NUTR 3336 Lecture 6Outline of Last Lecture ► Diseases of the Respiratory System► Nutrition Pathophysiology► Chapter 23► Anatomy of the Lungs► Measures of Pulmonary Function► Percussion► Auscultation► Pulmonary Function Tests Pulse Oximetry Spirometry► Nutrition and Pulmonary Health► Malnutrition has adverse effects on clinical outcomes May impact the strength and endurance of respiratory muscles (diaphragm) May depress immune function► Antioxidants may promote healthy lung function► Nutrition and Pulmonary Health► Respiratory Disease includes a variety of symptoms that may effect dietary intake such as: Early satiety Anorexia Weight loss Cough Dyspnea Asthma► Chronic Inflammatory Disorder of the airway Primary problem is inflammation► Causes wheezing, breathlessness, chest tightness, coughing► Usually associated with airflow obstruction► Asthma (etiology)► 2 Types Allergic (most common)► Triggered by inhaled allergens Non-allergic► Caused by anxiety, stress, exercise, cold air, dry air, hyperventilation, smoke, viruses, and other irritants► Asthma (pathophysiology)► When asthma occurs, bronchi and bronchioles respond to stimuli by contraction of smooth muscleThese notes represent a detailed interpretation of the professor’s lecture. GradeBuddy is best used as a supplement to your own notes, not as a substitute.► The mucosa is inflamed and edematous due to increased mucous production and a partial or total obstruction occurs in the airway► Asthma (clinical manifestations)► Initial Symptoms: Cough Dyspnea Tight feeling in chestSigns may include:Wheezing, Increased Respiratory Rate, Labored Breathing, Increased Heart Rate, Hypoxia► Chronic Obstructive Pulmonary Disease (COPD)► Airflow is limited through either:  inflammation of the lining of the bronchial tubes (bronchitis) Destruction of alveoli (emphysema)► Chronic Obstructive Pulmonary Disease (etiology)► Risk Factors: SMOKING Air pollution Second-hand  Hx childhood infections Occupational exposure to industrial pollutants Low body weight Chronic Obstructive Pulmonary Disease (etiology)► Chronic Bronchitis Inflammation and scarring of the lining of the bronchial tubes Restricted airflow Excessive mucous production Persistent cough► Chronic Obstructive Pulmonary Disease (etiology)► Emphysema Develops gradually over the years as a result of exposure to cigarette smoke► Chronic Obstructive Pulmonary Disease (pathophysiology)► Chronic Bronchitis Repeated exposure to cigarette smoke and other pollutants causes a generalized inflammatory response As a result, chronic inflammation causes hyperplasia of the mucus-secreting cells and edema occurs in the bronchioles► Airway walls thicken and mucus glands become hyperplastic► Chronic Obstructive Pulmonary Disease (clinical manifestations)► Chronic Bronchitis Decreased airflow rates Dyspnea Hypoxemia► Cyanosis► Clubbing► Secondary Polycythemia Hypercapnia Cor pulmonale (as disease progresses)► Chronic Obstructive Pulmonary Disease (pathophysiology)► Emphysema Complication of chronic bronchitis Destruction of lung tissue Bronchioles lose their elasticity, collapse, and trap air in lungs► Chronic Obstructive Pulmonary Disease (clinical manifestations)► Emphysema Expiration impaired and results in:► Dyspnea► Orthopnea► Hypercapnia► Respiratory acidosis► Cystic Fibrosis (CF)► Characterized by abnormally thick mucus secretions from the epithelial surface of various organs► Cystic Fibrosis (etiology)► Caused by a mutation of the cystic fibrosis transmembrane conductance regulator (CFTR)► Cystic Fibrosis (pathophysiology)► CFTR fails to function properly resulting in thick mucus secretions These secretions lead to obstruction of glands and ducts in affected organs Pulmonary insufficiency occurs leading to pulmonary failure Pancreatic Insufficiency also occurs in 85-90% of CF pt’s► Pneumonia (PNA)► Inflammation of lungs usually caused by bacteria, viruses, or fungi► Pneumonia (etiology)► 2 Types: Community acquired PNA► Caught when an infected person coughs or sneezes and spreads bacteria Hospital acquired PNA► Effects pt’s in ICU or on vents Pneumonia (nutrition implications)► Aspiration Pneumonia Inhaled materials into the airway below the level of the vocal cords Inflammatory response caused in the lungs as a result► Respiratory Failure (RF)► Occurs when the respiratory system is no longer able to perform normal functions This can result from a long-standing disease or as a result of an acute insult to the lungs such as ARDSOutline of Current Lecture ► Metabolic DisordersNutrition PathophysiologyChapter 28► Inborn Errors of Metabolism► A group of diseases that effect a variety of metabolic processes Caused by:► A defect in the activity of one of the enzymes that can catalyze synthesis of a given substrate when needed May lead to:► The accumulation of compounds► Deficiencies► Epidemiology► Epidemiology/Inheritance Over 200 metabolic disorders reported Inherited through autosomal recessive transmission Approximately 4% of individuals in the US are born with genetic or partial genetic disorders each year► Pathophysiology of Impaired Metabolism► May be related to: Deficient or absent enzyme activity Defective gene that results in a change to the binding site of cofactors Enzymatic block that results from a much needed end product► Diagnosis► Newborn Screening Babies must be able to perform physiological tasks Detection may be complicated due to non-specific symptoms (and similar symptoms from inborn error to inborn error)► Clinical Manifestations► Neurological► Respiratory► GI signs► Organ Dysfunction► Amino Acid Disorders► PKU Absence of the Phenylalanine Hydroxylase enzyme► Inability to convert phenylalanine into tyrosine► Tyrosine becomes a conditionally EAA► Results in a build up of phenylalanine, phenylacetic, and phenylpyruvic acid levels► If untreated may cause mental retardation, severe behavioral problems, neurological abnormalities► Found to have musty odor and demyelination of white matter of brain► Disorders of CHO Metabolism► Include problems processing simple sugars (galactose and fuctose) OR defects in