Case Study 6 - Cellular Adaptations 2 Flashcards
A 42 year old man has had a cough for the last 4 weeks, and has been getting more and more short of breath with minimal activity. He has been coughing up
some dark yellow coloured sputum and occasionally a small amount of dark red
blood. He is a heavy smoker and has been smoking 25 cigarettes a day for the last 20 years. The GP organises for him to have spirometry tests and a chest x-ray.
What different health problems can smoking cause?
COPD includes chronic bronchitis and emphysema, lung cancer, coronary artery disease, heart attack, stroke, hypertension, stomach ulcers, gastro-oesophageal reflux disease (GORD)
A 42 year old man has had a cough for the last 4 weeks, and has been getting more and more short of breath with minimal activity. He has been coughing up
some dark yellow coloured sputum and occasionally a small amount of dark red
blood. He is a heavy smoker and has been smoking 25 cigarettes a day for the last 20 years. The GP organises for him to have spirometry tests and a chest x-ray.
Below is a normal chest x-ray. Label the anatomical structures that you can see on it. (1)
Image
A 42 year old man has had a cough for the last 4 weeks, and has been getting more and more short of breath with minimal activity. He has been coughing up
some dark yellow coloured sputum and occasionally a small amount of dark red
blood. He is a heavy smoker and has been smoking 25 cigarettes a day for the last 20 years. The GP organises for him to have spirometry tests and a chest x-ray.
On the left is the chest xray of our patient. What
differences do you notice? (2)
Image
A 42 year old man has had a cough for the last 4 weeks, and has been getting more and more short of breath with minimal activity. He has been coughing up
some dark yellow coloured sputum and occasionally a small amount of dark red
blood. He is a heavy smoker and has been smoking 25 cigarettes a day for the last 20 years. The GP organises for him to have spirometry tests and a chest x-ray.
A diagnosis of chronic obstructive pulmonary disease is made. The patient is advised that he must stop smoking if he is going to stop the deteriorating function of his lungs. He is prescribed tiotropium.
What is Chronic Obstructive Pulmonary Disease and what are the two forms it can
take?
COPD is obstructive characterised by an increase in resistance to airflow due to partial/complete obstruction at any level from the trachea and the large bronchi to the terminal and respiratory bronchiole. The two main forms of COPD are chronic bronchitis and emphysema.
Chronic bronchitis is a persistent cough with sputum production for at least 3 months in at least 2 consecutive years. It involves long-term inflammation and irritation of the bronchial tubes (airways) in the lungs. This inflammation leads to increased production of mucus, which can block the airways. The symptoms of chronic bronchitis typically include a chronic cough with sputum production.
Emphysema is irreversible enlargement of the air spaces distal to the terminal bronchiole accompanied by the destruction of the walls without obvious fibrosis. Emphysema is characterised by damage to the air sacs (alveoli) in the lungs. Over time, the air sacs lose their elasticity, making it difficult for the lungs to expand and contract properly. This leads to the trapping of air in the lungs and a loss of oxygen exchange capacity. Symptoms of emphysema often include shortness of breath, especially during physical activity.
A 42 year old man has had a cough for the last 4 weeks, and has been getting more and more short of breath with minimal activity. He has been coughing up
some dark yellow coloured sputum and occasionally a small amount of dark red
blood. He is a heavy smoker and has been smoking 25 cigarettes a day for the last 20 years. The GP organises for him to have spirometry tests and a chest x-ray.
A diagnosis of chronic obstructive pulmonary disease is made. The patient is advised that he must stop smoking if he is going to stop the deteriorating function of his lungs. He is prescribed tiotropium.
Below is a microscopic image of part of the lung. Label the structures. (3)
Image
A 42 year old man has had a cough for the last 4 weeks, and has been getting more and more short of breath with minimal activity. He has been coughing up
some dark yellow coloured sputum and occasionally a small amount of dark red
blood. He is a heavy smoker and has been smoking 25 cigarettes a day for the last 20 years. The GP organises for him to have spirometry tests and a chest x-ray.
A diagnosis of chronic obstructive pulmonary disease is made. The patient is advised that he must stop smoking if he is going to stop the deteriorating function of his lungs. He is prescribed tiotropium.
This is a microscopic picture of the lung of a patient with COPD. What do you notice? (4)
Image
A 42 year old man has had a cough for the last 4 weeks, and has been getting more and more short of breath with minimal activity. He has been coughing up
some dark yellow coloured sputum and occasionally a small amount of dark red
blood. He is a heavy smoker and has been smoking 25 cigarettes a day for the last 20 years. The GP organises for him to have spirometry tests and a chest x-ray.
A diagnosis of chronic obstructive pulmonary disease is made. The patient is advised that he must stop smoking if he is going to stop the deteriorating function of his lungs. He is prescribed tiotropium.
Our patient has a biopsy taken of her airways. The sample is sent to the
pathologist.
What type of epithelium should line the airways? (5)
Image
A 42 year old man has had a cough for the last 4 weeks, and has been getting more and more short of breath with minimal activity. He has been coughing up
some dark yellow coloured sputum and occasionally a small amount of dark red
blood. He is a heavy smoker and has been smoking 25 cigarettes a day for the last 20 years. The GP organises for him to have spirometry tests and a chest x-ray.
A diagnosis of chronic obstructive pulmonary disease is made. The patient is advised that he must stop smoking if he is going to stop the deteriorating function of his lungs. He is prescribed tiotropium.
Our patient has a biopsy taken of her airways. The sample is sent to the
pathologist.
What is the definition of metaplasia and dysplasia?
Metaplasia is a reversible cellular adaptation in which one type of mature tissue is replaced by another type of mature tissue. This change occurs in response to chronic irritation, inflammation, or injury. The new tissue type is better suited to withstand the ongoing stress or insult, but it may not be as functional as the original tissue. Metaplasia is generally considered a protective mechanism, although it can increase the risk of subsequent pathological changes. An example of metaplasia is the transformation of the normal columnar epithelium in the respiratory tract into stratified squamous epithelium in response to chronic smoking.
Dysplasia is an increased proliferation of immature abnormal cells in exclusion of mature normal cells. It often involves changes in cell size, shape, and arrangement, and it can be a precursor to neoplasm. Dysplasia can be mild, moderate, or severe, depending on the extent of abnormality. While dysplastic changes are not cancer themselves, they represent a disturbance in the normal maturation and differentiation of cells. Dysplastic cells may have an increased potential to progress to cancer if the underlying cause is not eliminated. Dysplasia is commonly detected through histological examination of biopsy specimens.
A 42 year old man has had a cough for the last 4 weeks, and has been getting more and more short of breath with minimal activity. He has been coughing up
some dark yellow coloured sputum and occasionally a small amount of dark red
blood. He is a heavy smoker and has been smoking 25 cigarettes a day for the last 20 years. The GP organises for him to have spirometry tests and a chest x-ray.
A diagnosis of chronic obstructive pulmonary disease is made. The patient is advised that he must stop smoking if he is going to stop the deteriorating function of his lungs. He is prescribed tiotropium.
Our patient has a biopsy taken of her airways. The sample is sent to the
pathologist.
What type of epithelium is shown in the picture below? (6)
Image
A 42 year old man has had a cough for the last 4 weeks, and has been getting more and more short of breath with minimal activity. He has been coughing up
some dark yellow coloured sputum and occasionally a small amount of dark red
blood. He is a heavy smoker and has been smoking 25 cigarettes a day for the last 20 years. The GP organises for him to have spirometry tests and a chest x-ray.
A diagnosis of chronic obstructive pulmonary disease is made. The patient is advised that he must stop smoking if he is going to stop the deteriorating function of his lungs. He is prescribed tiotropium.
Our patient has a biopsy taken of her airways. The sample is sent to the
pathologist.
Why has the epithelium undergone metaplasia in our patient’s case? (6)
It is reprogramming of the stem cells that are present in all normal tissues, or reprogramming of the undifferentiated mesenchymal cells in response to signals generated by cytokines, growth factors, and extracellular matrix components which drive cells towards the specific differentiation pathway. In this case going from columnar to squamous
A 42 year old man has had a cough for the last 4 weeks, and has been getting more and more short of breath with minimal activity. He has been coughing up
some dark yellow coloured sputum and occasionally a small amount of dark red
blood. He is a heavy smoker and has been smoking 25 cigarettes a day for the last 20 years. The GP organises for him to have spirometry tests and a chest x-ray.
A diagnosis of chronic obstructive pulmonary disease is made. The patient is advised that he must stop smoking if he is going to stop the deteriorating function of his lungs. He is prescribed tiotropium.
Our patient has a biopsy taken of her airways. The sample is sent to the
pathologist.
Can this change in epithelium type help to explain some of our patient’s symptoms?
Provides respiratory tract with tough surface, going from pseudostratified into tough squamous epithelium, this compromises the elastic recoil of the lung, leading to shortness of breath.
The loss of healthy ciliated epithelium impairs the ability to effectively clear mucus and inhaled particles from the airways. This can result in difficulty clearing secretions, a persistent cough, and a heightened risk of respiratory infections.
The presence of squamous epithelium, reduced clearance of mucus, and chronic airway inflammation can make the patient more susceptible to respiratory infections, leading to symptoms like fever, increased sputum production, and worsened cough (no cilia being able to clear the mucus and therefore prone to infections)
A 42 year old man has had a cough for the last 4 weeks, and has been getting more and more short of breath with minimal activity. He has been coughing up
some dark yellow coloured sputum and occasionally a small amount of dark red
blood. He is a heavy smoker and has been smoking 25 cigarettes a day for the last 20 years. The GP organises for him to have spirometry tests and a chest x-ray.
A diagnosis of chronic obstructive pulmonary disease is made. The patient is advised that he must stop smoking if he is going to stop the deteriorating function of his lungs. He is prescribed tiotropium.
Our patient has a biopsy taken of her airways. The sample is sent to the
pathologist.
What is tiotropium? How does it help patients with COPD?
Tiotropium is a medication used in the management of Chronic Obstructive Pulmonary Disease (COPD) and sometimes asthma. It belongs to a class of drugs known as long-acting anticholinergics or long-acting muscarinic antagonists (LAMAs). It binds to muscarinic receptor (M3) on the surface of the muscle cells. Tiotropium acts as a bronchodilator, which means it helps to relax and widen the airways in the lungs. In COPD, the airways are often narrowed due to chronic inflammation and mucus production. Tiotropium helps to open up the airways, making it easier for patients to breathe and improving airflow.
By improving lung function and reducing breathlessness, tiotropium can enhance exercise tolerance, enabling patients to be more active and engage in physical activities, which is beneficial for their overall health and well-being.
Tiotropium has been shown to reduce the frequency and severity of COPD exacerbations. Exacerbations are episodes of worsening symptoms, often triggered by infections or environmental factors, which can lead to hospitalizations. By maintaining better control of COPD symptoms, tiotropium can help prevent these exacerbations.
A 50 year old woman who has been struggling with her weight for a number of years has been having some difficulty sleeping for the last few months.
Whenever she lies down, she has a burning pain in the centre of her chest. She has also noticed an acid taste in her mouth. This discomfort has been present for a long time,
on and off, but has now been getting worse and is now present throughout most the day. She finds that drinking milk helps to ease it slightly.
What do you think the underlying cause of our patient’s symptoms is?
GORD, caused by transient lower oesophageal sphincter relaxations allows acid to reflux back into the oesophagus
Obesity: Excess body weight can increase abdominal pressure, pushing stomach contents upward into the oesophagus
A 50 year old woman who has been struggling with her weight for a number of years has been having some difficulty sleeping for the last few months.
Whenever she lies down, she has a burning pain in the centre of her chest. She has also noticed an acid taste in her mouth. This discomfort has been present for a long time,
on and off, but has now been getting worse and is now present throughout most the day. She finds that drinking milk helps to ease it slightly.
What are the causes of gastro-oesophageal reflux?
The most common cause of GERD is a weakened or relaxed lower esophageal sphincter. The LES is a ring of muscle that acts as a one-way valve between the oesophagus and the stomach. When it doesn’t close properly, stomach acid can flow into the oesophagus
Smoking can weaken the LES and contribute to GERD
Consuming large meals, especially shortly before lying down or going to bed, can increase the risk of reflux
A 50 year old woman who has been struggling with her weight for a number of years has been having some difficulty sleeping for the last few months.
Whenever she lies down, she has a burning pain in the centre of her chest. She has also noticed an acid taste in her mouth. This discomfort has been present for a long time,
on and off, but has now been getting worse and is now present throughout most the day. She finds that drinking milk helps to ease it slightly.
The GP prescribes her some omeprazole, to be taken once a day for 4 weeks. However, after
this course is finished, the
patient still is having these symptoms although less severe. The GP requests an OGD test.
The endoscopist notices a very red area at the distal end of the oesophagus. They take some biopsies of her oesophagus and
send them to the pathologist. (7)
What is an ‘OGD’?
OGD (Oesophago-Gastro-Duodenoscopy) is a medical procedure used to examine the interior of the oesophagus, stomach, and duodenum. OGD is also commonly known as an upper endoscopy or upper gastrointestinal endoscopy.
