Lung II - Diseases Flashcards
Hypoxia lung response
Hypoxic Pulmonary Vasoconstriction
- redirect blood flow to areas w more oxygen
chronic hypoxia leads to hypertension, inflammation;
Whats Type I vs Type II respiratory failure
Type 1 “alveoli/gas exchange problem”
- Hypoxia without Hypercapnia; pO2 low, pCO2 normal
- Ventilation okay but gas exchange oxygen in affected; Corrected by hyperventilation
Type 2 “+ ventilation problem”
- pO2 low, pCO2 HIGH
- RETENTION of CO2 - by ventilation problem
- Obstruction, neuromuscular problem
- when failure of Type 1 compensation - Type 2 progression; failure of hyperventilation, hypoxia of brain - ventilation control gone;
What respiratory failure does COPD cause
Type II
- obstruction - leads to ventilation problems
- V/Q mismatch w V decreased
Name causes of Type I respiratory failure [4]
V/Q mismatch w Perfusion decreased
[Oxygenation problem]
- Pulmonary embolism
- Pneumonia, ARDS (these are oxygen diffusion problems, alveolar damage)
- Pulmonary Edema
Pulmonary Oedema pathophysiology and histo feature
LHF
- backpressure, capillary rupture;
- edema in interstitium, edema in alveolar spaces
- hemosiderin engulfed by macrophage - heart failure cells
Pulmonary Hypertension causes [4]
Cardiac:
Backpressure: LHF
Forward: Left to right shunt
Lung:
- Hypoxic Vasoconstriction of arteries
- Pulmonary emboli
- Idiopathic
Pulmonary HT histological changes [2]
Medial hypertrophy, intimal proliferation
- positive feedback - increased pressure
What necrosis found in Pulmonary Emboli and sequelae
Dual Blood Supply - Hemorrhagic Necrosis
- emboli (tissue damage) blocks blood leaving, necrosis; then hemorrhage, interrupts oxygenation, further necrosis
- pO2 low, ventilation ok - Type I respiratory failure
4 outcomes of Thrombus formation
Propagation - accumulate platelets and fibrin
Embolize - mobile thrombi
Dissolution - tPA break up
Organization - ingrowth of smooth muscle, fibroblast - forming capillary-sized channels
Most common type of G-nephritis?
IgA deposition
What’s atelectasis and causes [3]
Lung collapse
- Resorption - 2nd to obstruction
- Compression - pneumothorax
- Contraction - fibrosis, high surface tension - loss of surfactant
Lung infections general category between URTI and LRTI
URTI - viral
LRTI - bacteria + viral; if reflex bad, defenses bad from primary viral damage, bacteria from URT enters LRT
Bronchitis and Bronchiolitis causes
Viral mostly
Bacteria: Mycoplasma pneumoniae, Bordetella Pertussis
Whats pneumonia
- components and CXR presentation
Infective inflammation, exudate, consolidation
- debris, dead cells, pus, stiffening, scarring
- CXR: solid areas, Airless - hence radio-opaque - WHITE
Give classifications of Pneumonia by mode of spread
Bacteria:
Bronchopneumonia - bronchi to alveoli
Lobar Pneumonia - alveoli to alveoli
Viral:
Interstitial Pneumonia
Bronchopneumonia and Lobar Pneumonia
infective routes
BP: Primary infection on bronchi then spread to alveoli
- follows airway pattern
- More commonly HAPs: Staphylococcus aureus, Klebsiella, E. coli and Pseudomonas (from wiki)
LP: infect at distal airspaces rather than starting at bronchi - then spread bronchioles and alveoli spaces through entire LOBE
- usually Strep Pneumonia, H. Influenza, TB, Klebsiella
- Klebsiella both can
Recall MSSA makes penicillinase
Classify pneumonia by acquisition / Clinical classification lol
CAP: usually Gram Positive
Strep Pneumonia, H. Influenza (Gram-negative, coccobacillary)
HAP/ Ventilator AP: usually Gram neg
- Klebsiella pneumoniae, E. Coli, Pseudomonas aeruginosa (all these are GNR)
Recall P. Aeruginosa AB:
- Carbapenems minus ertapenem: imipenem, meropenem
- 3rd gen Ceft: Ceftazidime
- combine w Aminoglycosides (tobramycin, gentamicin, and amikacin)
also recall Streptomycin for TB
Pneumonitis vs Pneumonia
Interstitium Inflammation (allergy and what not)
- Pneumonia has INFECTION - pus, consodliation
Whats aspiration pneumonia and whats it caused by
Impaired swallowing, Unconsciousness
- commonly Oral anaerobes, OP bacteria + gastric acid + food
Whats atypical pneumonia
Marked inflammatory inflitrate - pneumonitis BUT minimal airspace exudate - absence of consolidation
but is infection
- atypical bacteria or atypical pattern
Give 2 infections and 1 cancer for HIV
Infection
- pneumocystis jirovecii, Cryptococcus neoformans
Cancer - kaposi sarcoma HHV 8
Whats bronchiectasis
Pathogenesis
Dilatation of bronchi
- with chronic inflammation, purulent exudate
- due to repeated, persistent infection
Poor drainage - predispose to R+P infection
- Obstruction
- Mucous viscosity increases - CF
- Immotile cilia syndrome
- hence persistence inflammation, damage to bronchial wall - Bronchiectasis
Studies have demonstrated that the small airways in bronchiectasis are obstructed from an inflammatory infiltrate in the wall. As most of the bronchial tree is composed of small airways, the net effect is obstruction.
Whats Lung Abscess
Cx:
Suppurative Necrosis, forming large cavities
rupture - empyema - pneumothorax; erode into pulmonary vessel - hemorrhage, sepsis
Whats coagulative necrosis
Ischemia,
Preserved cell outlines without nuclei
