DEVINE Flashcards
ATELECTASIS
collapse of lung w/absorption of air from alveoli
resorptive type
obstruction/block of bronchus by foreign body/mucous/tumor
most common cause of dyspnea
resorptive type - 1st 24hrs postop
compression type
mechanical collapse: pneumothorax, pleural effusion
ARDS
capillaritis = increased permeability»inflammation>widened gap jxn>exudation>neutrophils mediate injury
SARS/influenza
micro=diffuse alveolar damage
permits exudation fr injured vessles into alveoli w/formation of HYALINE MEMBRANES
INCREASED CAP PERMEABILITY
ARDS clinical
rapidly progressive dyspnea w/hypoxemia. poor response to O2 therapy
ARDS causes
local: inhalation smoke/chemicals; near drowning; aspiration of gastric contents, pulm infections, radiation
**SYSTEMIC: systemic inflamm response. septic shock, trauma, narcotics, surgery
spirometry: obstructive
decreased FEV1
spirometry: restrictive
decreased FVC
obstructive disease
block air, destruction of elastic fibers
most common
low O2, normal pH
obstructive disease CAUSES
parenchymal disease of lung (decreased FEV1) asthma emphysema chronic bronchitis/bronchiolitis bronchiectasis
bronchiectasis
bad smelling sputum PERM. dilation and scarring persistent &/or sever infection immotile cilia cystic fibrosis
asthma
smooth muscle hypertrophy
type I: IgE
wheezing
emphysema
acinus (sac)
airspace enlargement - alveolar wall destruction
tobacco smoke (elastase fr neutrophils…LOSS OF ELASTIC RECOIL)
dyspnea
bronchiectasis
bronchiole
inflamm scarring
pulmonary emphysema
dyspnea. barrel chest
“pink puffer” - malnourished, SOB w/o serious hypoxia. pursed lips, hunched over
may die fr resp failure, pneumothorax fr rupture bullae
secondary pulmonary hypertension w/cor pulmonale
bullae
subpleural balloon-like spaces (blebs)
associations w/all forms of pulm emphysema
lung apex
may rupture to produce spontaneous pneumothorax
intersitial emphysema
air w/in connective tissue of the lung
CHRONIC BRONCHITIS
prolonged cough productive of sputum (3mo-2yr)
tobacco smoke
submucosal mucous glands/gob cells increased: hyperplasia/trophy
infiltrates of lymphocytes//mucus plugs, incur mucus glands
ASTHMA
type 1
pollen, allergy
eosinophils, mast cells, IgE
asthma detail
IgE formed in response to exposure to allergen.
IgE antibody attaches to mast cells; mast cells release histamines, proteases; vagal receptors stimulated to produce edema and bronchial constriction.
Eosinophils and neutrophils recruited that damage mucosa; leukotrienes elaborated from arachadonic acid that intensify (2nd phase) bronchoconstriction.
Nonatopic type due to exercise, viral infection or aspirin
Morphology of asthma: Bronchi demonstrate edema, infiltrate of eosinophils, increase in mucous glands and smooth muscle hypertrophy
asthma clin course
first attack = childhood
recurrent eps of sever dyspnea w/wheezing, chron cough last >hours
may progress to COPD
bronchiectasis (ectasis=dilation)
PERMANENT ABNORMAL DILATION OF BRONCHI/BRONCHIOLES due to NECROSIS by INFECTION of WALL
bronchiectasis causes
CF
persistent cough, smells horrible
restrictive lung diseases
decreased FVC (lung vol) ground glass/reticulo (net) nodular appearance on radiographs honeycomb lung of increased interstitial fibrosis on biopsy
restrictive lung disease causes
lung disease in lupus
scleraderma, RA, other type III systemic immune complex diseases
immune complexes
no cough = no FEV1 = no obstructive
RLD pathology
type I pneumocyte injury /activation of macrophages w/producion of fibrogenic cytokines resulting in fibrosis of lung w/decreased compliance
interstitial fibrosis
injury, repair, injury, repair
dry/velcro like rub
pneumonoconisis
chronic fibrosing diseases of the lung due to occupational exposure to inhaled dusts
silica
increased risk of TB
ASBESTOS
insulation pleural plaques- CARCINOGENIC asbestos/ferruginous bodies (looks like a screw) progressive, involves lower lobes years after exposure
radiation & lung
1-6 mo after radiation
hyaline membranes, responds to corticosteroids
chronic radiation pneumotitis: interstitial fibrosis (permanent)
SARCOIDOSIS
multisystem disease characterized by NONCASEATING GRANULOMAS in many tissues & organs TYPE IV (cell mediated) GRANULOMAS = ALWAYS TYPE IV NON TB RELATED
laryngeal carcinoma
squamous cell carcinoma
arises from dysplasia>carcinoma in situe
Most associated with tobacco smoking and alcohol abuse May be due to asbestos; radiation

Tumors of the true vocal cords (glottis tumors) cause hoarseness Local growth into tissues of the neck; cure rate 65%
//suffocates one locally; doesn’t metastasis
laryngeal papillomas
Benign HPV-related neoplasm(s) of vocal cords, larynx
May be multiple and may recur, esp. in children
laryngeal nodules
nonneoplastic reactive proliferation of vocal cord due to voice oversuse, eg “singers nodes”
HOARSENESS
mesothelioma
(uncommon, distractor)
most assoc w/ asbestos. no tobacco assoc.
pleural cav: encases lungs, leads to pulm effusion; resp failture
pericardial: encases heart: heart failure
peritoneum: obstructs intestines
not curable
morphology: asbestos body
pneumothorax
air in pleural cav due to puncture
secondary to rupture emphysematous bleb in a pt w/emphysema or ruptured cavity
spontaneous pneumothorax: occurs in young adults (tall) due to paraseptal emphysematous bulla/bleb
HORNER SYNDROME
pancoast tumor - apex of lung
unilateral enophthalmos (shrunken in eyeball)
ROUND THE HORN, ROUND THE COAST
SUPERIOR VENA CAVA SYNDROME
tumour grows around VC blocking venous return fr head/arms
head & neck congested
cyanotic
inoperable
local effects of lung cancer
obstruction of bronchus: pneumonia
growth into adjacent organ/tissue - esophagous: diff swalling; rib: pain/fracturel recurrent laryngeal nerve (hoarseness) & othrs including SVC and symp ganglia
hyperplastic pulm osteoarthopathy
clubbing of distal fingers/arthritis
causes: lung cancer - paraneoplastic,CBD, RL shunt
paraneoplastic syndrome
effects related to a neoplasm distal from the tumor
not due to local extension
chronic pneumonia
lasts weeks-months
caseating (cheesy) granuloma
lung abscess
pus-filled cavity
contains neutrophils, living pyogenic BACTERIA
xray demonstrates air-fluid level
atypical pneumonia
viral infection
interstitial pneumonia w/lymphocytic response
no alveolar exudates, no consolidation
no sputum
aspiration pneumonia
due to anesthesia, no gag reflex
mixture of microbes + gastric acid
high death rate
morphology of lobar pneumonia
Congestion>red hepatization>gray hepatization>resolution (good) or organization (scar)
goodpasture syndrome
TYPE2 hypersensitivity
develops following injury exposing basement membrane: resp infection in someone exposed to solvents
pt produces anti-glomerular basement membrane antiB that cross reacts w/basement membranes in the lung
destruction of centriacinar septae
tobacco smoke
destruction of panacinar
alpha 1 antitrypsin deficiency
destruction of irregular septae
aging
destruction of paraseptal
spontanoues pneumothorax due to bleb rupture
ectasis
dilation
sarcoidosis assoc
gland enlargement/dry eyes & mouth: MICKULICZ DISEASE
hemoptysis causes
pulmonary emboli, lung cancer, TB, goodpasture, wegener’s granulomatosis
wegener’s granulomatosis
vasculitis w/cANCA antibodies
causes nasopharyngeal necrosis
eye/oribtal lesions
renal glomerular disease
pulmonary hypertension primary
defect in endothelium/SM
young women
pulmonary hypertension secondary
all chronic lung disease
recurrent pulmonary emboli
l-r shunts of CHD
common cause of lobar pneumonia
strep pneumonia
common cause of bronchopneumonia in COPD
h. influenza
lobar
confluent via alveolar pores
large dose virulent organisms
more common in alcoholics, smokers
bronchial
patchy, spread from bronchioles
elderly & very young
follows resp. infection/aspiration
LOBAR
CRGR
aenocarcinoma “non small”
more common in women
may arise in scar: stab= cancer later
trousseau syndrome
small cell carcinoma - neuroendocrine
aggressive local growth
adh production
