Obstructive lung disease: COPD-Chronic bronchitis

Question 1

Persistent cough with sputum for at least 3 months in at atleast 2 consecutive years, in the absence of any other identifiable causes
Known as what?

Answer 1

Chronic bronchitis

Question 2

Under pathogenesis of chronic bronchitis explain more about this statement
Continual irritants (Smoking, infection, pollution) to the lungs cause the airways to become swollen and inflammed

Answer 2

1. Constant irritants leads to enlargement of mucus secreting glands pf the bronchial tree, an increase in the number of goblet cells, whihc results in increased mucus secretion
2. The smooth muscle in the airways becomes hypertrophied and narrows the bronchioles

Question 3

Under pathogenesis of chronic bronchitis explain the statement that says:
Etra mucus is produced to trap any irritants and prevent them entering the lungs

Answer 3

1. The cilia become unable to cope with excessive secretions and therefore the mucus blocks the airwas. This is known as reversible airways obstructions
2. The mucus goes deeper into the lungs and become hearder to clear

Question 4

Under pathogenesis of chronic bronchitis what is meant by this statement explain
Excessive secretions are predispose to infection

Answer 4

The walls of the bronchioles become inflamed, continual inflammation causes gradual destruction of the bronchioles, resulting in fibrosis -Irreversible Airways Obstruction

Question 5

If the inflammation spreads to the blood vesseks this will lead to capillary bed wall atrophy. And what will happen

Answer 5

If the inflammation spreads to the blood vessels this will lead to capillary bed wall atrophy. This increases the pressure of the pulmonary circulation. Pulmonary arteries may become distended (stretched)and blood may back track into the right side of the heart resulting in right sided hypertrophy (enlargement)and heart failure. This is known asCor Pulmonale.

Question 6

Chronic bronchitis microscopic appearance based on the picture

Answer 6

Chronic bronchitis, microscopy
In the wall of this large bronchus is cartilage (♦) and the bronchial wall is expanded from increased size of mucus-secreting glands (∗) along with chronic inflammatory cell infiltrates (□) to expand the bronchial wall and promote airway obstruction.
At the right, above the respiratory epithelium, is increased mucus (✚) in the airway

Question 7

Gross appearance of CB

Answer 7

Hyperemia, swelling and oedema of mucous membranes, with excessive mucinous or mucopurulent seretions.

Question 8

Microscopy appearance of CB

Answer 8

Microscopy:
Submucosal gland hypertrophy producing increased Reid index.
Chronic inflammation
Enlargement of mucus-secreting glands of * trachea and bronchi
Increased number of goblet cells
Squamous metaplasia and dysplasia of bronchial epithelium
Narrowing of bronchioles by mucous plugging, inflammation and Fibrosis
_/+bronchiolitis obliterans

Question 9

Submucosal gland hypertrophy producing what?

Answer 9

Increased Reid Index

Question 10

What is meant by Reid index

Answer 10

The thickness of mucous glands in relations to thickness of the wall, in chronic bronchitis it is > 0.40

Question 11

explain the clinical findings od chronic bronchitis

Answer 11

Depends on disease severity and proportion of emphysematous and bronchitic changes (most patients are a mixture of both):
Smoking history of >40 pack-years.
Mostly present with slowly increasing dyspnoea on exertion and chronic productive cough that is worse in the morning;):
Patients adapt to hypoventilation with decreased oxygenation and hypercarbia, appear to be cyanotic with weight gain from peripheral oedema.

Question 12

Complications of COD

Answer 12

Complications of COPD=
Progressive lung dysfunction causing pulmonary hypertension, cor pulmonale, death due to heart failure.
Death due to acute respiratory failure from superimposed infections,
Fatal pneumothorax from rupture of subpleural blebs (in emphysematous patients)

Question 13

Blue bloasters

Answer 13

Chronic bronchitis

Question 14

Pink puffers

Answer 14

Emphysema

Question 15

Affects younger (40-45 yo) name the disease

Answer 15

Chronic bronchitis

Question 16

Affects older patients (50-75 yo)

Answer 16

Emphysema

Question 17

Cough and sputum +++ with frequent infections,dyspnoea mild and late

Answer 17

chronic bronchitis

Question 18

Cough and sputum +/- with occasional infections, dyspnoea severe and early

Answer 18

emphysema

Question 19

Early respiratory insufficiency due to increased airway reistance&raquo_space; cor pulmonale common

Answer 19

Chronic bronchitis

Question 20

Respiratory insufficiency and cor pulomonale usually only end-stage as airway is usually normal/slightly increased

Answer 20

emphysema

Question 21

Entrance of air into the connective tissue of the lung, mediastinum or subcutaneous tissue produces what?

Answer 21

Interstitial emphysema

Question 22

when air leaking from lungs has produced what?

Interstitial emphysema

Answer 22

Air leaking from the lung has produced clear bubbles (♦) of gas within subcutaneous adipose tissue of the chest wall, as shown here with pale red skeletal muscle at the top.

Question 23

The term [ulmonary interstitial emphysema is used when?

Answer 23

The term pulmonary interstitial emphysema is used when air leaks within the lung into peribronchovascular sheaths, interlobular septa, and visceral pleura

Question 24

What are risk factors for pulmonary interstitial emphysema

Answer 24

Trauma and mechanical ventilation