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Respiratory System (CA) > 12. Pathology of Obstructive Lung Disease > Flashcards

12. Pathology of Obstructive Lung Disease Flashcards

1
Q

What are some obstructive airway diseases?

A

Chronic Bronchitis
Emphysema
Asthma

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2
Q

What do these three obstructive airways diseases have in common and what differs?

A

All caused by airway obstruction but the mechanism for the the obstruction is different

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3
Q

What is Chronic Bronchitis and Emphysema better known as?

A

Chronic Obstructive Pulmonary Disease

COPD

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4
Q

What is FEV1?

A

The Forced Expiratory Volume of air exiting the lung in the first second of this exercise

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5
Q

What is FVC?

A

The Final Total amount expired

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6
Q

What percentage of FVC is usually FEV1?

A

70-80%

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7
Q

What are the statistics for normal FEV1, FVC and FEV1:FVC?

A

FEV1 is about 3.5 – 4 litres
FVC is about 5 litres
FEV1 : FVC is 0.7 – 0.8

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8
Q

What is the predicted FVC based on?

A

Age
Sex
Height

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9
Q

How can COPD be measured accurately?

A

Spirometry

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10
Q

How may obstructive lung disease also be demonstrated?

A

Peak Expiratory Flow Rate

PEFR

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11
Q

What is the normal PEFR?

A

400-600 l/min

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12
Q

What is the normal range of best value for PEFR?

A

80-100%

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13
Q

What is the moderate fall of best value for PEFR?

A

50-80%

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14
Q

What is the marked fall of best value for PEFR?

A

<50%

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15
Q

What happens in Obstructive Lung Disease?

A 
There is AIRFLOW LIMITATION
Peak Expiratory Flow Rate (PEFR) is reduced
FEV1 is REDUCED
FVC may be reduced
FEV1 is less than 70% of FVC
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16
Q

What is Bronchial Asthma considered to be?

A

Considered to be REVERSIBLE airways obstruction either spontaneously or as a result of medical intervention

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17
Q

What is Bronchial Asthma considered to be?

A

Considered to be REVERSIBLE airways obstruction either spontaneously or as a result of medical intervention

18
Q

How can bronchial smooth muscle contraction and inflammation be modified?

A

By drugs

19
Q

What is the aetiology for Chronic Bronchitis and Emphysema?

A

SMOKING
Atmospheric Pollution
Occupation
Effect of age and susceptibility

20
Q

What is an extremely rare cause of emphysema?

A

Alpha-1-antiprotease (antitrypsin) deficiency

21
Q

What is the prevalence of chronic bronchitis and emphysema?

A

Men > Women but increasing in developing countries

22
Q

What is is Chronic Bronchitis clinically defined as?

A

Cough productive of sputum most days in at least 3 consecutive months for 2 or more consecutive years

(This excludes TB, bronchiectasis etc Clinically may be confused with Chronic bronchial asthma)

23
Q

What are the morphological changes of large airways in Chronic Bronchitis?

A

Mucous gland hyperplasia
Goblet cell hyperplasia
Inflammation and fibrosis is a minor component

24
Q

What are the morphological changes of small airways in Chronic Bronchitis?

A

Goblet cells appear

Inflammation and fibrosis in long standing disease

25
Q

What is the pathological definition of emphysema?

A

Increase beyond the normal in the size of airspaces distal to the terminal bronchiole arising either from dilatation or from DESTRUCTION OF THEIR WALLS and without obvious fibrosis.

26
Q

What are forms of emphysema?

A

Centriacinar
Panacinar
Periacinar
Scar ‘irregular’ ‘bullous emphysema’

27
Q

What happens in centre-acinar emphysema?

A

Begins with bronchiolar dilatation

Then alveolar tissue is lost

28
Q

What is the difference between pan-acinar and centri-acinar?

A 
Pan-acinar = By area
Centri-acinar = By number
29
Q

What is a Bulla or bleb?

A

An emphysematous space greater than 1cm

Bleb is often used to describe such spaces just underneath the pleura

30
Q

What is pathogenesis of emphysema?

A

Smoking
- Protease - antiprotease imbalance
Ageing
Alpha-1-antitrypsin deficiency

31
Q

What equilibrium occurs in a normal individual?

A

Anti-elastase (anti-proteases) Elastase (proteases)

32
Q

What are neutrophils and macrophages transformed into?

A

Elastase (proteases)

33
Q

Repair mechanisms, elastase and elastin synthesis form ________

A

Elastin framework in alveolar tissue

34
Q

What is absent in Alpha 1 antitrypsin deficiency?

A

Anti-elastase (anti-proteases)

35
Q

What happens for emphysema to occur?

A

Elastin framework in alveolar tissue is not produced, only tissue destruction

36
Q

What happens for emphysema to occur?

A

Elastin framework in alveolar tissue is not produced, only tissue destruction

37
Q

What is reduced due to smoking?

A

Anti-elastase (anti-proteases)
Repair Mechanisms
Elastin Synthesis

38
Q

What is increased due to smoking?

A

Neutrophils
Macrophages
Elastase (proteases)

39
Q

What is traditionally believed about airway obstruction in COPD?

A

Irreversible but there may be a reversible component

40
Q

What is the small airways of a person with COPD reacts to pharmological intervention?

A

Smooth muscle tone

Inflammation

41
Q

In emphysema what is most important?

A

Loss of alveolar attachments

Respiratory System (CA) (32 decks)

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