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
What is asthma?
chronic disorder with episodic bronchocontriction, bronchial wall inflammation and increased mucus secretion
episodes of wheezing, dyspnea, chest tightness, cough
at least partly reversible
What is unusual about the lungs shown in this autopsy?
This is consistent with what pathology?
notice lungs are overlapping at the pericardium
asthma
What microscopic findings would you expect to see in an asthma case?
- thickend airway with increased vessels
- goblet hyperplasia & increased size of submucosal glands
- thickened basement membrane
- submucosal inflammation (eosinophils)
- Smooth muscle hypertrophy
- Charcot-Leyden crystals
- Sputum with Curschmann spirals (extruded mucus plugs)
What pathology is shown in the provided image?
Asthma
- lot of normal alveolar lung
- bronchioles filled with mucus
What pathology is showni n the provided image?
Asthma
- lots goblet cells
- thick, prominent basement membrane
- lots of inflammation w/ eosinophils
The provided histological finding is indicative of what disease?
Curschmann’s spiral
Astham
The provided histological finding is indicative of what disease?
Charcot-Layden crystals
from eosinophil degranulation
Asthma
Describe the reversible vs. irreversible components of asthma
- Reversible
- muscular bronchoconstriction, edema, mucus plugs
- Irriversible
- fibrosis, submucosal gland & smooth muscle hypertrophy
What is bronchiectasis?
chronic infections that lead to destruction of smooth muscle & elastic tissue causepermanent dilatin of bronchi and bronchioles
What gross findings do you expect to see on a lung with bronchiectasis?
Where in the lung is this pathology most commonly located?
- Severely dilatd airways, may appear cystic with mucopurulent secretions
- usually lower lobes
- more severe in bronchi & bronchioles
What pathology is shown in the provided image?
bronchiectasis
notice dilated bronchi extending to visceral pleura
