Lecture 58 - Pathology of Obstructive Disease Flashcards
what are the obstructive pulmonary diseases ?
COPD:
Chronic bronchitis
Emphysema
Asthma
Bronchiectasis
where do the following occur anatomically ?
- chronic bronchitis
- Emphysema -
- Asthma
CB - bronchus, bronchioles
Emphysema – acinus
Asthma – bronchus, bronchioles
what is emphysema?
what are the different pathological types?
Abnormal enlargement of the air spaces distal to the bronchiole (acinus)
Destruction of the airspace walls, and their elastic recoil
“think of trying to inflate plastic bag, rather than balloons”
Centriacinar
Panacinar
Paraseptal
Centriacinar emphysema –
what is it associated with?
where is it worse
what does it look like under the microscope
Associated with smoking
More severe in the upper lobes
Looks like cysts but there is no scar or fibroustissue; no discrete lining
Panacinar emphysema
- what is it associated with?
- where is it worse?
Associated with 1-antitrypsin deficiency
most severe at lung bases, lower lobes
Paraseptal emphysema
- what is seen patholgocially
- what complication can arise
blebs and bullae
which can cause spontaenous pneumothorax
pneumothorax
what is the pathophysiology of Emphysema?
Abnormal balance of proteolysis -ant proteolysis
what cells secrete elastases, how are they kept in check?
Elastases – secreted by macrophages, mast cells, neutrophils and even bacteria in response to inflammation (such as foreign particles of smoking). Usually kept in check by Elastase inhibitors so they will do their job but not damage the lung
how does smoking lead to an imbalance of proteases and antiproteases
Smoking – can activate macrophage that relase IL-8 and other neutrophil chemotactic factors
Neutrophils and macropages secrete elastases
Cigarette ROS can inhibit anti-proteolytic activity
how does alpha 1 anti-trypsin lead to emphysema ?
what other organ is damaged?
Autosomal recessive d/o
Defect in the folding of the alpha 1 anti-trypsin enzyme which is produced in the liver
therefore deficienct
leads to pan acinar emphysemia
cirrhosis
what is the pathophysiology of chronic bronchitis?
Smoking/smog
leads to increased goblet cells and increased mucous gland production
complications of chronic bronchitis ?
Cor pulmonale
Pulm HTN
Presenation of Chronic bronchtis vs emphysema
Chronic Bronchitis – the blue bloater. Productive cough;
Dyspnea
Common infections
Emphysema - the pink puffer
cough with minimal sputum
prused lips
worse dyspnea
Bronchiole Asthma
what is it?
causes?
Chronic relapsing inflammatory disease with hyperreactive airways
Episodic reversible bronchoconstriction
Causes – Atopy (IgE mediated)
non atopic (virus, irritants, cold, aspirin, exercise)
pathologic changes in an asthma attack?
Broncho - constriction
Mucous production
smooth muscle