Lung Patho Flashcards
What are the types of emboli that can form?
- thromboemboli (>95% most common)
- atherosclerotic emboli
- gas (air) emboli
- fat emboli
- amniotic fluid emboli
-could also be tumour and bacterial
What can cause gas emboli?
- Decompression sickness (divers; nitrogen precipitates out of blood too quickly in rapid descent)
- -> chronic form known as Caisson disease; characterized by multifocal ischemic necrosis of bone - Laparoscopic surgery (air pumped into abdomen)
What is most common source of pulmonary embolism? Involving which specific vessels?
-> Deep vein thrombosis (DVT) Involving commonly: -femoral vein -iliac v. -popliteal v.
When does sudden death occur in a pulmonary emboli?
When a large saddle embolus blocks both left and right pulmonary arteries (large enough thromboembolic blocking pulm. a bifurcation)
OR
Significant occlusion of large pulmonary artery
What type of infarct is observed on gross examination of pulmonary infarction?
Wedge-shaped infarction
Signs + symptoms of DVT:
Blood clot within deep vein:
- swelling
- redness
- warmth
- pain
- -> Predisposed by Virchow’s triad
Treatment of DVT:
PROPHYLAXIS + ACUTE MANAGEMENT:
-LMWH (enoxaparin)
or
- unfractionated heparin
LONG TERM PREVENTION:
-oral anticoags (warfarin, rivaroxaban)
What imaging is best used for DVT?
Compression ultrasound with Doppler
Symptoms of pulmonary emboli?
- sudden-onset dyspnea
- tachypnea
- tachycardia
- pleuritic chest pain
(pain due to visc and parietal pleura rubbing together from inflamed pleura)
Causes for transudative pleural effusion?
- congestive heart failure
- liver cirrhosis
- nephrotic syndrome
- acute atelectasis
- myxedema
Causes for exudative pleural effusion?
- bacterial pneumonia (most common)
-
What is pleural effusion?
excessive fluid accumulating in pleural cavity
Explain tuberculosis
It is a chronic granulomatous disease.
Caused by m. tuberculosis, causes caseating necrosis and hiller lymph nodes undergo fibrosis and calcification.
Form ghon complexes. Often asymptomatic in primary.
Secondary TB –> typically affects apex (high O2)
Can systemically spread to: meninges (meningitis), kidneys (sterile pyuria), lumbar vertebrae (Potts disease)
What are the main pathological changes in A) asthma B) bronchitis C) emphysema D) bronchiectasis
A) Asthma –> smooth muscle hyperplasia, excessive mucus, inflammation
B) bronchitis –> hypertrophy + hyperplasia of mucous glands
C) emphysema –> airspace enlargement, wall destruction
D) bronchiectasis –> dilation and scarring
Describe microscopic changes in
a) acute pulmonary congestion
b) chronic pulmonary congestion
a) Acute –> blood engorged alveolar capillaries, and some alveolar septal edema and intra-alveolar hemorrhage
b) Chronic –> septa become thickened and fibrotic, and alveolar spaces contain hemosiderin-laden macrophages derived from phagocytosed RBCs
What is the main cause of pulmonary congestion?
Left sided heart failure
What can we find histologically in chronic bronchitis?
- enlargement of mucus-secreting glands
- goblet cell metaplasia
- bronchiolar wall fibrosis
What is brown induration?
In progressive (chronic) pulmonary congestion, the hemosidern-laden macrophages together with interstitial fibrosis cause "brown" colouring --> Extensive fibrosis can lead to intra-pulmonary hypertension
What is bronchiectasis caused by?
Necrotizing inflammation with damage to airway walls b/c of one of the following :
- cystic fibrosis
- Karteneger syndrome (dynein arm defect, needed by cilia, thus poor mucous clearance b/c cilia not working)
- tumor or foreign body
- necrotizing infection
- smoking
- allergic bronchopulmonary aspergillosis
What is karteneger syndrome?
Inherited defect of dynein arm which is needed by cilia for movement. There is poor mucosal clearance in the lung due to lack of cilia function.
Can cause bronchiectasis (permanent dilation of bronchi + bronchioles)
What is pneumoconiosis?
Interstitial fibrosis due to occupational exposure
–> requires chronic exposure
What are the main types pneumoconiosis?
-asbestosis
-coal workers’ pneumoconiosis
-
List restrictive lung diseases:
- idiopathic pulmonary fibrosis
- sarcoidosis
- pneumoconiosis (asbestosis, berrylliosis, silicosis, coal workers pneumoconiosis)
- hypersensitivity pneumonitis
What can having asbestosis lead to?
Lung carcinoma and mesothelioma
>80% of mesotheliomas caused by exposure to asbestos
What is sarcoidosis?
Systemic disease characterized by non-caseating granulomas in multiple organs. Granulomas typically in hillier lymph nodes and lung –> leading to restrictive lung disease
What is the pathogenesis of ARDS?
Due to some underlying condition (i.e. sepsis, infection, pancreatitis, drugs, aspiration, trauma, shock) there is an activation of neutrophils which induces protease-mediated and free radical damage of type I and II pneumocytes. The capillary-alveolar barrier is damaged. Edema with protein-rich fluid occurs, collapse of air sacs (b/c of surfactant abnormality).
