at night, for reasons which are not clear but relate to circadian
variation in airway receptor threshold. Attacks may also abruptly follow exposure to a specific
allergen, physical excertion, a viral respiratory infection, or emotional excitement.

At the onset the patient experience s a sense of constriction in the chest, often with a nonproductive
cough. Respiration becomes audibly harsh and wheezing in both both phases of respiration become
prominent. Patients frequently have tachypnea, and expiration becomes prolonged.

9. Pneumonia (1223)

Pneumonia is defined as inflammation in the lung parenchyma, the portion distal to the terminal
bronchioles and comprising the respiratory bronchioles, alevolar ducts, alveolar sacs, and alveoli.
While the inflammation may have different causes and varying durations, the term pneumonia most
commonly refers to infection.

10. Bronchiectasis (1230)

Brochoiectasis can be defined as a permanent abnormal dilation of one or more large ( greater
than 2mm in diameter) bronchi due to  destruction of the elastic and muscular components of
the bronchial wall. This definition is not completely satisfactory because bronchi are also abnormally
dillated in chroncic broinchitis. Thus chronic bronchitis merges into bronchietiasis, and the distintion
depends on the degree of dilation. The sematic problem is complicated further by the fact that the
two conditions coexist.
 
11.Broncholithasis (1232)

Broncholiths, or bronchial stones, occur when calcified particles in lymph node or the lung
parenchyma erode into the continguous bronchus. Broncholithasis, therfore, is a secondary
complication of an antecedent disease that has resulted in residual intrathoraoic calcifications.
Numerous disorders leave calcified deposits that can be detected by chest roentgenography,
but clinically sgnificant bronchlithiasis is rare.

12. Cystic Fibrosis (1233)

Cystic fibrosis (CF) is  autosomal recessive  disease characterized by abnormal thick secretions
from mucous glands, pancreatic insufficiency in approximately 80 percent of patients and three to
five fold increase in the concentration of sodium and chloride in sweat. The clinical features are
related to the dysfunction of the pancreas and to chronic diffuse , obstructive pulmonary process.
Although the disease is commonly diagnosed and treated by pediatricians, an increasing number
of patients survive to or diagnosed for the first time in adulthood. 

13. Chronic Bronchitis (1235)

Chronic bronchitis is a   condition associated with excessive tracheobronchial mucus production
sufficient to cause cough with expectorant for atleast 3 months of the year for more than 2
consecutive years. Simple chronic bronchitis describes the condition characterized by mucoid
sputum production. Chronic mucopurulent bronchitis is characterized by persistent or recurrent
purulence of sputum in the absence of suppurative diseases such as bronchiectasis. 

14.Emphysema  and Chronic Obstructive lung disease (1235)

Emphysema is defined as distention of the air spaces distal  to terminal bronchiole with destruction
of alveolar septa. 
Chronic Obstructive lung disease is defined as a condition in which there is a chronic obstruction
to the airflow due to chronic bronchitis and /or emphysema. Although the degree of obstruction may be
less when the patient is free from respiaratory infection and may improve somewhat with
brochodilator drugs, some obstruction is always present.

15. Primary Pulmonary Hypertension (1247)

Primary (or idiopathic) pulmonary hypertension is an uncommon disease, the diagnosis of
which can be established after a through search for usual causes of pulmonary hypertension.
The patient with primary hypertension  typically is a young female between the ages of 20 and 40
although older and younger patients of either sex have been described. The clinical and laboratory
features of severe pulmonary hypertension are present, but there is no evidence of parenchymal
pulmonary disease or of primary heart disease, not there is evidence for the occurrance of pulmonary
emboli.

16. Pulmonary Thromboembolism (1249)

Pulmonary Thromboembolism (PTE) is a leading cause of morbidity and mortality, and can appear
in many clinical contexts.Epidemiologic surveys indicate PTE is responsible for more than 50,000
deaths in the United States annually.

The three factors involved in thrombogenesis are stasis, abnormalities in the vessel wall, and
alterations in the blood coagulation system. Conditions which are associated with high risk of
thromboembolism  include the postoperative period, pregnancy,particularly the postpartum period;
in the opinion of many , the use of anovulatory drugs, congestive heart failure, chronic pulmonary
disease, fractures or the injuries of the lower extremities, chronic deep venous insufficiency of the
legs, prolonged bed rest, and carcinoma.

17. Rhinitis and Nasal Obstruction (1254)

Intermittant or persistent discharge may be caused by a variety of disorders, including hay fever,
vasomotor rhinitis and complicating nasal polyposts, acute coryza, and other forms of viral rhinitis,
the upper respiratory manifestations of measles, syphilis, and nasal diphteria, intranasal foreign
bodies, and chronic use of vasoconstrictor drugs.

18. Ozena (1255)

This is a severe chronic rhinitis of unknown cause, characterized by thick, greenish discharge,
mucosal crusts, atrophy of the turbinates, and offensive odor. Patients eventually become anosmic.
Even when the nasal  pasages are widened and resistence to airflow is decreased, obstruction
is a common complaint.

19. Acute Pharyngitis (1255)

The oustanding symptom of acute pharyngitis , regardless of the cause,is a sore throat. About
two-thirds of all acute illness in families are viral infections of the upper respiratory tract, with
varying degrees of pharyngeal discomfort present. The acute pharyngitides can be classified
into three groups - 1. treatable infections 2. untreatable infections and 3. noninfectious disorders

20. Acute Sinusitis (1257)

The organisms most often responsible for acute sinusitis are S.pneumoniae, group  A S pyrogenes,
S.aureus and H influenzae. The commonest predisposing factor of acute purulent sinusitis  is
viral infection of the  upper respiratory tract, which lead to obstruction of drainage of the paranasal
sinuses and development of localised pain, tenderness, and low grade fever. These manifestations
clear as the viral disease subsides