Clin Med: Respiratory system & Circulatory system

• Any condition that impedes the development of the thoracic cavity
• May lead to unilateral or bilateral underdevelopment of the lungs

• Partial or total absence of the diaphragm
• May result in herniation of abdomen into thoracic cavity

• Peribronchial cysts
• Lined by bronchial epithelium
• May contain air or mucoid material
• May lead to abcess formation
• May rupture into bronchi or pleural cavity

• Lung tissue w/ no connection to bronchial system
• Extralobar: outside visceral pleura w/ its own
• Intralobar: within visceral pleuro

• Incomplete expansion of alveoli; collapse
• Primary: failure of ventilation @ birth
• Secondary: insufficient surfactant, loss of negative pressure, obstruction, direct pressure on lungs

• Dilation of bronchi & bronchioles
• B/c of destruction of muscle & elastic supporting tissue
• Result of: chronic necrotizing infections, or mechanical obstruction of bronchi

• Lesions: peribronchiolar & within alveolar walls
• Walls widened by edema
• Persistent non-productive cough
• Rare chest pain
• Dyspnea

Inflammation & solidification of pulm parynchyma

• Bacterial
• Inflammatory consolidation
• Patchy distribution
• Usually LOWER lobe

• Bacterial
• Inflammatory consolidation
• Involves ENTIRE lobe
• Streptococcus Pneumoniae

• Congestion: Bacterial proliferation & inflammatory response & serous exudation into alveolar space
• Red Hepatization: neutrophils & fibrin into alveolar space; produced consistency like the liver
• Gray hepatization: disintegration of neutrophils & erythrocytes, w/ fibrin accumulation
• Resolution: Digestion & reabsorption of exudate & restoration of pulm parenchyma to normal

• Weak antigens
• Cause tissue damage via hypersensitivity reactions

• Localized suppuration
• Liquefaction necrosis of lung parenchyma
• Due to aspiration of foreign material
• From altered consiousness
• Usually on RIGHT side b/c of shallow angle of right bronchus
• Cough w/ foul smelling sputum

• Incr. in resistance to air flow from partial or complete obstruction @ any level of lung
• Normal total lung capacity
• Decreased expiratory flow rate
• Anatomic airway narrowing or loss of elastic recoil
• Ex: asthma, empysema, chonic bronchitis, bronchiectasis

• Reduced expansion of lung parenchyma
• Decreased total lung capacity
• Reduced compliance
• Normal expiratory rate

• Episodic, reversible bronchocontriction
• Increased responsiveness to chronic inflammation of tracheobronchial tree
• Dyspnea, cough, wheezing, (during expiration)

• Chronic obstructive
• Increase in size of air space distal to terminal bronchiole

• Absence of breath during sleep
• Inspiratory obstruction--> relaxed walls of the pharynx
• Relieved with strong inspiratory efforts

• 90% of primary malignant tumors of lung
• Begin in hilar regions
• Metastases to regional lymph nodes & distant organs
• Squamous cell carcinoma
• Adenocarcinoma
• Bronchoalveolar
• Small cell carcinoma

• Accumulation of cholesterol-rich fat in the INTIMA of arteries
• Occlude arteries
• Cause: ischemic heart disease, myocardial infarction, stroke & gangrene of extremities
• Vascular smooth muscle has receptors for LDL

• High LDL level- hereditary, diet, exercise
• Cigarette Smoking- oxidizes LDL
• High Blood Pressure- damage to intima
• Lack of exercise- change in lipoprotein receptor count
• Hereditary- hypercholesterolemia
• Low HDL levels

• Systolic blood pressure over 160 mmHg
• Diastolic blood pressure over 90 mmHg
• Result from imbalance b/n:
• Cardiac output
• Renal function
• Peripheral resistance
• Sodium homeostasis

• Inflammation & necrosis of blood vessels
• Raynaud phenomenon
• Polyarteritis nodosa
• Thromboangitis obliterans- Buerger disease

• Abnormal dilation of arteries or veins
• Saccular type or disecting type
• Weakening of the wall- tunica media
• Frequently in the aorta

• Type A: ascending part of aorta
• Type B: decending part of aorta
• Berry type: @ base of skill; imp cause of intracranial bleeding in young patients

• Injury to an arterial wall allows escape of blood to form a hematoma confined by arterial adventitia
• Usually from penetrating trauma

Abnormally dilated veins caused by increased vessel intraluminal pressure

• Thrombophlebitis
• Usually in legs
• Associated with prolonged bed rest
• May lead to embolization to the lung
• May or may not be associated with infection

• Benign
• In blood vessel in skin usually
• can be in internal organs
• Tumors have capillary-like channels filled with blood.

• Highly malignant
• Begins as as a small, painless red nodule located in skin, liver

• Blood contains:
• reduced hemoglobin away from pulm circuit into systemic circuit
• Less O2 saturation
• Results in cyanosis
• Ex: Tetralogy of Fallot
• 1) Pulmonary stenosis
• 2) Ventricular septal defect
• 3) Dextroposition of aorta
• 4) Right ventricular hypertrophy

• Oxygenated blood diverts from systemic circuit into pulm
• Deprives systemic tissues of oxygen
• Increased blood --> increased demand on right side --> Hypertrophy of pulmoary arrteriol walls -> incr pulm hypertension --> right ventricular hypertrophy --> possible shunt reversal

• Local constriction
• Upper extremities show higher blood pressure, left ventricular hypertrophy
• Lower extremities show decreased blood pressure, lower peripheral pulses, coldness, intermittent claudications in calves

• Heart is no longer able to supply enough blood to tissues for norm metabolism
• Related to:
• Loss of myocardial contractility
• Increased resistance
• Inadequate ventricular filling
• Increased ventricular blood volume

• Increased heart rate
• Increased contractility
• Hypertrophy of muscles
• Dilation of ventricles
• Heart later decompesates b/c of additional burden

• Insufficient cardiac output
• Due to:
• Ischemic heart disease & systemic hypertension
• Result:
• Hypertrophy and/or dilation of left ventricle
• Increased hydrostatic pressure in pulm circulation
• Pulm edema
• Dyspnea
• Orthopnea
• Cough

• Right side unable to overcome increased pulm arterial pressure
• Pulm hypertension may be due to parenchymal or vascular disease (pulm emboli)
• Presents:
• Distention of neck veins
• Congestion of liver & ascites
• Pitting edema

• Result of atherosclerosis of coronary arteries
• Blood flow is inadequate for O2 demands of the heart

• Due to transient ichemic myocardial injury
• Discomfort/pain in chest, may extend to neck, left jaw, left shoulder, left arm
• 3 types:
• Stable: from physical activity, use beta blockers
• Unstable: from stress (at rest), coronary artery vasospasm, use Calcium ch blockers
• Variant: Thrombosis is coronary artery

• Irreversible myocardial damage
• Inadequate oxygenation of heart
• Occulded coronary artery & reduced blood flow
• Associated with: high cholesterol level, hypertension, smoking
• Severe persistent chest pain

Occulusion of coronary artery incolving full thickness of ventricular wall (left)

• Hypoperfusion,
• partial thickness
• not associated with regional thrombosis
• 1/3 to 1/2 of left ventricle

• Cardiac arrhythmia
• Left ventricular dysfunction
• Myocardial rupture
• Ventricular aneurysm

• Systemic
• Immuno response
• Symptoms 2 weeks after strept infection:
• Polyarthritis
• Carditis in all 3 heart layers (myocardium, pericardium, endocardium)
• Erithema

• Calcific aortic stenosis
• Mitral valve prolapse
• Endocarditis
• Lupus
• May result in: failure of valve to open for fwd flow, or inability of valve to close causing back flow

• Inflammation involving the myocardium
• Associated with necrosis of myocytes

• One of 3:
• Dilated (congestive): dilation & hypertrophy of heart
• Hypertrophic (obstructive): hypertrophied myocardium w/ mitral insufficiency
• Restrictive cardiomyopathy: restriction of ventricular filling

• Pericarditis, with appearance 1 of 4 ways:
• Serous- from bacteria or virus w/ inflammation
• fibrinous- from infarct or trauma
• purulent- from infection
• hemorrhagic- from injury, TB or neoplasm

Myoxomas- most frequent, left atrium, may cause valve obstruction

Angiosarcoma- most common malignant, but rare