Lecture 58 - Pathology of Obstructive Disease Flashcards

1
Q

what are the obstructive pulmonary diseases ?

A

COPD:
Chronic bronchitis
Emphysema

Asthma

Bronchiectasis

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2
Q

where do the following occur anatomically ?

  • chronic bronchitis
  • Emphysema -
  • Asthma
A

CB - bronchus, bronchioles

Emphysema – acinus

Asthma – bronchus, bronchioles

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3
Q

what is emphysema?

what are the different pathological types?

A

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

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4
Q

Centriacinar emphysema –

what is it associated with?
where is it worse

what does it look like under the microscope

A

Associated with smoking
More severe in the upper lobes

Looks like cysts but there is no scar or fibroustissue; no discrete lining

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5
Q

Panacinar emphysema

  • what is it associated with?
  • where is it worse?
A

Associated with 1-antitrypsin deficiency

most severe at lung bases, lower lobes

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6
Q

Paraseptal emphysema

  • what is seen patholgocially
  • what complication can arise
A

blebs and bullae
which can cause spontaenous pneumothorax

pneumothorax

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7
Q

what is the pathophysiology of Emphysema?

A

Abnormal balance of proteolysis -ant proteolysis

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8
Q

what cells secrete elastases, how are they kept in check?

A

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

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9
Q

how does smoking lead to an imbalance of proteases and antiproteases

A

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

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10
Q

how does alpha 1 anti-trypsin lead to emphysema ?

what other organ is damaged?

A

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

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11
Q

what is the pathophysiology of chronic bronchitis?

A

Smoking/smog

leads to increased goblet cells and increased mucous gland production

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12
Q

complications of chronic bronchitis ?

A

Cor pulmonale

Pulm HTN

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13
Q

Presenation of Chronic bronchtis vs emphysema

A

Chronic Bronchitis – the blue bloater. Productive cough;
Dyspnea
Common infections

Emphysema - the pink puffer
cough with minimal sputum
prused lips
worse dyspnea

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14
Q

Bronchiole Asthma

what is it?

causes?

A

Chronic relapsing inflammatory disease with hyperreactive airways
Episodic reversible bronchoconstriction

Causes – Atopy (IgE mediated)

non atopic (virus, irritants, cold, aspirin, exercise)

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15
Q

pathologic changes in an asthma attack?

A

Broncho - constriction

Mucous production

smooth muscle

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16
Q

what is the role of mast cells?

what is the role of eosinophils

A

Eosinophils (IL-5, IgE) –

17
Q

gross morphological findings of patients who’ve died of asthma attacks ?

A

mucus plugs

hyperinflated lungs

18
Q

Mircoscopic findings of patients who’ve died of asthma attacks?

what are the two eponym findings?

A

Microscopic: Bronchial inflammation, layer of eosinophils, prominent smooth muscle cells, mucous gland hyperplasia, thick basement membrane

		Curschmann's Spiral -- whorls of shed epithelium 

		Charcot Leyden Crystals --- eosinophil derived crystals
19
Q

Bronchiectasis –
what is it?
what causes it?

A

Inflammatory destruction of bronchial wall; loss of airway tone leading to trapping

Cystic fibrosis 
TB 
Kartagener syndrome (cilia dont' work) 
Post obstructive infections and inflammation 
allergic bronchopulmonary aspergillosis