lung path II Flashcards
PE
10% of acute hospital deaths
underdiagnosed
elevated LDH
PHTN
abnormal when pressurs reaches 1/4 of systemic
pulmonary arterial HTN
primary idiopathic arterial HTN
autoimmune CT disorder
drugs
idopathic primary pulmonary HTN
adults mostly females 20-40
rare familiar primary PHTN
autosomal dominant with only 10-20%
mutation in BMPR2
in vascular smooth m cells BMPR2 inhibits proliferation and favors apoptosis
mutation inactivated inhibition
secondary PHTN
endothelium dysfunction and normal reduction of pulmonary aa to increased pressure
diffuse alveolar hemorrhage syndrome
goodpasture syndrome
idiopathic pulmonary hemosiderosis
vasculitis (wegners, hypersensativity pneumonitis, SLE)
goodpastures
autoimmune, anti-basement membrane Abs
alpha 3 chain of collagen IV
proliferative rapidly progressive glomerulonephritis
necortizing hemorrhagic interstitial pneumonitits
M>F, young smokers
renal failure usually COD
idiopathic pulmonary hemosiderosis
rare condition usually in children
episodes of diffuse hemorrhage
no antivascular Abs have been found, but immunosupression works
diffuse hemosiderin deposistion in macrophages and alveolar walls
symptoms of idiopathic pulmonary hemosiderosis
productive cough, hemoptysis, anemia, weight loss
polyangitis w/granulomatosis
necrotizing granulomatous arteritis of lungs and URT
necrotizing crescentic glomerulonephritis
hard to diagnose
M>F 5th decade
immunoRx
variable prognosis
cytoplasmic pattern anti-neutrophil Abs (PR3/c-ANCA)
nasopharynx defenses
nasal hair
turbinates
mucociliary apparatus
IgA
oropharynx defenses
saliva
sloughing of epi
local complement production
interference from resident flora
trachea and bronchi defenses
cough, epiglottic reflexes
sharp angled branching of airways
mucocilliary apparatus
IgM, IgG, IgA
lower respiratory tract defenses
alveolar lining fluid cytokines alveolar macros polymorphonuclear leukocytes cell-mediated immunity
community acquired acute penumonia
alveolar exudates strep pneumoniae H. influenza M. catarrhalis Staph aureus legionella penumophilia enterbacteriaceae
strep pneumonaie
community acquired
G+ diplococci
most common
increased risk w/splenectomy/sickle cell -> need vaccine
H. influenza
community acquired also meningitis and pink eye G- pleomorphic vaccine for encapsulated form #1 in COPD
M. catarrhalis
community acquired
G- diplococci
#2 in COPD
Staph aureus
community acquired
G+ cocci
common in post viral pneumonia w/IVDA
legionella pneumophilia
community acquired
gram - rod
macrophages in small bronchioles
legionellas disease and pontiac fever
enterobacteriaceae
community acquired
klebsiella pneumoniae
pseudomonas aerginosa
klebsiella pneumoniae
community acquired
Gram - rod
seen in debilitated/malnourished (alcoholics) with bloody thick sputum
pseudomonas aeruginosa
community acquired
gram neg coccobacilli
CF and neutropenia
angioinvasive
community acquired atypical pneumonia
patchy or interstitial inflammation mycoplasma pneumoniae chlamydia coxiella burnetti viruses
mycoplasma
community acquired atypical
sperhical to filimentoud w/o cell wall
gram -
have cold agglutinins
viruses w/atypical pneumoniae
respiratory synctial virus parainfluenza human metapneuomia virus influenza A and B adenovirus rhinoiviruses rubeola varicella SARS
health care associated and hospital acquired pneumonia
gram neg rods
enterobacteriae
psudomonas
staph aureus (MRSA)
aspiration pneumonia
anaerobic and aerobic bacteria
necrotizing pneumonia and lung abscesses
anaerobic bacteria
staph aureus
klebsiella
strep pyogenes
chronic pneumonia
nocardia
actinomyces
granulomatous chronic pneumonia
TB atypical myobacterium histoplasma capsulatum coccidodes immitis blastomyces dermatitdis
pneumonia in immunocompromised host
CMV pneumocytis jirovecci myocobacterium avium-intracellulare invasive aspergillosis invasive candidiasis
lobar pneumonia
mostly caused by strep pneumonia
stages of bacterial pneumonia
acute- early red hepatization
early organization- streams thru the pore of kohn
advanced organizing pneumonia
viral pneumonias
usually self-limiting ‘chest cold’, but can be lethal
co-exist with bronchitis
can be epidemic
pulmonary abscess organisms
staph aureus and other gram neg mixed, including anaerobic: bacteriodies fragilis fusobacterium peptococcus
complications of pulmonary abscesses
empysema
hemorrhage
brain abscess/meningitis
amyloidosis
symptoms of pulmonary abscesses
cough fever fould smelling, purulent and/or bloody sputum chest pain weight loss
pulmonary abscess sources
#1- aspiration antecedent lung bacterial infection septic emboli neoplasia penetrating wounds infection from adjacent organ hematogenous spread of infection
perinatal infections timing
early onset 0-7 days: group B strep and E. coli
late onset 7-90 days: listeria, candida
transcervical/ascending perinatial infections
inhalation of infected amniotic fluid in utero or infected passing thru birth canal
most bacterial, some viral
pneumonia, sepsis, and meningitis common
tranplacental infections
most parasitic (malaria, toxoplasma) or viral (hep B, HIV) few bacterial
TORCH
pneumonia, encephalitis, chorioretinitis, myocarditis, dermatitis
TORCH
Toxoplama Rubella CMV Herpes other (treponema palllidum)
Respiratory synyctial virus (RSV) bronchiolitis
most common cause of bronchiolitis and pneumonia in children <12months
initial URT infection but in 1-2days spread to lower airways moving cell-cell
associated otitis media
can cause pneumonia in elderly
xray shows areas w/entrapped air
supportive Tx
chronic penumonias
frequently a localized lesion immunocompetent patients
many are granulomatous processes: TB, leprosy, fungal
TB primary infection
Ghon complex
granulomatous response, usually asymptomatic and self limiting but clinically symptomatic in 5%
Ghon complex
parenchymal lesion and involved lymph nodes
secondary TB
reactivation of old walled off lesions, usually apical
cavitary caseous necrosis w/subsequent scarring or progressive disease
miliary TB
occurs when tubercle erodes into a vessel
immunosupressed TB
may see w/o granulomas
at risk for dissemination
dimorphic fungal pneumonias
fungal spores ubiquitous
induce localized granulomatous response OR may be disseminated
can have angioinvasion, thrombosis, and septic infarcts
histoplasma capsulatum
ohio and miss river and carribean
soil spores from birds or bat feces
microcondia and macorcondia
blastomyces dermatidis
central and SE USA, canada, mexico, middle east, africa, india
soil spores
microconidia
coccidioides
SW, far west, and mexico
soil spores
arthroconidia
pulmonary diffuse pneumonias HIV
pneumocystis hirovecii
CMV
mycobacterium avium complex
pulmonary focal pneumonias HIV
aspergillus
cnadida albicans
diseases that warrant lung transplant
emphysema
idiopathic pulmonary fibrosis
CF
idiopathic/familial PHTN
complications of lung transport
infections
acute regjection
chronic rejections
79% 1yr, 53% 5yr, 30%10yr survival rates
pneumocystis pneumonia
foamy cotton candy exudate and cup and saucer- shaped organisms
