Chronic Obstructive Pulmonary Disease and Lung Abscess

Question 1

Emphysema
Chronic bronchitis
Asthma

Overlaps

Answer 1

Alveolar wall destruction and overinflation

Productive cough and airway inflammation

Bronchial hyperresponsiveness from allergens and infections

Question 2

Emphysema def and acini shape

Answer 2

Abnormal dilitation from the level of the terminal bronchiole on down and permanent and not associated with scar

Acini are roughly spherical and 7 mm in diameter…this is where gas exchange occurs

Question 3

Centri
Pana
Distal
and Irregular

Answer 3

Central - middle…central acinus is abnormally dilated up

Panacinar - entire

Question 4

Emphysema

Etiology and patho

Answer 4

Smoking…and rarely alpha-1-antitrypsin def…smoking increases elastase which leads to elastic damage…due to neutrophil recruitment

antitrypsin def…decrease antielastase and more elastic damage…this also happens in smoking

Protease-antiprotease theory

Question 5

Emphysema microscopic pathology and gross

Answer 5

Gross - panacinar/centroacinar

Destruction of bronchial walsl

Question 6

Clinical features of emphysema

Answer 6

1st sx - shortness of breath

Only reliable finding is slowing of forced expiration

“pink puffer” - puffing, working hard, good oxygenation, thin

Relatively decent oxygenation

Question 7

Chronic bronchitis etiology and patho

Answer 7

Smoking, airpollution, infection

Large vs. small airway change airflow obstruction and role of infections…in small airways, will feel more SOIB

Obstructive chronic bronchitis - if you add the SOB

Chronic asthmatic bronchitis - coughing up stuff with variable wheezing

Most important aspect is the sputum production***

Question 8

Chronic bronchitis gross vs. microscopic

Answer 8

Mucinous plugs

Increase in size of submucosal glands, goblet cell hyperplasia, mucous plugging, and inflammation of msall airways

Question 9

Chronic bronchitis clinical

Answer 9

Sputum production

DOE with eventual ABG changes…will stop exercising and comfortable being hypoxic

Blue bloaters - overweight person becoming more blue

Exacerbations - mucous becomes infected and pours out all of the sudden

Most common basteria is heamophilus influenza

LT comps - pulmonary hypertension…right sided heart failure…core pulmomaly?

Question 10

Asthma patho

Answer 10

Depends on subtype

Atopic - IgE mediated hypersensitivity intitial and subsequent exposure to offending allergen

Non atopic - not IgE but secondary to virus or chemicals

Drug induced - aspirin

Occupational - industrial chemicals

Question 11

Non atopic

Drug induced

Occupational

patho

Answer 11

Virus, cold, or stress lower the threshold of responsiveness of the bronchi

Aspirin blocks the COX and tips balance toward leukotrienes

Many mechanisms

Question 12

Asthma gross pathology

Answer 12

Mucous plugging

Question 13

Asthma microscopic patho

Answer 13

Overall thickening of airway wall

Subbasement membrane thicening

Increased vasculairty

increase in size of submucosal glands

Hypertrophy and hyperplasia of smooth muscle wall of bronchus

Question 14

Asthma clinical

Answer 14

Classic attack - sudden onset of cough, SOB and wheezing

Often lasts several hours and can last for several hours

Dx can be aided by increase in airway obstruction, prolonged exp, and increase in blood eosinophil couns

Status asthmaticus may persist for days or weeks and if severe can produce cyanosis and death

Question 15

Bronchiectasis etiology, patho

Answer 15

Obstruction, congenital, infection

Obstruction and infection

Bronchi seen grossly out to the pleura

Inflammation, fibrosis and loss of the linign epithelium

Question 16

Bronchiectasis clinical

Answer 16

Cough with large volumes of foul sputum

Long standing fever

Question 17

Lung abscess etiology, gross path, mciro path, clinical dcourse

Answer 17

Most common is aspiration oneumonia, septic emboli, or cancer

Single or multiple, small or large depends on etiology - “lung gangrene”…single - aspiration…multiple - septic emboli in both lungs

Classic finding is suppurative destruction of pung parenchyma within the central cavity

Course - like bronchiectasis…confrim dx using radiologically…rule out cancer