32 respa Flashcards
congenital anomalies
acute lung injury
manifest as
congestion edema surfactant disruption atelactasis and progress to ards
pulm. edema
define
causes
accumulation of fluid in lungs
hemodynamic edema
edema due to microvascukar injury
edema of undetermined origin
hemodynamic edema
define due to
example cause
histology
lung appearance
due to hydrostatic pressure
left sided chf
hemosiderin laden macrophages prsent
chronic firm and brown induration
ARDS is caused by
diffuse alveolar capillary damage
Clinical features
Hypoxemia and cyanosis with respiratory distress—due to thickened diffusion
barrier and collapse of air sacs (increased surface tension)
‘White-out’ on chest x-ray (Fig. 9.I7B)
alveloar wall become…………. in ARDS
hyalinized
injury is to………..in ARDS
pathogenesis
endothelial and alveolar epi injury
il1
il8 and TNF increase
neutrophil activated
phases of ARDS
EXUDATIVE
proliferative
fibrotic
NEONATAL RESPIRATORY DISTRESS SYNDROME
due to
what cell
associtaed with
Respiratory distress due to inadequate surfactant levels
1. Surfactant is made by type II pneumocytes; phosphatidylcholine (lecithin) is the
major component.
2. Surfactant decreases surface tension in the lung, preventing collapse of alveolar
air sacs after expiration.
3. Lack of surfactant leads to collapse of air sacs and formation of hyaline
membranes.
prematurty
cesarian section
maternal diabetes
why prematurity affect
—Surfactant production begins at 28 weeks; adequate levels are not
reached until 34 weeks.
i. Amniotic fluid lecithin to sphingomyelin ratio is used to screen for lung
maturity.
ii. Phosphatidylcholine (lecithin) levels increase as surfactant is produced;
sphingomyelin remains constant.
iii. A ratio > 2 indicates adequate surfactant production.
why cesearian section cause NARDS
—due to lack of stress-induced steroids; steroids
increase synthesis of surfactant,
why maternal DM causes NARDS
—Insulin decreases surfactant production,
Clinical features OF NARDS
3
- Increasing respiratory effort after birth, tachypnea with use of accessory muscles,
and grunting - Hypoxemia with cyanosis
- Diffuse granularity of the lung (‘ground-glass’ appearance) on x-ray
acute interstitial pneumonia
like ARDS but unknown etiology
Obstructive versus restrictive pulmonary diseases
Obstructive characterized by an increase in resistance to airflow, owing to partial or complete obstruction at any level from the trachea and large bronchi to the terminal and respiratory bronchi restrictive disease characterized by reduced expansion of lung Panka, which is decreases total lung capacity
COPD diseases list
Chronic bronchitis, bronchiectasis , asthma, emphysema
Emphysema
Is characterized by abnormal, permanent enlargement of airspace distal to the terminal bronchioles, accompanied by destruction of their walls , without obvious fibrosis
Types of emphysema
Central Panacinar paraseptal, irregular
From the types of emphysema, which are clinically significant
Central and panacinar
Central or centri acinar emphysema affects
lesions are
What is seen in the walls occurs predominantly in?
Proximal parts of the acinar are affected and distal parts are spared. Lesions are more common in the upper lobe
wall often contain large amounts of black pigments.
Predominantly in heavy smokers
Panacinar emphysema
Involves both proximal and distal bronchioles
it’s more common in the lower lobe and
is associated with alpha 1 anti-trypsine deficiency
Distal or paraseptal emphysema
Spares the proximal acinus
Emphysema is adjacent to the plural along the lobular connective tissue septa, and the margins of the lobules
Occurs adjacent to areas of fibrosis and scarring
More severe in the upper half of the lung
Under lies many cases of spontaneous pneumothorax in adults
Forms blebs and bullous
Most plausible hypothesis to account for the destruction of Alveolar walls
Protease anti-protease mechanism
Can you call manifestations of emphysema do not appear until
1/3 of functioning, pulmonary paranchyma is damaged
Clinical features of emphysema include
- Dyspnea and cough with minimal sputum
- Prolonged expiration with pursed lips (‘pink-puffers’)
- Weight loss
- Increased anterior-posterior diameter of chest {‘barrel-chest,’ )
- Hypoxemia (due to destruction of capillaries in the alveolar sac) and cor
pulmonale are late complications.
Other types of emphysema list
Compensatory hyper inflation, emphysema obstructive over inflation, bullous emphysema interstitial emphysema
Compensatory hyperinflation emphysema
Hyper inflation of the residual lung parenchyma that follow surgical removal of a diseased lung or lobe
Obstructive over inflation, define and give example
Refers to the condition in which the lung expands because air is trapped within it. Common cause is obstruction by tumor or foreign object. Example is congenital labor over inflation in infants.
Interstitial emphysema
Presence of air or gas within the interstitial space of the lung
CHRONIC BRONCHITIS
Chronic productive cough lasting at least 3 months over a minimum of 2 years;
highly associated with smoking
c. bronchitis Characterized by
hypertrophy of bronchial mucinous glands
1. Leads to increased thickness of mucus glands relative to overall bronchial wall thickness (Reid index increases to > 50%; normal is < 40%)
reurrent infection because of of mucus plus and smoking
metaplasia of brochiol epithelium follows
Chronic bronchitis patients known as
blue bloaters
asthma define and types
Reversible airway broncho constrict ion, most often due to allergic stimuli (type I
hypersensitivity)
Atopic
non atopic
drug induced
occupational
atopic asthma
define
pathogenesis
Presents in childhood; often associated with allergic rhinitis, eczema, and a family
history of atopy
Pathogenesis
1. Allergens induce TH2
2. TH2 cells secrete IL-4 (mediates class switch to IgE), IL-5 (attracts eosinophils),
and IL-10 (stimulates T|}2 cells and inhibits T^l).
3. Reexposure to allergen leads to lgE-mediated activation of mast cells.
IL4 IL5 IL10 functions
TH2 cells secrete IL-4 (mediates class switch to IgE), IL-5 (attracts eosinophils),
and IL-10 (stimulates TH2 cells and inhibits TH1).
early phase rxn and late phase rxn in asthma
i. Release of preformed histamine granules and generation of leukotrienes C4,
D4, and E4 lead to broncho constrict ion, inflammation, and edema (earlyphase reaction),
ii. Inflammation, especially major basic protein derived from eosinophils,
damages cells and perpetuates bronchoconstrict ion (late-phase reaction).
clinical triads in asthma
cough
wheezing
dyspnea
macroscopic and microscopic finding of asthma
tnecious mucus
crushman spirals
and
charcot leydon crystals
made of eosinophil membrane proteins
if asthma persists
status athmaticus
BRONCHIECTASIS
define
due to
Permanent dilatation of bronchioles and bronchi ; loss of airway tone results in air trapping.
1. Cystic fibrosis
2. Kartagener syndrome
3. Tumor or foreign body
4. Necrotizing infection
5. Allergic bronchopulmonary aspergillosis
kartagener syndrome
inherited defect of the dynein arm, which is necessary
for ciliary movement. Associated with sinusitis, infertility (poor motility of
sperm), and situs inversus (position of major organs is reversed, e.g., heart is on
right side of thorax)
etiology and pathogenesis of BRONCHECTASIS
obstruction and infection
bronchial obstruction
normal clearing mechanism impaired
pooling of secretion distal to obstruction
inflammation
bronchoectasis usually affects the
lower lobes bilaterally
Clinical features of bronchoectasis
- Cough, dyspnea, and tbul-smelling sputum
- Complications include hypoxemia with cor pulmonale and secondary (AA)
amyloidosis.
diffuse pulmonary hemorhage syndromes 3
goodpastures sydrome
idiopathic pulmonary hemosiderosis
vasculitis associated hemorehage
PNEUMONIA
A. Infection of the lung parenchyma
B. Occurs when normal defenses are impaired (e.g.. impaired cough reflex, damage to
mucociliary escalator, or mucus plugging)
loss of clearin mechanism interfered by
loss of cough reflex
injury to mucociliary apparatus
interference with phagocytic action of alveolar
pulm congestion and edema
accumulation of secretions
2 patterns are classically seen on chest x-ray in pneumonia
lobar
lobular
lobar pneumonia
DEFINE
usually what
A. Characterized by consolidation of an entire lobe of the lung
B. Usually bacterial; most common causes are Streptococcus pneumoniae (95%) and
Klebsiella pneumoniae
Classic gross phases of lobar pneumonia
- Congestion—due to congested vessels and edema
- Red hepatization—due to exudate, neutrophils, and hemorrhage tilling the alveolar
air spaces, giving the normally spongy lung a solid consistency (Fig. 9.3B,C) - Gray hepatization—due to degradation of red cells within the exudate
- Resolution
BRONCHOPNEUMONIA
define
where
cause
age
A, Characterized by scattered patchy consolidation centered around bronchioles; often
multifocal and bilateral and basal
B. Caused by a variety of bacterial organisms viral benzene
in extreme of ages
difficulty in resolution
the 7 pneumonia syndromes or pneumonia can arise in 7 clinical settings
community acquired acute
communiy acquired atypical
nosocomial
aspiration
chronic
necrotizing pneomnia and abcsess
pneumonia in immunocom.
community acquired acute pneumonia
cause
organism specific
risk factors
bacterial or viral
bacterial infection follows viral
risk factors
extreme ages
chronic diseases
immunodeficiency
absent spleen - encapsulated infection
organism
strep pneumonea
H. influenza
Moraxella catarhalis
staph aures follow viral
klebsella
pseudomonas
legionella organ transplant
complications of community acquired pneumonia
abscess formation
empyma acc. of pus in pleural space
organization of exudate then solid tissue
bacteria dissemination
community acquired atypical
define
present as
organisms
A. Characterized by diffuse interstitial infiltrates
B. Presents with relatively mild upper respiratory symptoms (minimal sputum and low fever); ‘atypical’ presentation lack of alveolar exudate
C. Caused by bacteria or viruses
org.
mycoplasma
coxiella
chlamydia
influenza virus
adeno rhino rubeola varcilla
influenza infectios cause epidemics and pandemics how
epidemics
mutations of hemaglutinin and neuramindase
virus escape host antibody
antigenic drift
pandemics
both agglutinin and neuraminidase are replaced through recombination of rna of animal viruses
antigenic shift
nosocomial pneumonia
org
gram negative rods
staph aures
not strep pneumoniea
aspiration pnemonia
seen in
common org
and often causes
which lung
Seen in patients at risk tor aspiration (e.g., alcoholics and comatose patients)
Most often due to anaerobic bacteria in the oropharynx (e.g., Bacteroides,
Fusobacterium, and Peptococcus)
necrotizing pneumonia with abcsess
right lung
lung abscess
define
organism
A lung abscess is a localized collection of pus within the lung tissue characterized by necrosis of lungs
mixed
causative organisms of lung abscess are introduced by
aspiration
primary bacterial infection
septic emboli
neoplasia
miscellaneous trauma , from other organs
primary cryptogenic pneumonia
when all causative agents are excluded and no reason for abscess formation
pulm. abscess due to aspiration are
place and bi or uni
right lung
single
pulm. abscess that develop in course of pneumonia or bronchoectasis are
multiple basal scattered
when abscess and other communication exists it creates
air filled cavity
superimposed saprophytic infections are prone to develop
gangrene of lung
pulm. abcsess manifestations are like
bronchoectasis
complication of lung abscess
extension to pluera
hemorrhage
brain abscess or meningitis
secondary amyloidosis
chronic pnemonia
granulomatous inflamation by bacteria or fungi
tb
histoplasmosis blastomycosis
coccidomycosis
HBC fungi discussed togethere because 2
granulomatous disease like tb
dimorphic hyphae at envrt temp and spore at body temp.
pnuemonia in immunocompromised orgnaism include
bacteria
pseudomonas mycobacterium legionella listeria
virus
CMV herpes
fungi
candida aspergillus cryptococcus pneumocytis carni
in HIV CD4 counts
>200
<200
<50
bacterial
pneumocystis pneumoniea
CMV M. avium
lung cancer classification anatomically
central arise from main bronchi
peripheral in the parenchyma solitary pulm. nodule
4 type of precursor cancerous lesions recognized
Squamous dysplasia and CIS
aatypical adenomatous hyperplasia
adenocarcinoma in situ
diffuse idiopathic pulm. neuroendocrine cell hyperplasia
lung cancers arise mostly in
and also which type
hilus of lung
cental 2/3rd
small number arise in the peripheral lung and are predominantly
adenocarcinomas
lung tumors have habit of spreading except ……………….which metastasis outside of thorax late
SCC
Most organ involved in the metastasis of lung cancers
adrenals
SCC
risk factor
sex
frequency of mutation
assoc. with smoking
male
high frequency of p53 mutation
adenocarcinoma
sex and risk factor
precursor lesion
mutation different from SCC
women and non smokers
atypycal adenomatous hyperplasia
adenomatous CIS
K-RAS mutation lower in non smokers
adenomatous grow ……… and metastasize …………….. compared to SCC
grow slowly
metastasize rapidly
small cell carcinoma
define
characterize epithelial cells
complications
derived from
epithelial cells are small with scant cytoplasm ill defined cell borders finely granular nuclear chromatin and absent nucleoli
necrosis is common
neuroendocrine progenitor cells of linig of bronchial epithelium
………….. staining of vascular walls due to encrustation by …… from necrotic tumor cells present
basophilic
DNA
characteristics of small cell carcinoma 7
ectopic hormone production
strong relationship with smoking
occur both in central and peripheral bronchus
no preinvasive lesion
most aggressive metastasize widely
incurable by surgical resection
p53 and RB mutation
large cell carcinoma
undefferentiated epithelial cell tumours that lack cytologic features of small cell carcinoma , adenocarcinoma and squamous cell carcinoma
probably represent SCC and adenocarcinoma that are so undefferentiated that they can no longer be recognized
local effects of lung tumor
lipid pnemonia
pneumonia
svc syndrome
diaphgram paralysis
horner syndrome
which tumors have better prognosis and which have bad
adenocarcinoma and aquamous cell better prognosis
systemic manifestations of lung cancer
lambeert eaton
peripheral neuropathy
acanthosis niagrans
leukmoid reaction
hypertrophic pulm. osteoarthritis
apical lung cancer (aka) tend to invade …………… and produce………..
pancoast tumors
neural structures around trachea
horner syndrome
carcinoid tumors age types and grade
low grade malignant tumor
younger than 40
typical and atypical
typical carcinoid tumors and atypical
no p53 mutation
central carcinoid tumors characteristics
polypoid mass that projects into lumen
covered by intact mucosa
peripheral carcinoid tumor chrxts
specific name (like what)
intaluminal masses that penetrate bronchial wall and fan out
collarbutton lesion
classic carcinoid syndrome
diarrhea
flushing
cyanosis
most carcinoid tumors ………………….. (secretory activity ) and ……………… metastasis
dont have secretory activity
donot metastasize
among the miscellenous tumors of lung which one is common in children
inflammatory myofibroblastic tumor
normal pleural fluid volume and content
15 ml
acellular
clear lubricating fluid
inflammatory pleural effusion types
serous serofibrous
fibrous
suppurative (empyma)
hemmorhagic pleritis
empyma most common cause
contigous spread from intrapulmonary infection
hemmorhagic pleuritis is found in or caused by
hemorhagic diatheses
ricketssial disease
neoplastic involvement
serofibrous pleural effusion most common cause
radiation
non inflammatory pleural effusion list
hydrothorax
hemothorax
chylothorax
chylothorax where
difference b/n true and pseudochyle
more on left bc thoracic duct
true chyle contain fat
ascites assoc.ted pleral effusion which lung
right lung
types/ causes of pneumothorax
traumatic/ tension pneumothrax
spontanous idiopathic
tension pneumothorax manifestation
pushed trachea to opposite side
spontaneous idiopathic pneumothotax manifestation
rupture of blebs
subsides spontaneously
trachea pushed towards the lesion
MESOTHELIOMA
Malignant neoplasm of mesotheiial cells; highly associated with occupational
exposure to asbestos
Presents with recurrent pleural effusions, dyspnea, and chest pain; tumor encases the lung
