10/30 - Lung Pathology Flashcards
function of the lung
facilitate exchange of gases (oxygen and carbon dioxide) between inspired air and blood
midline trachea branches into what
lobar bronchi
what allows air to pass in and out of lung?
lobar bronchi
what is a firm cartilage wall and are lined by columnar ciliated epithelium with abundant subepithelial glands that produce mucus
lobar bronchi
which bronchus is more vertical and direct in line with trachea
right bronchus
aspirated material (blood, vomit, foreign material) tend to enter what lung
right lung
right and left bronchi branch give rise to what
progressiely smaller airway
distally, bronchi gives way to what
bronchioles
what lacks cartilage and has submucosal glands present within their walls
bronchioles
further branching of bronchioles give rise to ___ which are how many mm in diameter
terminal bronchioles - 2mm in diameter
beyond terminal bronchioles is the what
acinus
what is a spherical structure with a diameter of 7 mm
acinus
what is acinus composed of
respiratory bronchioles, alveolar duct, and alveolar sac
what is the blind end of the respiratory passage whose walls are formed entirely of alveoli, the site of gas exchange
alveolar sac
what is in a pulmonary lobule
a cluster of 3-5 terminal bronchioles, each with its appended acinus
what is the space between epithelial cells in alveoli
interstitial space
what are congenital lung abnormalities
- pulmonary hypoplasia
- forgut cysts
- pulmonary sequestration
what is defect in development of both lungs, resulting in decrease in lung size
pulmonary hypoplasia
in pulmonary hypoplasia, can one be affected more than the other?
YES
when is severe hypoplasia fatal
early neonatal periodw
what arise from abnormal detachment of primitive forgut
foregut cysts
what BRANCHIOGENIC CYSTS are rarely attached to tracehobronchial tree
foregut cyst
forgut cysts cause compression to what
nearby structures
what is a discrete area of tissue that:
- Is not connected to the airway
- Has an abnormal blood supply arising from the aorta or its branches
pulmonary sequestration
what sequestration occurs EXTERNAL to lung and present in infants as a mass
extralobar sequestration
what sequestration occurs WITHIN lungs? who gets it?
intralobar sequestration - present in older children, often due to recurrent localized infections of bronchiesctasis
what is incomplete expansion of lungs (neonatal) or the collapse of previously inflated lungs
atelectasis
what does atelectasis result in
collapse results in areas of poorly aerted pulmonary parenchyma
types of atelectasis
- resorption
- compression
- contraction
what atelectasis:
Stems from airway obstruction
Over time, air is absorbed from distal alveoli, which collapses lung
resorption atelectasis
what atelectasis:
Results whenever significant volumes of fluid, tumor, or air accumulates in the pleural cavity
compression atelectasis
what atelectasis:
Occurs when foci or generalized pulmonary or pleural fibrosis prevents full lung expansion
contraction atelectasis
what is excessive interstitial fluid in the alveoli
pulmonary edema
what can pulmonary edema result from
- hemodynamic disturbances
- increased capillary permability
hemodynamic disturbaces is due to what
cardiogenic pulmonary edema
increased capillary permeability is due to what
microvascular injury (non-cardiogenic pulmonary edema)
what produces heavy and wet lungs
pulmonary edema
therapy and outcome of pulmonary edema depends on what
underlying cause
what is:
Caused by increased hydrostatic pressure
Occurs most commonly in left-sided heart failure
hemodynamic pulmonary edema (Cardiogenic)
what is:
Primary injury to the vascular endothelium or damage to the alveolar epithelial cells
An inflammatory exudate leaks into the interstitial space and in more serious cases, into the alveoli
microvascular injury pulmonary edema
injury related alveolar edema is an important feature of serious often fatal conditions called what
Acute Respiratory Distress Syndrome (ARDS)
what ALI stand for
acute lung injury
what does ARDS stand for
acute respiratory distress syndrome
what does DAD stand for
diffuse alveolar damage
does ALI lead to ARDS?
YES
DAD is described to diagnose when viewed how?
under microscope (histologic)
___ is characterized by the abrupt onset of hypoxemia and bilateral pulmonary edema in the absence of cardiac failure
ALI
T/F: ARDS is the manifestation of severe ALI
TRUE
___ and ___ are associated with inflammation-associated increase in pulmonary vascular permeability , edema, and epithelial cell death
ALI and ARDS
histologic manifestation of ALI an ARDS is what
diffuse lung damage (DAD)
conditions associated with development of ARDS
- infections
- physical injury
- inhaler irritants
- chemical injury
- hematologic conditions
- Pancreatitis
- Uremia
- Cardiopulmonary bypass
- Hypersensitivity reactions
- Organic solvents
- Drugs
examples of infections causing ARDS
Sepsis, viral, mycoplasma, and pneumocystis pneumonia, gastric aspiration
examples of physical injury causing ARDS
Mechanical trauma including head injury, pulmonary contusion, near-drowning, burns, fracture emboli, ionizing-radiation
examples of inhaler irritants causing ARDS
Oxygen toxicity, smoke, irritant gases and chemicals
examples of chemical injury causing ARDS
Heroin and methadone overdose, acetylsalicylic acid, barbiturate overdose
examples of hematologic conditions causing ARDS
Transfusion-associated lung injury, disseminated intravascular coagulation
clinical features of ARDS
Results in profound dyspnea and tachycardia
Followed by increased respiratory failure, hypoxemia, and cyanosis (blue body)
radiograph findings of ARDS
bilateral infiltrates
is there proven scientific treatments for ARDS
NO! which sucks because it is common in acutely ill patients
mortality rates for ARDS
35% for mild
40% for moderate
45% for severe
what this
ARDS -> extensive BILATERAL ALVEOLAR INFILTRATES with air bronchograms (yellow arrows)
which one normal which one DAD
what is characterized by an increase in resistance to airflow due to diffuse airway disease, which may affect any level of the respiratory tract
obstructive lung disease (OLD)
what is characterized by reduced expansion of lung parenchyma and decreased total lung capacity
restrictive lung disease (RLD)
what lung disease:
- Feels hard to breathe enough air
- Breathing difficulties may cause panic
- Patient may change position to attempt to make it easier to breathe
restrictive lung disease
what lung disease:
- Lungs may feel chronically full or part full
- Wheezing
- Mucus production
ostructive lung dsiease
what is the clinical distinction between OLD and RLD determined by
FEV1/FVC ratio called modified Tiffeneau-Pinelli index
Tiffeneau-Pinelli index for OLD and RLD
OLD: FEV1/FVC less than 0.7 (ratio decreased)
RLD: FEV1/FVC remains normal (ratio is normal)
what is the the volume of air that can forcibly be blown out in first 1-second, after full inspiration
FEV1 (forced expiratory volume at 1 second)
what is the volume of air that can forcibly be blown out after full inspiration, measured in liters)
FVC (forced ventilator capacity (Forced vital capacity (FVC) )
what does chronic obstructive pulmonary disease include
- emphysema - COPD
- chronic bonrchitis - COPD
- asthma
- bronchiectasis
what is a common preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitations that is due to airway and/or alveolar abnormalities caused by exposure to noxious particles or gases.
chronic obstructive pulmonary disease (COPD)
chronic bronchitis
bronchiectasis
asthma
emphysema
what is defined by irreversible enlargement of the airspaces distal to terminal bronchioles, accompanied by destruction of their walls
emphysema
who is empyhsema largely confined to
Largely confined to smokers and patients with alpha-1 antitrypsin (AAT) deficiency
first symptom of patients with emphysema
Dyspnea (breathlessness) first symptom
Wheezing and cough occur if chronic bronchitis coexists
what is a protease inhibitor (Pi) of the proteolytic enzyme elastase? what does protease do?
Alpha-1 antitrypsin (AAT)
Protease is an enzyme that breaks down peptides
pathology of emphysema
- centriacinar
- panacinar
what is associated with cigarette smoking and involves respiratory bronchile first
centriacinar emphysema
what is not associated with cigarette smoking, but associated with AAT deficiency inheritance and involves alveolar duct and alveoli
panacinar emphysema
how does smoking cause tissue destruction
inflammation
activation of neutrophils
inactivation of antiproteases
increase elastase activity
tissue destruction
how does hereditary deficiency of AAT1 cause tissue destruction
increases elastase acticity
___ (shortness of breath- SOB)
first symptom
dyspnea
what disease:
Cough & wheezing present if chronic bronchitis coexists, often the case
Weight loss common
Later, barrel-chested, prolonged expiration, hunched-over position helps with breathing
emphysema
what disease:
Gas exchange & blood gas values are normal until very late in the disease due to hyperventilation (pink puffers)
emphysema
what is defined clinically as persistent cough with sputum production for at least 3 months in at least 2 consecutive years
chronic bronchitis
what is the main cause of chronic bronchitis? what else it blamed?
main: cigarette smoking
additionally: severe air pollution
time length for chronic bronchitis
at least 3 months in at least 2 consecutive years
in later stages of chronic bronchitis, what is seen
significant outflow obstrution w/ severe COPD seen
what disease:
Hypercapnia (CO, retention), hypoxemia (low blood 02) and, eventually, cyanosis (blue bloaters)
chronic bronchitis
how may chronic bronchitis terminate
May terminate with pulmonary hypertension and cor pulmonale with congestive heart failure
Emphysema
Chronic Bronchitis
pink puffer vs blue bloater
emphysema = pink puffer
chronic bronchitis = blue bloater
does asthma fall under COPD
no
what is the most common chronic disease in childhood
asthma
what is a heterogenous disease, usually characterized by chronic airway inflammation and variable expiratory airflow obstruction that produces symptoms such as WHEEZING,
shortness of breath, chest tightness, and cough, which vary over time and in intensity
asthma
when do symptomatic asthma episodes most likely occur
night or in the early morning
symptoms of asthma
cough
dyspnea
excessive mucus production
WHEEZING on expiration due to bronchial constriction (if severe, on inspiration also)
morphology of asthma
- Occlusion of bronchi & bronchioles by thick, tenacious, mucus plugs
- Patchy necrosis & shedding of bronchial epithelial cells
- Edema, hyperemia & an inflammatory cell infiltrate within the bronchial wall
- Hypertrophy and hyperplasia of bronchial smooth muscles
- Increased number of submucous glands (goblet cell hyperplasia) over time
what is immune mediated asthma
Type I HS (Atopic asthma)
describe immune mediate atopic asthma
onset stage: 0-20 years
patient has allergic tendencies
elevated blood IgE and eosinophils
what is the most common type of type I HS reaction
atopic asthma
what are causes of nonimmune (nonatopic) asthma
- viral infections (influenza, rhinovirus, RSV)
- inhaled air pollutants (sulfur dioxide, ozone, nitrogen dioxide)
- NSAID sensitivity
- exercise-induced asthma
do you have elevated, normal, or decreased IgE levels in nonimmune asthma?
NORMAL
can asthma attack occur during dental procedure
YES
___ can result from frequent use of steroid inhalers, especially if patient is diabetic or immunosuppressed
Oral candidiasis
what is a disorder in which destruction of smooth muscles and elastic tissues by inflammation stemming from persistent or severe infection leads to permanent dilation of bronchi and bronchioles
bronchiectasis
why is bronchiectasis not uncommon
because of better control of lung infections
causes of bronchiectasis
- congenital or hereditary conditions
- severe necrotizing pneumonia
- bronchial obstruction
- immune disoder
- idiopathic
congenital or hereditary conditions cause bronchiectasis that predisposed what chronic infections
cystic fibrosis, primary ciliary dyskinesia, Kartagener syndrome
what causes severe necrotizing pneumonia that causes bronchiectasis
bactera, fungi, or viruses
what can cause bronchial obstruction that causes bronchiectasis
tumor, foreign body, or mucus
what can cause immune disorder that causes bronchiectasis
RA, SLE
two categories of chronic diffuse interstitial (restrictive) lung disorders
- chronic interstitial or infiltrative disease
- chest wall disorders
what is chronic interstitial or infiltrative disease that cause restrictive lung disease
pneumoconiosis or interstitial fibrosis of unknown causes
what are chest wall disorders that cause restrictive lung disease
severe obesity, neuromuscular disease, pleural disease, kyphoscoliosis
in restrictive lung disease, what are the FV1 and FVC levels
NORMAL
what diseases associated with fibrosing restrictive lung disease:
Idiopathic pulmonary fibrosis
Pneumoconioses (coal workers, silicosis, asbestos- related diseases)
__ refers to a clinicopathologic syndrome marked by progressive interstitial pulmonary fibrosis and respiratory failure
idiopathic pulmonay fibrosis
cause of idiopathic pulmonary fibrosis
unknown, but arises in genetically predispoed individuals
does idiopathic pulmonary fibrosis have gradual increase in dyspnea on exertion and dry cough
yes
patients with idiopathic pulmonary fibrosis have what survival rate
3.8 years
what is nonneoplastic lung reactions to inhalation of mineral dusts encountered in the workplace or by chemical fumes, and vapors
pneumoconiosis
what is lung disease caused by inhalation of coal particles and other admixed forms of dust
coal worker’s pneumoconiosis
what CWP has little or no pulmonary dysfunction
simple CWP
what CWP has progressive massive fibrosis or compromised pulmonary function
complicated
does CWP have increase in lung cancer risk
NO
Common lung disease caused by inhalation of
proinflammatory crystalline silicon
dioxide (silica)
silicosis
Affects miners, rock workers, glassworkers,
etc.
May be asymptomatic or eventuate as progressive massive fibrosis
LUNG CANCER RISK INCREASED
silicosis
___ is a family of proinflammatory crystalline hydrated silicates that are associated with Pulmonary fibrosis and Various forms of cancer
Asbestos
Pleura; each of a pair of serous membranes lining the thorax and enveloping
the lungs in humans and other mammals
Pleural fibrosis: thickening and calcification of pleura; fire fighters,
construction workers, shipyard workers
asbestosis pleural fibrosis
what has high risk of MESOTHELIOMA (cancer of pleura)
asbestosis pleural fibrosis
A wide variety of idiopathic, immunologic,,
infectious (fungal) and neoplastic
processes can cause a chronic granulomatous
reaction
granulomatous disease
what has a focal area of chronic inflammation
granuloma
granulomatous reaction is characterized histlogically by what
epithelioid cells (transformed macrophages) surrounded by lymphocytes
these epi cells may later fuse to form giant cells
what is systemic granulomatous disease of unknowncause that may involve many tissues and organs
sarcoidosis
histoligic feature of sarcoidosis
formation of noncaseating granulomas
clinical manifestations of sarcoidosis
- LN enlargement, eye involvement (dry eyes, iritis) skin lesions (erythema nodosum), and visceral (liver, skin, marrow) involvement
- Lung involvement occurs in 90% of cases with formation of granulomas and interstitial fibrosis
who gets sarcoidosis
african americans and scandinavians
adults between 30 and 50 years of age
___ seen on the upper back region. Multiple erythematous raised lesions are evident
Papular sarcoidosis as a cutaneous manifestation
treatment of sarcoidosis
- Frequently undergoes spontaneous regression without causing any permanent damage to the affected organs
- Glucocorticoids, is the cornerstone for treatment (associated with several serious adverse effects)
when is treatment for sarcoidosis indicated
Treatment is indicated only when symptoms are disabling and/or the granulomatous inflammation is relentlessly progressive, causing life- or organ-threatening disease
are sarcoidosis lesions common?
NO! RARE!
if present: localized swelling, nodules, ulcers, gingivitis, gingival hyperplasia, gingival recession
what disease:
Communicable chronic granulomatous disease
caused by Mycobacterium tuberculosis
Person to person airborne spread usually
HIV has become single most important risk factor
tuberculoss
in TB, what cell mediated is impaired
t cell mediated immunity
oropharyngeal and intestinal infection can be contacted by what in TB
infected cow’s milk, but rare: M. bovis
TB results is development of what HS
type IV
what disease:
Previously unexposed and unsensitized person
Elderly & profoundly immunosuppressed may develop primary infection more than once
About 5% of primary infections lead to significant disease
primary TB
what is a primary lesion usually subpleural
Ghon focus TB
what is a radiologically detectable finding characteristic of primary tb
Ghon complex
what disease:
Disease occurring in a previously sensitized
host (Most common after many decades following primary infection)
May follow:
- Exposure to heavy inoculum of M. tuberculosis
- May follow loss of T-cell immunity (HIV, Corticosteroids, Debilitating illness in elderly)
secondary reactivation TB
what disease:
Apex of one or both upper lobes usually site
CASEATING GRANULOMAS form
to prevent spread
- Cavitation occurs readily with erosion in bronchi leading to spreading of infection via airways
secondary (reactivation) TB
what is pott’s disease
spinal tuberculosis (and bone)
what is oral tuberculosis
painless ulcer diagnosis made only by biopsy
nothing clinically distinctive
