7 - Injury, Obstructive Dz, Infections, Transplantation Flashcards
3 forms of acquired atelectasis
resorption (obstructive), compressive, contraction
resorption atelectasis
airway obstruction, air resorption
lung vol diminished > mediastinum shifts towards collapsed lung
mucus plugs, foreign bodies, tumors
compressive atelectasis
pleural cavity filled w/ air, fluid, blood, etc
mediastinum shifts away
contraction atelectasis
fibrosis or tumor involving pleura or lung prevents expansion
name of pathologic process behind ARDS
diffuse alveolar damage
how does ARDS look on CT?
ground glass changes w/ consolidation
pathogenesis of ARDS
damage centers on cap/alveolar junction loss of integrity of microvasc endothelium and alveolar epithelium inflammatory cascade leakage of fluid and inflam cells sloughing of epithelial cells
2 phases of diffuse alveolar damage
exudative (acute) (<1wk)
proliferative (organizing)
histologic hallmark of exudative phase of DAD
hyaline membranes
histologic findings in proliferative phase of DAD
type 2 pneumocyte hyperplasia, intra alveolar granulation tissue, alveolar septal thickening, eventual resolution of organization - macrophages clear debris and granulation tissue becomes fibrosis
obstructive lung disease
asthma
chronic bronchitis
bronchiectasis
emphysema
asthma histologic changes
hyperinflated lungs goblet cell metaplasia submucosal gland hypertophy Curschmann spiral - mucus plugs thickened BM and muscle wall hypertrophy
Curschmann spiral
mucus plugs in asthma
Reid index
ratio of thickness of submucosal glands to lung wall
increased in chronic bronchitis
chronic bronchitis histologic changes
inc Reid index
goblet cell metaplasia
chronic inflammation
bronchiectasis lung changes
destruction of muscle/elastic tissue w/ inflammation and fibrosis due to repeated infxn/obstruction
permanent dilation of bronchi/bronchioles in lower lobes
what chronic disease results in a lot of bronchiectasis?
CF
centriacinar emphysema
95% cases, smokers
upper lobe dominant
both emphysematous and normal airspaces present in lobule
panacinar emphysema
alpha 1 antitrypsin def
lower lobe
no normal airspaces
4 pulm defense mechanisms to infxn
cough reflex
mucociliary elevator
alveolar macrophage
host resistance
bronchoPNA begins in ___, lobar PNA begins in ___
airway, alveoli
4 histologic patterns in PNA
congestion/edema
red hepatization - massive exudate of RBCs/WBCs/fibrin
gray hepatization - breakdown of RBCs, persistance of fibrin and neutrophils
resolution - granulation tissue
3 complications of PNA
abscess, fibrinous pleuritis, empyema, hematogenous spread
MC indications for lung transplantation
end stage emphysema
idiopathic pulm fibrosis
CF
primary pulm HTN
