Histopathology 12 - Respiratory pathology Flashcards
What are the 2 types of causes of pulmonary oedema?
- Leaky capillaries (drugs, inhalation of particles, pancreatitis)
- Back pressure from a failing left ventricle (left heart failure)
How does diffuse alveolar damage appear on CXR?
Firm and expanded lungs
whiteout appearance
What are the acute features of the airway in asthma?
Acute bronchospasm
Acute mucosal oedema
Inflammation
What are the chronic features of the airway in asthma?
Smooth muscle hypertrophy Goblet cell hyperplasia Eosinophil infiltration Airway narrowing Mucus plugging
What are the features of COPD?
Chronic bronchitis and emphysema
Describe the features of chronic bronchitis
Chronic cough productive of sputum
Most days for at least 3 months over at least 2 consecutive years
How does chronic hypoxia affect the heart?
Pulmonary hypertension —> right heart failure
What is emphysema?
Permanent loss of the alveolar parenchyma distal to the terminal bronchiole
What is the genetic association of emphysema?
Alpha 1 anti-trypsin
Recall the pathophysiology of emphysema
Smoking causes inflammation
Neutrophil and macrophage involvement
Proteases recruited
Breakdown of epithelium
What does lung bullous rupture cause?
Pneumothorax
What is bronchiectasis?
Permanent abnormal dilatation of bronchi with inflammation and fibrosis into adjacent parenchyma
Recall the complications of bronchiectasis
Haemoptysis
Pulmonary HTN
RHF
Amyloidosis secondary to chronic inflammation
Which condition has the strongest association with bronchiectasis?
Cystic fibrosis
What is bronchopneumonia?
Inflammation centred around airway
More common in immunocompromised patients with low virulence pathogens
Where does bronchopneumonia often affect?
Lower lobes
Which type of pneumonia has become much rarer since ABx have been in use?
Lobar pneumonia
What is empyema?
Infected pleural effusion
Which type of pneumonia is most likely to cause interstitial inflammation?
Atypical pneumonias
What are the most common lung tumours?
Epithelial tumours - non small cell and small cell
What are the 3 subtypes of non-small cell lung cancer?
Adenocarcinoma (most common in non-smokers, KRAS, EGFR mutations)
Squamous cell carcinoma (PTHrp, p53 mutations)
Large cell carcinoma
Which 2 types of lung cancer are most associated with smoking?
Squamous cell (strongest correlation to smoking) Small cell (p53, RB1 mutations common, small "oat cells")
Where is squamous cell carcinoma most likely to develop in the lung?
Centrally
Where do adenocarcinomas typically develop?
Peripherally
Most common cancer in non-smokers
Which mutations are smokers most likely to develop in adenocarcinomas?
K ras
p53
Which mutations are non-smokers most likely to develop in adenocarcinomas?
EGFR
Which type of lung cancer is assoiated with the most paraneoplastic syndromes?
Small cell
Cystic fibrosis gene mutation?
35y/o non-smoker, liver and lung problems. Diagnosis?
small oat cells?
CFTR on chrm 7
alpha1 anti-trypsin
small cell lung cancer
iron-laded macrophages?
heart-failure cells- seen in pulmonary oedema due to heart failure
lung path: eosonophilic infiltrates vs neutrophilic infitrates
eos- asthma
neut- copd
