9- Obstructive Lung Disorder Flashcards
Obstructive lung disease functional lung test presents , and physical how?
TLC ^ RV^ Percussion bilateral hyper resonant Auscultation faint Barrel chest Fev1/fvc= decreased
How does the diaphragm present in Ob LD
Pushed down
What mind of diagnosis is emphysema
Anatomical
What kind of diagnosis is chronic bronchitis?
Clinical
What is the cause of airflow obstruction in chronic bronchitis
Edema ,fibrosis and recurring infections of bronchial tree
What is the cause of airflow obstruction in emphysema
Loss of elastic recoil so small respiratory acini collapse
Second cause for Emphysema after cigarette smoke
A1 anti trypsin deficiency
What protease damages the elastic tissue of the lung ?
Serine protease
Destruction of elastic tissue causes what?
Loss of radial traction
Small airways collapse
Air gets trapped
What airways does centriacinar involve
Only dilation of respiratory bronchial
Alveoli normal
The other name for centriacinar
Centri lobar emphysema
What is the mc type of emphysema
Centriacinar
What part of lungs does centriacinar involve
Apical segment of upper lobes where smoke goes up to
Who is centriacinar mostly seen in
Smokers and CWP
Who is panacinar emphysema seen in ?
Patients with AAT deficiency
What organ makes AAT
Liver
Two problems in AAT deficiency ?
Lungs have decreased anti trypsin and liver has accumulation of misfolded ATT - cirrhosis of liver
What does accumulation of misfolded AAT lead to in panacinar emphysema
Cirrhosis of liver cells
What is the thee other name for paraseptal emphysema
Distal acinar
Does paraseptal emphysema cause obstruction
No
What does distal acinar paraseptal emphysema MC lead to
Spontaneous pneumothorax from rupture of sub pleural bullae
What does the thinking and destruction of large air spaces and alveolar capillaries lead to in emphysema
Pulmonary hypertension
3 symptoms of emphysema
Dyspnea
Dec exercise tolerance
Tachypnea– hyperventilation
What does pursing lips in emphysema do and what are these people called
Creates positive backwards pressure- over oxygenated skin so PINK BUFFERS
WhAt develops late in emphysema from PH
COR pulmonary
How does X-ray look in emphysema
Hyperlucent lung fields
Depressed diaphragm
Increased ap diameter
Vertically orientated hidden heart
Mc type of COPD
Chronic bronchitis
Clinical requirement of chronic bronchitis
3 months for two years of cough and sputum
What airways does chronic bronchitis affect
Large-trachea and bronchi
and small airways -terminal bronchi
What do the large airways in chronic bronchitis produce
Mucous gland hyperplasia
Excess mucous
In chronic bronchitis what happens in the small airways
There is goblet cell metaplasia and mucous plugs with smc hypertrophy causing obstruction
What does mucous plug in chronic bronchitis cause
Hypoxemia- acidosis - constriction -cyanosis -PH- COR pulmonale
In chronic bronchitis what does mucous gland
Hypertrophy lead to
Increased Reid index more than .40
What is the reid index
Is the thickness of mucosal gland to entire wall thickness
What do patient with chronic bronchitis look like
Blue bloaters with peripheral edema from RVF
What does late stage chronic bronchitis lead to
Severe hypoxia from broncoconstriction
Pulmonary HT
COR pulomonale
PH in COPD develops from what combination of things
Pulmonary vasoconstriction -Hypoxia
Increased blood viscosity
-polycythemia
Loss of pulmonary vasculature surface area
Why does COPD develop increased lung viscosity
Due to polycythemia from chronic hypoxia
What kind of lung disease is Asthma
Obstructive
What kind of lung disease is bronchiectasis
Obstructive
What airways do bronchiectasis involve
Medium dialated airways extending to pleura
What does inflammation in bronchiectasis cause
Destruction of cartilage muscle And elastic tissue which cause weakness and permanent and irreversible dilatation
Mc cause of bronchiectasis in America
CF
Mc agents causing bronchiectasis in CF patients
Pseudomonas aeruginosa
Mc cause of bronchiectasis in the world
Tb
What causes bronchiectasis
Obstruction from mucous from infection
Chronic persistent infection
Organism that cause bronchiectasis in children
H. Influenza
Common organism that cause bronchiectasis
Strep pneumo
Staph aureus
Pneumococci
Pseudomonas aeroginosa
Causes for bronchiectasis
CF
TB
Broncogenic Carcinoma
Kartagners*
What are the bronchioles In bronchiectasis filled with
Pus
Bronchiectasis clinical findings
Digital clubbing
Cupfull sputum
How does the X-ray of bronchiectasis look
Bronchial markings toward periphery
Obstruction pattern in emphysema
Airway collapse
Obstruction pattern in bronchiectasis
Functional obstruction
Obstruction pattern in chronic bronchitis
Mucous plug
In bronchiectasis what do you find In ct scan of lung
Signet ring and dialated bronchi with thickened walls
Bronchiectasis is reversible or irreversible ?
Irreversible
Asthma is reversible or irreversible
Reversible
What cause obstruction in asthma
Broncospasm
Mucosal inflammation-edema
Excessive secretion of mucous
What airways does asthma involve
Bronchi and terminal bronchioles
Not resp unit
What is the most common cause of children absence in school from respiratory disease
Asthma
Other name for idiosyncratic asthma
Intrinsic asthma
Non allergic asthma
What kind is asthma is aspirin induced asthma
Intrinsic non immune
What kind of asthma is virus induced asthma
Intrinsic
What mind of asthma is ozone produced asthma
Intrinsic
When’re do you see nasal polyps in adults
Aspirin produced asthma
Where do you see nasal polyps in children
CF
In early phase of extrinsic Asthma what is The signal for mast cells to degenerate
Cross link of igE on them
Asthma early stage IL-4 Cause
IgE production
Early stage asthma what cells secrete IL -4 and IL-5
CD 4 TH2 cells
What mind of hypersensitivity is asthma
1
Does does il-5 do in asthma
Chemo tactic for activation of eosinophils
At what time is the late phase of asthma
4-8 hours later
What cells are involved in late phase in Asthma
Neutrophils mononucleosis cells and eosinophils
What is the important mediator in late stage asthma
Leukotrienes cde4
In late phase asthma what do eosinophils release
Mbp- damage epithelial cells
Cationic protein- damage epithelial and cause constriction
What histology changes happen in the cells in asthma
Hyperplasia of mucous glands
Hypertrophy of smc
Edema
Eosinophils infiltrate
What are asthma curshmann spirals
Shed epithelial cells in spiral
Shaped mucous plugs
In asthma What are crystalline granules in eosinophils fuses to form ?
Spear shaped Charcot Leyden crystals
