Chapter 12 for exam II Flashcards
What cancer causes the most cancer related deaths in males and females?
lung cancer
What is an acinus?
found distal to terminal bronchiole
berry shaped, contain alveolar duct –> alveolar sac –> alveolus
What is the major pneumocyte found on the alveolar surface?
What is the major pneumocyte found in surfactant?
type I makes up 95% of alveolar surface
Type II is in surfactant
What is atelectasis? what happens to the blood?
Atelectasis is a collapsed lung– failure to expand
decrease in oxygenated blood is shunted, hypoxemia to hypoxia
What are the categories of atelectasis?
resorption
compression
contraction
Details about resorption atelectasis?
airway obstruction that prevents air from reaching distal airways
MC: mucopurulent plug: bronchial asthma, bronchiectasis, chronic bronchitis
single lobe or entire lung
Details about compression atelectasis
aka passive atelectasis
pleural cavity fills with serous fluid, blood, air
CHF is the MC cause
may follow pleural effusion
pneumothorax: air accumulation around lungs
Details about contraction atelectasis
aka cicatrization atelectasis
Scarring of the lungs (interstitial fibrosis, pleural fibrosis)
decreased inhalation– decreased expansion/distention, limits alveolar opening = collapse
Recovery is limited
What is acute respiratory distress syndrome?
severe trauma or infection causes diffuse alveolar damage & bilateral vascular and epithelial damage
with ARDS, what leads to hypoxia?
inflammation prevents gas exhange which leads to hypoxemia then hypoxia
obstructive pulmonary diseases
airflow resistance
decreased expiratory flow rate = wheezing
emphysema, chronic bronchitis, bronchiectasis, asthma
restrictive pulmonary diseases
decreases lung expansion: chest wall disorders (pleura, NMS) & Intersititial lung diseases (fibrosis)
decreased forced vital capacity, normal expiration
What is emphysema?
permanent pulmonary destruction– destruction of alveolar septa and enlarged acini
is there fibrosis found with emphysema?
No!!
What accumulates with emphysema?
inflammatory cells: increase in proteases and ROS, decrease in anti-protease
What are they types of emphysema?
Centriacinar/centrilobar
panacinar/panlobular
details about centriacinar emphysema
20x MC than panacinar
destroys central acini
spares distal lobule
MC in lung apices
risk: chronic smokers
details about panacinar emphysema
acini are uniformly affected/destroyed
MC in lower lungs
risk: alpha-antitrypsin deficiency = increased protease activity
smoking accelerates destruction
Smoking contributes to emphysema in what way?
ROS from the smoke and from the WBC’s brought by the inflammation
‘pink puffer’ refers to…
emphysema
symptoms of emphysema
progressive dyspnea (forced expiration)
cough
hyperventilation
wheezing
weight loss
emphysema is: obstructive or restrictive?
obstructive because there’s wheezing
what is the hallmark of chronic bronchitis?
hypersecretion of mucus
in trachea and bronchi
hypertrophy/hyperplasia of mucous glands
who is most at risk for chronic bronchitis?
males
25% are between 40-65
Symptoms of chronic bronchitis
pronounced & productive cough lasting > or equal to 3 consecutive months in > or equal to 2 consecutive years
sputum production is yellow/green
dyspnea, wheezing, cyanosis, cor pulmonale, recurrent lung infxns
chronic bronchitis is a risk for what?
a secondary microbial infection
blue bloater refers to
chronic bronchitis
chronic bronchitis is almost always complicated by what other condition?
emphysema
Chronic obstructive pulmonary disease (COPD)
T/F: The airflow obstructions associated with COPD are reversible
False, the airflow obstructions associated with COPD are IRREVERSIBLE
what is a risk factor for emphysema, chronic bronchitis and COPD?
cigarette smoking (MC)
air pollution
T/F: The airway obstruction associated with asthma is reversible
True, asthma airway obstruction is REVERSIBLE
What physiologically occurs during asthma?
reversible bronchoconstriction– smooth muscle hypertrophy & hyperreactivity
inflammation & increased mucous
what are curschmann spirals and charcot-leyden crystals associated with?
Asthma
What are the symptoms associated with asthma?
wheezing, dyspnea, cough or chest tightness
difficulty inhaling & exhaling**
Where is asthma most prevalent?
westernized world
Atopic vs. Non-atopic asthma
atopic: (MC) Type I hypersensitivity, Allergens
Non-atopic: bronchial hyper-responsiveness, various non-allergic stimuli
details about atopic asthma
aka extrinsic asthma
MC type: 70% of all cases
childhood onset, family Hx
triggered by environmental antigens
associated with additional allergies
details about non-atopic asthma
aka intrinsic asthma
idiopathic–no allergen sensitization, not genetic
bronchial inflammation & hyper- responsiveness
various stimuli (stress, exercise, cold air, aspirin, inhaled irritants)
what are the differences between normal and bronchial asthma histology?
increased: mucus, WBCs, goblet cells, fibrosis present, smooth muscle, submucosal glands and increased submucosal vascularity
chronic asthma is obstructive or restrictive?
obstructive
what occurs with chronic asthma?
bronchial narrowing
thickened airway wall– hypertrophy of bronchial smooth muscles & submucosal glands –> mucous plugs
fibrosis & increased submucosal vascularity
progressive hyperinflation of the acini–dysfunctional expiration
may be lethal
NO response to bronchodilators or steroids
what is permanent dilation of the bronchial tree?
bronchiectasis
is bronchiectasis restrictive or obstructive?
obstructive
when does bronchiectasis occur?
it is a necrotizing infection
occurs with lung cancer, TB, chronic bronchitis, foreign bodies
impacted mucus: asthma, cystic fibrosis
T/F: during bronchiectasis, there is connective tissue and musculature destruction
True
location of bronchiectasis? if localized or if bilateral, what does it mean caused it?
MC in lower lobes
if localized: caused by foreign body
if bilateral: cystic fibrosis
What causes bronchiectasis/necrotizing pneumonia?
Klebsiella spp. and Staph. aureus
What characterizes chronic intersititial lung diseases?
decreased compliance
MC bilateral and chronic
dyspnea, pulmonary HTN and hypoxia
What do chronic interstitial lung diseases progress into?
respiratory failure, pulmonary HTN and cor pulmonale
What type of fibrosing chronic intersititial lung disease produces velcro-like crackles, an insidious non-productive cough, dyspnea and cyanosis?
idiopathic pulmonary fibrosis, it also produces bilateral/patchy interstitial fibrosis
Who will most likely develop idiopathic pulmonary fibrosis?
men > 60 years
What is the hypothesis for idiopathic pulmonary fibrosis?
repeated endothelial activation
faulty repair –> progressive fibrosis
What produces pneumoconiosis?
inhalation of particulates – MC workplace exposures
pulmonary alveolar macrophages create fibrosis
What are the types of pneumoconioses?
Coal dust
silica
asbestos
Which of the three pneumoconiosis does NOT increase risk of lung cancer?
Coal dust/coal workers pneumoconiosis
Silicosis can be caused by what occupations?
sandblasting
rock mining
rock quarries
ceramics
cutting stone
What is the most common pneumoconiosis worldwide?
silicosis
What pneumoconiosis increases the risk for malignant mesothelioma?
Asbestosis
What professions cause asbestosis?
asbestos insulation
mining
milling
What are the types of coal workers pneumoconiosis?
- Anthracosis
- Simple coal worker’s pneumoconiosis (CWP)
- Progressive massive fibrosis
What is anthracosis? Who’s most at risk?
pigment accumulates in lungs
NO inflammation or dysfunction
asymptomatic
Most city dwellers & smokers are at risk
What is simple coal worker’s pneumoconiosis? What is the hallmark?
Macrophages and little-to-no dysfunction
Hallmark is coal macules & nodules
What is progressive massive fibrosis? What can it lead to?
massive black scars
extensive fibrosis and decreased lung function
pulmonary HTN leads to cor pulmonale
What part of the lung does coal workers pneumoconiosis affect?
MC affects the upper lobes
What is both the MC occupational disease worldwide and the MC pneumoconiosis?
silicosis
Why does silicosis cause so much damage?
the inhalation of silica crystals (quartz) activates macrophages and increases ROS
what does silicosis increase the risk of?
TB and lung CA
What does silicosis destroy?
alveoli which leads to hypoxia
nodular scarring occurs
pulmonary HTN and cor pulmonale
where in the lungs does silicosis occur?
in the upper lung near hilar lymph nodes
How is silicosis most likely detected?
MC detected on routine x-ray of asymptomatic patients
Which pneumoconiosis has whorled appearance on histology?
silicosis
Asbestos exposure may cause:
fibrotic pleural plaques (MC)
mesothelioma
Which pneumoconiosis has interstitial fibrosis, failed phagocytosis and progressive dyspnea and cough?
Asbestosis
where does asbestosis occur in the lung?
begins in the lower lungs/pleura
ferruginous bodies are associated with what?
asbestosis, they are remants of asbestos that was failed to be phagocytized
Asbestosis increases the risk of what cancers?
bronchogenic cancer
mesothelioma
What is the hallmark of sarcoidosis?
noncaseating granulomas!!
affects hilar lymph nodes (lungs)
affects skin: erythema nodosum
T/F: Sarcoidosis is a multisystem inflammatory disorder
true, affects lungs, skin, eyes, liver, spleen
What’s another name for sarcoidosis?
bilateral hilar lymphadenopathy
what populations is sarcoidosis MC in?
african americans
young adults 20-40 years
MC among non-smokers
Do people with sarcoidosis typically recover?
yep, 70% recover
what are most pulmonawry emboli caused by?
95% from DVT
T/F: only 20-30% of pulmonary emboli are diagnosed prior to death
True– there are a small amount that are small enough not to kill you but big enough to cause symptoms
Consequences of pulmonary emboli
depend on size
- increase pulmonary artery pressure–HTN
- tissue ischemia & infarction
sudden pulmonary HTN causes….
diminished cardiac output –>acute cor pulmonale –>hypoxia/death
cardiogenic shock
T/F: infarction from embolus is quite common
FALSE– infarction from embolus is RARE
What has dula blood supply?
pulmonary & bronchial arteries
What is a large pulmonary embolism referred to as?
a saddle embolism
occlusion of >or equal to 60% of pulmonary arterial supply
What percentage of PE are clinically silent?
60-80%
What arteries sustain lungs?
bronchial arteries
infarction caused by a pulmonary embolism is referred to
hemorrhagic: it is raised and red-blue
What are the symptoms of non clinically silent pulmonary emboli?
MC: sudden onset dyspnea
chest pain worse with breathing
cyanosis
collapse
pulmonary HTN is diagnosed as a systemic BP…
> or equal to 30/20
Pulmonary HTN is MC secondary to what diseases?
What happens physiologically?
fibrosis, recurrent emboli and heart disease
decreased cross-sectional area of pulmonary vessels
increased blood volume due to a left-to-right shunt (VSD), congestion is secondary to mitral valve stenosis
What age does pulmonary HTN develop?
any age
mechanisms vary by age: pulmonary or cardiac
vascular alterations that can cause pulmonary HTN
atherosclerosis
smooth muscle hypertrophy
what is primary pulmonary HTN?
when there is no pulmonary pathology
idiopathic
MC sporadic
primary pulmonary HTN is caused by what? who’s it most common in?
endothelia dysfunction– smooth muscle cell proliferation
young adult females
What are the symptoms of primary pulmonary HTN?
dyspnea, fatigue, exertional syncope, angina
possible severe respiratory insufficiency/cyanosis
cor pulmonale decompensation
poor prognosis
What is diffuse alveolar hemorrhage syndrome?
a group of immune-mediated diseases– pulmonary hemorrhage
What is the classic triad associated with diffuse alveolar hemorrhage syndrome?
hemoptysis (coughing up blood)
anemia
diffuse pulmonary edema
Goodpasture syndrome is associated with what? what is it?
associated with classic DAHS
Lung & kidney involvement –type II hypersensitivity
progressive–hemoptysis & hematuria
anemia
Does DAHS have granulomas or sinuses?
NOPE that’s Wegners
What makes up 1/6 of all US death?
pulmonary infection
Pneumonia
What are the sources of pulmonary infections?
- Contaminated air
- Aspiration of nasopharyngeal flora–alcoholics (Klebsiella pneumoniae)
- various comorbid lung pathologies
What are some extrinsic factors that contribue to pulmonary infections?
smoking: decreases mucociliary clearance & decreases immune cell mobilization
Alcohol: decreases cough & epiglottic reflexes
What are some intrinsic factors that contribute to pulmonary infections?
defects in cell-mediated immunity
defects in humoral immunity
Where does pneumonia infections most commonly occur within the lungs?
withing the alveoli
What are the two types of acute bacterial pneumonia?
- Bronchopneumonia– multiple lobes
- lobar pneumonia– one lobe
90% of lobar pneumonia results from infection with what organism?
Strep. pneumoniae
What is community acquired acute pneumonia? what is the main symptom?
Who acquires it?
**MC bacterial: strep. pneumoniae **
not recently hospitalized
mucopurulent sputum: yellow-greenish sputum
acquired by high-risk patients: diabetes, CHF, COPD, immunosuppressed, those with decreased/absent splenic function
How does community acquired acute pneumonia typically present itself on xray?
What organism causes community-acquired acute pneumonia?
lobar
Strep. pneumoniae
What are the additional community acquired pneumoniae besides Strep. pneumoniae?
- *Staph. aureus: *secondary viral URTI, children (MC)
- Klebsiella pneumoniae: alcoholics/debilitated
- Pseudomonas aeruginosa: secondary to burns, chemo and cystic fibrosis
- *Leginella pneumophila: *aquatic–inhalation or aspiration
What are the two community-acquired acute pneumonia caused by Legionella pneumophila?
- Legionnaire disease– aggressive, possible hospitalization, immunocompromised
- Pontiac Fever– limited to an URTI, NO lung involvement, spontaneously resolves
Acute respiratory distress syndrome
Asbestosis
Bronchiectasis
Chronic interstitial lung diseases
coal workers pneumoconiosis
Emphysema
Ferruginous body, asbestosis
silicosis
whorled appearance
silicosis
picture on right is emphysema
centriacinar emphysema
panacinar emphysema
