Exam 3 - Respiratory Flashcards
Accumulated alveolar macrophages. Cells that are filled with hemosiderin deposits (brown induration)
Hear failure cells
What offers protection against edema in the wall fo the lungs?
Tight junctions of endothelial and epithelial cells
Common causes of pulmonary edema
- Any condition that contributes to pulmonary HTN
- Hypoalbuminemia (reduced oncotic pressure)
- Lymph obstruction
What condition(s) contributes to pulmonary HTN? And what can pulmonary HTN lead to?
Left side heart failure & Mitral stenosis (etc.)
Leads to: Pulmonary edema
What are causes of Hypoalbuminemia (reduced oncotic pressure)? And what can that lead to?
Liver disease, nephrotic syndrome, severe burns
May lead to pulmonary edema
What can cause lymphatic obstruction? And what is the concern?
Tumors, renal disease, congestive heart failure.
The concern is pulmonary edema
What can cause pulmonary emboli and infarcts?
Any factor that leads to systemic thrombosis including: Cardiac disease Immobilization Trauma Surgery Burns Cancer Hypercoagulability states
What is ARDS
Adult respiratory distress syndrome aka Lung Shock
Diffuse alveolar and capillary damage contribute to increased permeability, accumulated fluid and respiratory failure.
On plain film, you would see fluid filled, firm, red, boggy lungs.
ARDS (adult respiratory distress syndrome)
Causes of ARDS?
Most common: sepsis Chemical and thermal injury Oxygen toxicity Severe lung infections Near drowning Narcotic overdose
Atelectasis
Decrease in lung volume for whatever reason
“incomplete expansion of the lungs,”
Greek: ateles “imperfect, incomplete,” literally “without an end,” (from a-, privative prefix, + telos “completion”) + ektosis “extention
Why does atelectasis happen in neonatals?
Stillborn where lungs are airless or secondary deficiencies of surfactant leads to collapsed alveoli
What is acquired atelectasis?
Either obstructive (absorptive) or compressive
Obstructive: airways blocked by foreign bodies, tumors, secretions
Compressive: contributing causes include pneumothorax and hydrothorax
In obstructive atelectasis, what way does the mediastinum shift?
Toward affected side
In compressive atelectasis, what way does the mediastinum shift?
Away from affected side
E.g. pneumothorax and hydrothorax
A group of chronic pulmonary disorders that restrict ventilation (airflow)
COPD (chronic obstructive pulmonary disease)
Characteristics of COPD?
Narrowing of bronchi and bronchioles, chronic or episodic patterns and dyspnea during symptomatic stages
What are major disease characterized by COPD?
Emphysema
Chronic bronchitis
What is common characteristic in emphysema in terms of the alveoli?
Enlargement of alveoli and reduced pulmonary elasticity
E.g. like an office building with a bunch of cubicles — take out some of the cubicle walls and you make the spaces bigger
A serum enzyme produced in the liver protects against action of Proteoglycan enzymes derived from leukocytes activated within lung
Alpha-1-antitrypsin (anti-elastase)
This is associated with the pathogenesis of emphysema
What is the enzymatic hypothesis associated with the imbalanced actions of proteases and protease inhibitors within the lung?
Alpha-1-antitrypsin
Reduced antitrypsin activity includes tobacco smoke and hereditary deficiency of alpha-1-antitrypsin
Whatare the anatomical patterns of emphysema?
Centrilobular — most common
Panlobular — most severe
Other types: paraseptal and irregular (patchy)
What are first signs of emphysema?
- Progressive dyspnea
- Cough but NOT productive
- Weight loss because breathing burns calories
dyspnea
Difficult or labored breathing
What are advanced signs of emphysema?
- Lungs become hyperinflated “barrel chest”
- X-ray shows reduced pulmonary density
- Prolonged expiration
- Pts compensate by overventilating “pink puffers”
One cause of mortality for people with emphysema is pneumothorax which is associated with the rupture of
Bullae
4 causes for mortality of emphysema
- pneumothorax
- Cor pulmonale with increased risk for heart failure
- respiratory acidosis - decreased ventilation lead to elevated CO2
- increased vulnerability to respiratory infection
Pink puffer
Emphysema
Lungs become hyperinflated which contributes to “barrel chest” and depressed diaphragm. Pts overcompensate by overventilating and elevating intrapulmonary pressures, thus they are well oxygenated.
Blue bloater
Chronic bronchitis
Respiratory dysfunction with cyanosis combined with increased risk for heart failure and edema
Persistent productive cough for 3+ months for 2 consecutive years in the absence of other causes
Chronic bronchitis
Pathogenesis and risk factors of chronic bronchitis
Bronchiolitis — small airways disease — interferes with pulmonary ventilation
Risk factors: air pollution, cigarette, pulmonary infection 2˚
Recurrent infections of chronic bronchitis contribute to squamous cell
Metaplasia with loss of cilia. So the secretions are “trapped” and can’t get bumped out by the cilia (because you lost your cilia)
What is another name for bronchial asthma? And what is it?
paroxysmal dyspnea
Chronic inflammatory disorder of airways leading to recurrent episodes of wheezing, breathlessness, chest tightness, cough.
What are the 2 classes of bronchial asthma/paroxysmal dyspnea? and which one is associated with being IgE mediated?
Extrinsic — reaginic, atopy** IgE mediated (type I hypersensitivity)
Intrinsic — non-reaginic, idiosyncratic
Chronic necrotizing infection of bronchi and bronchioles lead to permanent dilation of air passages with pooling of secretions
Bronchiectasis
Usually 2˚ and seen as the “end stage” of other disease
Pathogenesis of bronchiectasis
Infection
- bronchial obstruction may contribute to secretions building up and being a medium for infection
- reduced cilia movement
- necrotizing infections such as measles, staph or pertussis, TB
Infection of lung parenchyma
Pneumonia, pneumonitis
Acute bacterial infections give rise to exudates that fill alveolar spaces with ________ of affected pulmonary tissue
Consolidation, solidification
4 types of acute bacterial pneumonia infections
- Lobar pneumonia - 4 stages/phases of progression
- Bronchopneumonia - caused by staph and strep, more common in the very young or old with pre-existing disease
- Acute necrotizing pneumonia - sudden onset, rapid progression, high mortality
- Acute interstitial pneumonitis or primary atypical pneumonia “PAP” - mild
Acute bacterial infections uniformly affect a large region of the lung, this is called _______ pneumonia
Lobar
90% due to pneumococcus
Name 4 stages of lobar pneumonia
Congestion — inflammation with dilation of alveolar capillaries
Red hepatization — exudates fill alveolar spaces = productive cough
Gray hepatization — consolidation persists, RBCs lysed, antibodies to bacteria form, symptoms persist
Resolution — recovery, exudates lysed, drop in temp
Acute necrotizing pneumonia caused by what organisms or conditions?
Plague
Anthrax “wool-sorters disease”
Legionnaire’s disease
Primary atypical pneumonia (PAP) is also called
Acute interstitial pneumonitis (AIP)
Etiology of acute interstitial pneumonitis?
Mycoplasma pneumoniae
What are the symptoms of acute interstitial pneumonitis?
Mild, acts like a chest cold
Tuberculosis leaves behind granulomas and causes what kind of necrosis?
Caseous necrosis and liquefaction, so the infected tissue is destroyed
1˚ or 2˚ TB? Early stages free of symptoms
1˚ and then 2-3 weeks delayed hypersensitivity and cell immunity develop
1˚ or 2˚ TB? Occurs in “sensitized” subjects who have had prior TB infection
2˚ and caseous necrosis lesions are commonly localized in lung apex
What pulmonary infection is characterized by Ghon complex?
1˚ (childhood) tuberculosis
What are examples of fungal infections of the lung?
- Histoplasmosis 🦇
- Coccidiomycosis
- Candida
What is it called when you inhale suspended particles and that causes lung damage and scarring?
Pneumoconiosis
What specific named dust/breathable chemicals can cause pneumoconiosis (3)?
Silicosis - silicon dioxide particles
Asbestosis - fibers are visible as ferruginous bodies
Anthracosis - coal (carbon) dust
Most 1˚ lung tumors are
Carcinomas
What kind of cancer tumor arises in bronchial mucosa
Bronchogenic carcinoma
What is associated with most lung cancer?
- Cigarette smoke
- Inhaled industrial carcinogens: radon, asbestos, arsenic, etc
- Pulmonary scars: abscesses, surgery, infarcts
4 histological types of Bronchogenic carcinoma (note which ones are related to cigarettes, which ones aren’t)
Squamous cell *cigarette smoking
Small cell “oat cell” *cigarette smoking
Adenocarcinoma - non-cigarette
Large cell
