Obstructive Lung Disease Flashcards
What is emphysema?
irreversitble airspace enlargement distal to terminal bronchiole with destrubtion of airspace walls
What is the definiton of the acinus?
portion from respiratory bronhiole ot the alveoli
What is the difference in pathological location of centriacinar emphysema vs. panacinar emphysema?
- centriacinar: proximal aspect of acinus - not including alveoli
- panacinar: from respiratory bronchioles to alveolar sac
What lobe is it most common to see centriacinar emphysema?
upper lobe apices
What type of obstructive lung disease commonly occurs in heavy smokers?
centriacinar emphysema
What type of emphysema are shown in the provided images?
- Left: centriacinar emphysema
- can see some normal lung tissue (patchy emphysematous changes)
- Right: panacinar emphysema
- involving entire pulmonary lobule
What area of lung is most commonly affected by panacinar emphysema?
lower lungs & anterior margins
Panacina emphysema is associated with what disease?
anlph-1-antitrypsin deficiency
Describe the general pathogenesis of emphysema
- Inflammatory mediators increase inflammation & induce structural changes
- Proteases released from inflammatory cells breakdown tissue
-
oxidative stess results in even more inflammation & damage
- NRF2 upregulates other genes that protect from oxidative damage
- Infections may exacerbate the process
What is the role of alpha-1-antitrypsin?
What chromosome is its gene located on?
inhibits elastase (protease) secreted by neutrophils
chromosome 14
What is the normal alpha-1-antitrypsin allele?
What is the allele that leads to a deficiency?
PiMM is homozygous normal
PiZZ is homozygous for deficiency
What is the difference between a bleb and a bullae?
bleb: enlarge airspace up to 1 cm
bullae: enlarged airspace over 1cm
What gross findings would you expect to seen in lungs with emphysema?
- Large lungs
- Upper portion of lung most affected
- pical blebs & bullae
- cut sections of parenchyma will show enlarged air spaces
What pathology do you see with the lungs in the provided image?
Emphysema
- lumpy in the apical lobes & anterior portion
- bullae
- anthracosis
- dark carbon pigment
What disease is characteristic of the provided microscpic finding?
emphysema
- enlarged alveoli
- thin septa
- loss of attachments of aleoli to small ariways
- septa look like they end blindly inot alveolar spaces
What pathology is shown in the provided image?
Centrilobular (Centriacinar) Emphysema
- enlarged airspaces
- patchy
- dark lymph nodes (also pick up carbon pigment)
What pathology is shown in the provided image?
emphysema
- enlarged & normal alveli
- more normal in background - probably centriacinar emphysema
What is the clinical definiton of chronic bornchitis?
persistent cough with sputum, at least 3 months in 2 consective years with no other cause
Describe the general pathogenesis of chronic bronchitis
- Mucus hypersecretion
- inflammation
- acute & chronic
- infection results in acute exacerbation
What gross findings would you expect to see on lungs with chronic bronchitis?
- hyperemia (excess blood in the vessels), swelling, edema of mucosa
- increased mucinous secretions
- sometimes mucopurulent
What is the major microscopic findings associated with chronic bronchitis?
- submucosal mucus gland hyperplasia
- increased number goblet cells
- chronic inflammation of airways (lymphocytes)
- thickened basement membrane
- squamous metaplasia or dysplasia
What is the Reid index?
What is a normal score on it?
-
Reid index: ratio of thickness of mucus gland layer to thickness of tissue between epithelium and cartilage
- bc : ad
- normal is 0.4
- higher in bronchitis
thicker the glands, the worse it is
What pathology is shown in the provided image?
chronic bronchitis
chronic inflammation, goblet cells, mucus in lumen with neutrophils
What pathology is shown in the provided image?
chornic bronchitis
thick eosinophilc basemement membrane consistent with chronic inflammation
