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Pulmonology > Lecture 13: Pathology of Airway Disease > Flashcards

Lecture 13: Pathology of Airway Disease Flashcards

1
Q

Asthma: definition

A

Episodic condition of airflow obstruction characterized by REVERSIBLE airway narrowing

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2
Q

Three types asthma

A

Extrinsic (Type 1 hypersensitivity); intrinsic (nonimmune: aspirin/cold/exercise); status asthmaticus (unremitting due to previously sensitized antigens)

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3
Q

Which asthma can be deadly?

A

Status asthmaticus

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4
Q

Asthma: gross (3)

A

Overdistended lungs, small areas of atelectasis, thick mucus plugs in proximal bronchi

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5
Q

Asthma: microscopic (6)

A

Mucus plugging, EOSINOPHILIC inflammation, increased mucosal goblet cells, THICKENED BASEMENT MEMBRANE, bronchial SM hypertrophy, airway wall edema

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6
Q

Do you see enlarged submucosal glands in asthma?

A

Somewhat

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7
Q

When you think asthma, what should you think is filling the airways?

A

MUCUS

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8
Q

COPD: diagnosis

A

History (chronic bronchitis), physical exam, gross pathology, PFTs + DLCO, ABG

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9
Q

DLCO is ________ in COPD and ________ in chronic bronchitis

A

Reduced; normal

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10
Q

Emphysema: definition

A

Permanent enlargement of the airspace distal to the terminal bronchiole due to destruction

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11
Q

Three kinds of emphysema

A

Centriacinar (smoking, 95%), panacinar, paraseptal

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12
Q

Which kinds of emphysema cause clinically significant airflow obstruction?

A

Centriacinar and panacinar

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13
Q

Centriacinar: define

A

Central/proximal parts of acini are affected, whereas distal alveoli are spared that typically involves upper lobes (smoke floats upward)

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14
Q

Centriacinar is often associated with…why?

A

Chronic bronchitis; smokers/coal miners

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15
Q

Panacinar: define

A

Acini are uniformly enlarged associated with alpha-1 antitrypsin deficiency

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16
Q

Paraspetal: define

A

Proximal portion of acinus is normal, but distal is involved (adjacent to pleura), can result in spontaneous pneumothorax

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17
Q

Alpha-1 antritrypsin deficiency: what does AAT do and where is it from?

A

AAT of liver provides 90% of elastase inhibition in plasma

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18
Q

Alpha-1 antritrypsin deficiency: normal allele and bad allele

A

“M” vs “Z”

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19
Q

Alpha-1 antritrypsin deficiency: presentation

A

Young emphysema and cirrhosis

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20
Q

How does AAT work?

A

Inhibits proteases (elastase) secreted by neutrophils –> if AAT is not there, you end up with too much elastase, which destroys lung tissue

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21
Q

How does smoking work?

A

You end with a functional AAT deficiency because free radicals, etc, inactivate antiproteases (like AAT) –> increase in neutrophil elastase –> tissue damage

22
Q

How much lung is lost before you get symptoms?

A

1/3

23
Q

Bullos emphysema: define

A

Any form of emphysema that forms very large air spaces (>2 cm) right under the pleura

24
Q

What can bullos emphysema cause?

A

Pneumothorax and hemorrhage

25
Q

Is chronic bronchitis more common in smokers? Pathology?

A

Yes (4-10x), tobacco interferes with ciliary action –> directly damages airway epithelium, inhibits WBC ability to clear bacteria, infections maintain the bronchitis

26
Q

Chronic bronchitis: gross

A

Boggy mucosa with excessive mucinous secretions and pus (if infection)

27
Q

Chronic bronchitis: histologically (early and late)

A

Early: hypersecretion of mucus in large airways w/ hypertrophy of submucosal glands; later: increase in goblet cells in small airways cause excessive mucus production and airway obstruction

28
Q

At what stage in chronic bronchitis do you see an increased Reid index? What is the Reid index?

A

Later stages; ratio of thickness of mucus gland layer to wall b/t epithelium and cartilage

29
Q

Does chronic bronchitis have eosinophil infiltrate?

A

Nope: more neutrophil and lymphocyte

30
Q

Normal Reid index

A

0.4

31
Q

Bronchiectasis: definition

A

IRREVERSIBLE dilatation of proximal bronchi due to destruction of bronchial wall

32
Q

Two types of bronchiectasis

A

Localized (obstructive process) or diffuse (non-obstructive)

33
Q

Bronchiectasis is not a disease itself, but a…

A

Pulmonary manifestation of some other disorder

34
Q

Obstructive cause of localized bronchiectasis

A

Tumor, foreign body, inspissated mucus

35
Q

Congenital cause of diffuse bronchiectasis

A

CF, immunodeficiency states, immotile cilia: Kartegeners syndrome

36
Q

Infectious causes of bronchiectasis

A

Severe necrotizing pneumonia (staph, TB)

37
Q

Pathogenesis of bronchiectasis: 3 main points

A
  1. Impaired clearance –> 2. Inflammation –> 3. PMNs and their cell products
38
Q

Bronchiectasis: gross

A

Dilated, tortuous airways extending to pleura with mucus

39
Q

Why is bronchiectasis obstructive?

A

Collapse of dilated airways on expiration

40
Q

Why can bronchiectasis cause hemorrhage?

A

Airways pairs with pulmonary artery, can be eroded into

41
Q

Bronchiolitis: definition

A

Inflammatory response to injury of small airways +/- fibrosis in a diffuse or nodular fashion

42
Q

What is a small airway and epithelium

A

Internal diameter of less than 2 mm devoid of cartilage; simple columnar cells +/- cilia with little connective tissue, resting on SM cells

43
Q

Function of small airways

A

Don’t contribute much but can harm lung function if damaged

44
Q

Etiology of small airway disease

A

Primary: constrictive bronchiolitis; secondary: lots of other airway disease

45
Q

Histological appearance of small airway disease

A

One restricted airway (for example, fibrotic) with nearby dilated airway and adjacent airspaces filled with foamy macrophages

46
Q

Form of bronchiolitis that is more problematic. Two types?

A

Fibrotic; constrictive and intralumenal

47
Q

Describe constrictive bronchiolitis

A

Primary disease of small airways; subepithelial collagen deposition (increased CT b/t epithelium and SM layers)

48
Q

What do you see constrictive bronchiolitis with (main association)?

A

Chronic transplant rejection (abnormal healing response)

49
Q

Late in the stage of constrictive bronchiolitis, what can you see histologically?

A

Airway lumen completely filled with scar due to OUTSIDE –> INSIDE CONSTRICTION

50
Q

Describe intraluminal bronchiolitis (obliterans)

A

Organization of luminal inflammatory exudates; polypoid plugs of fibroblastic tissue; FILLING COMES FROM INSIDE –> OUTSIDE

51
Q

What is intraluminal bronchiolitis associated with? What is it rarely?

A

Alveolar organizing pneumonia; rarely an isolated disease

Pulmonology (21 decks)

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