lung julia Flashcards
Tracheoesophageal (TE) Fistula
congential
- abnormal connection between the trachea and esophagus
- associated with esophageal atresia (absence or closure of a portion of the esophagus)
classic lobar PNA: what bacteria and stages
associated with streptococcus
4 stages:
- congestion
- red hepatization: red lung with exudation - neutrophils, red cells, fibrin in alveolar space
- gray hepatization: disintegrated red cells but persistence of fibrinosuppurative exudate
- resolution: exudates broken down to produce granular semifluid debris that is resorbed by macrophages or organized by fibrobalsts
Atelectasis: and types
Atelectasis – incomplete expansion of lung, or collapse
Resorption atelectasis – usually cause be obstruction, e.g tumor
Compression atelectasis – pleural fluid compresses lung
Contraction atelectasis – assoc. with diffuse fibrotic lung diseases
ARDS: Acute Respiratory Distress Syndrome
ARDS (Acute Respiratory Distress Syndrome) = non-specific pattern of lung injury –> alveoli lined by hyaline membranes so no oxygen exchange can take place
= “end-stage” lung
- Multiple causes-
- diffuse alveolar damage
Pulmonary edema
INC venous P + DEC oncotic P + lymphatic obstruction + alveolar injury
Chronic Obstructive Lung Disease: emphysema, types
Emphysema – destruction of alveolar walls causing enlargement of air spaces
- progressive air trapping and can cause recurrent PNA
Centriacinar emphysema: Cigarette smoking
Panacinar emphysema: alpha-1-antitrypsin deficiency
emphysema xray findings
Hyperexpansion
flattened/blunted diaphragm
increased lucency
heart may appear narrow
Bullae/blebs
Chronic Bronchitis
main cause usually smoking
- mucus hypersecretion due to GOBLET cell hyperplasia
- chronic inflammation -> can progress to emphysema
Asthma: histological findings
Histological findings in bronchi(oles)
- mucus hypersecretion with plugging
- Eosinophils/lymphocytes
- lumen narrowing
- smooth muscle hypertrophy around bronchi & bronchioles: constant spasms = hyperplasia
wheezing is characteristic!!!**
Atopic (allergic) vs Non-atopic:
- strong allergic role: IgE, eosinophils
Restrictive Lung Diseases
Density of lung is increased, less “spongy,” dec compliance
- cant inhale
- reduced gas exchange: anatomic or functional barriers between the endothelial cells of capillaries and type-1 pneumocytes (gas exchange cells) in the alveoli.
types:
- fibrosing
- granulomatous
- eosinophilic
- smoking related
- PAP: pulmonary alveolar proteinosis
Bronchiectasis
Bronchiectasis = dilated bronchus
- associated with chronic necrotizing inflammation
- congenital, TB, bronchial obstruction, RA, SLE, IBD
- condition where large bronchi damaged and dilated
Fibrosing Restrictive Lung Diseases types
idiopathic pulmonary fibrosis
- typical histology: usual interstitial pneumonia with areas of young and old fibrosis scattered together through lung
- injured epithelial cells may produce TGF-beta which is fibrinogenic
non-specific interstitial pneumonia:
- fibrosis and cellular infiltration but better diagnosis
other associations: collagen vascular diseases
- RA
- SLE (lupus)
- systemic sclerosis
Pneumoconioses/Occupational lung diseases
articles 1 – 5 um most dangerous - coal, silica, asbestos
- Macrophages ingest them –> stimulate immune system
- Over 5: cilia can push it out; under 1 - macrophages can push it out
types: coal workers pneumoconiosis, asbestos-related lung disease, silica
Granulomatous restrictive lung ds
Sarcoidosis
- systemic but usually involves lung
- immune, genetic factors
–> non-caseating (non-necrotizing) granulomatous inflammation [some with Schaumann bodies and asteroid bodies]
Hypersensitivity pneumonitis :
- Granulomatous reaction to inhaled organic antigens -> interstitial fibrosis
- dusts, bacteria, fungi, Farmer’s Lung, Pigeon Breeder’s Lung = immune mediated-reaction to inhaled organic dusts
- 2/3 pts: non-caseating granulomas
- When removed from source, patient improves but then recurs upon re-exposure
DIP = desquamative interstitial pneumonia
- = presence of alveolar macrophages with pigment
- smoking related restrictive lung disease
pulmonary alveolar proteinosis
restrictive lung ds
caused by
- deficiency in GM-CSF
- macrophage dysfunction
- accumulation of intra-alveolar precipitates containing surfactant
- 90% autoimmune
Pulmonary Vascular Diseases : Pulmonary embolism
-may be secondary to immobilization, debilitative states
- thrombi usually come from deep leg veins or deep pelvic veins
Key Features for dx:
- acute chest pain, decreased pO2
- VQ scan shows ventilation-perfusion mismatch *
- angiogram important *
Pulmonary hypertension
High pressure in the pulmonary circuit (mean arterial pressure > 25 mm Hg; normal is 10 mm Hg), caused by
- COPD
- congenital heart disease: increased left atrial pressure
- recurrent PE
- autoimmune diseases: scleroderma
Leads to right ventricular hypertrophy with eventual cor pulmonale
- Presents with exertional dyspnea or right-sided HF
Hemorrhagic syndromes of pulmonary vascular ds
Goodpasture syndrome
– autoimmune, usually male, autoantibodies to alpha 3 chain of collagen IV
- glomerular basement membrane also affected so renal disease occurs as well
Idiopathic Pulmonary Hemosiderosis
- A rare disease characterized by episodic diffuse alveolar hemorrhage
- Hemosiderin from repeated episodes of bleeding accumulates over time, causing permanent fibrosis
- etiology: unclear but may be autoimmune-related.
Granulomatosis with polyangiitis = granulomas of upper and lower respiratory tract, vasculitis, kidney disease
CAP: acute bacterial what PNA presentation
Community acquired atypical pneumonia: causes and types
usually viral or mycoplasma (intracellular microorganism)
- viral - Usually affects the interstitium, not the alveoli of lungs ==> fibrotic changes ==> ARDS
viral:
- influenza
- SARS – coronavirus 2002 China
- COVID-19 – coronavirus
COVID-19 – coronavirus
can range from asymptomatic to ARDS to death
- many different signs and symptoms
- main sx: fatigue, fever, cough, SOB
pathology:
- virus attaches to ACE2 receptor especially present in lungs but also present in other tissues such as heart, cardiac manifestations, coagulopathies, and many others associated with virus
CT: “ground glass” opacities *
Nosocomial PNA
hospital acquired
risk factors:
- debilitation: weak immune system
- catheters
pathogens:
- MRSA (worry the most w/ this one)
- P aeruginosa, Klebsiella, E coli, S pneumoniae, H influenzae
Aspiration pneumonia
Aspiration pneumonia : unconscious/bedrest pt
- Aspirate gastric contents –> involve posterior lobes (superior segments of lower lobes)
- often leads to ABSCESS
Lung abscess
- ## aspiration
Chronic pneumonias types and what characteristics
all usually have granulomas (mimics/like tuberculosis) include:
TB:
- Form granulomas and caseous necrosis
- caseous necrosis @ center <– Ghon focus (area of gray-white inflammation w/ consolidation)
- Ghon complex = lung lesion + LN involved
Histoplasmosis:
- Transmission - present in bat and bird droppings, Ohio/Mississippi Valley ~~~> tiny microorganisms within macrophages (histoplasma capsulatum)
- Can affect other organs
Blastomycosis:
- Transmission - broad-based budding, spores in soil, also associated with geography, large distinct spherules
- Can affect other organs (skin)
Coccidioiomycosis:
- Transmission - spores in soil, Southwest
- Other organs affected
Immunocompromised hosts/HIV pulm infections
Pneumocystis jiroveci –> foamy exudate within alveoli
- can see organisms with silver stain
CMV
Lung Tumors: general characteristics and development sequence
- 90% are carcinomas (not sarcomas)
- very associated with tobacco smoking but also associated with radiation, asbestos, and radon
- Lung is the MC site for metastatic tumors (sarcomas)
Sequence of development
- normal mucosa –> metaplastic –> dysplastic –> carcinoma-in-situ (squamous, adeno) –> invasive/infiltrating cancer
types of Lung Cancer: NSCLC vs SCLC
Non-small cell v. small cell (not amenable to surgery because metastasizes early)
Non-small cell:
- Adenocarcinoma (MC lung CA): produces mucus, peripheral, Associated with woman and non-smokers
- SCC (2nd MC lung CA): usually located centrally in lung, Strongly associated with smoking, paraneoplastic syndrome - PTHrP = hypercalcemia
- Large cell carcinoma
Small cell carcinoma is derived from neuroendocrine cells and is very aggressive.
- Associated w/ smoking
- Paraneoplastic Syndrome - It can produce ectopic hormones such as ADH and ACTH
- High ADH –> SIADH manifested by hyponatremia
- High ACTH –> Cushing syndrome
- lambert eaton: myastenia gravis
pleural effusion: types
Hydrothorax - transudate vs exudate
- exudative = pus
Hemothorax
Chylothorax (lymph)
Mesothelioma
= is NOT bronchogenic (lung cancer), PLEURAL-based malignancy related to ASBETOS EXPOSURE**
- A malignant neoplasm that develops from mesothelial cells (which line several body cavities) and most commonly manifests as PLEURAL mesothelioma
- Can affect visceral/parietal pleura, pericardium, or peritoneum
- NOT a lung CA
- Has a latency period of about 30 years and a poor prognosis
- compresses lung from the OUTSIDE
