COPD Flashcards
____ respiratory disease:
decreased total lung capacity, O2, diffusing capacity, and compliance
restrictive
paraseptal emphysema =
sub-pleural involvement
spontaneous pneumothorax
no COPD
irregular emphysema =
localized, scar associated
no copd
emphysema vs chronic bronchitis
pt appearance
blue bloater - CB
E - pink puffer
cover 95% of alveolar surface
type I pneumocytes
4 types of COPD
(obstruction to airflow out)
emphysema
chronic bronchitis
asthma
bronchiectasis
emphysema vs chronic bronchitis
infections
CB common
E- occasional
physical exam findings chronic bronchitis
productive cough
cyanosis
blue bloaters
dypsnea
expiratory wheezing and ronchi
cor pulmonae
causes, bronchiectasis
cystic fibrosis
infections (TB adenovirus, H ifluenzae, Staph A.)
bronchial obstruction
primary ciliary dyskinesia
allergic bronchopulmonary aspergillosis
gros findings bronchiectasis
bilateral lover lobes, distal bronchi, broncioles
dilated airways out to plueral surface
cut surface - bronchi = cystlike with mucopurlent scretions
tissue distal to termial bronchiole
acinus
CXR chronic bronchitis
enlarged, horizontal heart
increased bronchial markings
physical exam findings, emphysema
severe, early onsset dyspnea
pink puffers
chronic bronchitis
cor pulmonae
diminished breath sounds (hyper inflation)
gross morphology chronic bronchitis
hyperemia, swelling, and edema of mucous membranes
mucinous and mucopurulent secretions
emphysema vs chronic bronchitis
age
CB - 40-56
E 50-75
CXR bronciectasis
bronchial markings extending to periphery of lungs
microscopic findings bronchiectasis
acute inflam exudate in bronchial walls
necrotizing ulceration
squamous metaplasia of bronchial epi
lung abcess
fibrosis > brochiolitis obliterans
most common cause of bronchiectatsis
genetics?
cystic fibrosis
AR
pathogenesis cystic fibrosis
chr7 deletion (Phe) >
CFTR transporter for Cl >
increased Na and water reab from luminal secretions, decreased Cl secretion >
>dehydration due to lack of NaCl
emphysema vs chronic bronchitis
cor pulmonae
CB - common
E - rare, terminal
3 causes emphysema
smoking
pollution
a1 antitrypsin deficiency
chronic bronchitis =
productive cough for at least 3months for 2 consecutive years
FEV1/FVC ratio obstructive vs restrictive
obstructive = reduced FEV1/FVC ratio
restrictive = increased
FEV1 =
forced expiratory volume in one second
pathogenesis emphysema
increased macrophages, CD8 Tcells, PMNs >
> activated by tissue damage >
>elastase and free radicals from PMNs and macrophages >
>destruction of elastic tissue >
increased compliance and decreased elasticity
a1-antitrypsin defiency emphysmea (proteas-antiprotease imbalance) impacts lower lung becasue
perfusion and neutrophil numbers greatest
permanent enlargement of all or part of the repiratory unit acompanied by wall destruction without obvious fibrosis
emphysema
Panacinar emphysema=
areas affected
a1-antirypsin deficiency
genetic (AD) or cigarette smoking
lower lobes, all parts of respiratory unit
repair alveolar epithelium
type II pneumocytes
2 types of emphysema
cantriacinar (95%)
panacinar
____ smokers emphysema area of lung impact
centriacinar emphysema > apical segments of upper lobes
clinical presentation bronchiectasis
copoius sputum
hemoptysis
clubbing
cor pulmonale
reid index
rate of the thickeness of mucous gland later to thickness of epithelium and cartilage
increased in chronic bronchitis
measured as lungs forcibly emptied at maximal speed from full inspiration
forced vital capacity FCV
destroyed in bronchiectasis
permanent destruction of cartilage and elastic tissue
pathogenesis chronic bronchitis
irratant > mucus hypersecretion > obstruction (more proximal than emphysema) > irreversible fibrosis
or
infection
bronchospasm
most common causes of death in cystic fibrosis
resp failure
liver failure
oxidative injury from smoke inactive native anti-proteases, bring on a functional ____
a1-antitrypsin deficiency
location of disorders, obstructive and restrictive disease
obstructive - airway, trachea to terminal bronchiole
restrictive - parenchymal - respiratoy bronchiole, alveoli and alveolar ducts
____ respiratory disease:
increased resistance to air flow and limited expiratory rates on forced expiration
obstructive
trapped air in airways in emphysema leads to
dilation and destruction of alveolie, alveolar ducts (also distal/terminal bronchioles)
tissue morphology proximal t bronchioles
pseudostratified ciliated columnar epithelium
clinical presentation cystic fibrosis
nasal polyps
resp infxn>failure (psuedomonas aeruginosa, Staph A, H influenzae, Cor pulmonae)
Malabsorption
DM I
Vas deferens atresia (infertility)
meconium ileus (small bowel obstruction in newborns)
secondary billiary cirrhosis (bile duct obstrction by secretions)
CXR empysema
increased AP diameter
hyerlucent lung fields
verticle heart
depressed diaphram
emphysema vs chronic bronchitis
cxr
CB prominent vessels, large heart
E - hyperinflation, small heart
