Obstructive Lung Disease - Pathology Flashcards
At what anatomic levels does obstructive lung disease typically occur? (3 places)
Bronchi.
Small airways (bronchioles).
Acini (respiratory bronchioles and alveolated parenchyma).
Obstructive lung disease has increased resistance to airflow. How does this resistance happen? (2 types of cause)
Physical obstruction: mucus, inflammation, bronchospasm, fibrosis.
Destruction of airspaces -> premature closure of airways.
What causes the airflow obstruction in bronchial asthma?
Constriction by bronchospasm.
Thickening of airways (edema / inflammation/ mucus and debris in lumen)
Some histology buzzwords for bronchial asthma?
Sloughed off epithelium. Edema and chronic inflammation and in bronchial walls. Thickened basement membrane. Many eosinophils. Excess asthma. *rather, "mucus"*
What can happen to submucosal glands in asthma?
Hypertrophy -> increased mucus production.
How does the basement membrane change in asthma?
How about smooth muscle?
They both thicken - subepithelial fibrosis, smooth muscle hypertrophy.
What happens to goblet cells in asthma?
They go from “inconspicuous” to plentiful.
goblet cell metaplasia
2 changes shown in the gross picture of fatal asthma?
Areas of hyperinflation, areas of atelectasis (alveolar collapse).
How does the cellular infiltrate vary between asthma and chronic bronchitis?
Asthma - many eosinophils.
Chronic bronchitis - chronic inflammatory infiltrate.
Does the submucosal glands hypertrophy in chronic bronchitis?
Yes they do.
What can happen to the bronchial epithelium in chronic bronchitis?
Squamous metaplasia.
When there’s fatal chronic bronchitis, what causes death?
Mucus plugging.
What’s an anatomical-ish reason for why bronchiectasis develops?
Bronchiectasis often develops after an obstruction.
(Though… as per the bronchiectasis lecture, there are many other etiologies.. such as CF and primary cilia dysfunction.)
3 kinds of obstruction that can lead to bronchiectasis?
Tumor.
Foreign body.
Mucus oversecretion (chronic bronchitis/asthma).
Why might you confuse bronchiectasis for an abscess on histology?
The lumen will be filled with a purulent exudate.
though the examples we’ve seen still have the bronchiolar epithelium intact
There’s often squamous metaplasia in bronchiectasis, too.
Okay.
In emphysema, what part of the bronchial tree?
Airspaces distal to terminal (nonrespiratory) bronchioles are permenantly enlarged / alveoli are damaged.
3 variants of emphysema, based on location within the lobule?
Centrilobular (aka. centriacinar)
Panlobular
Paraseptal
With what major risk factor is centrilobular emphysema associated?
What area of the lungs does it most affect?
Associated with smoking.
Affects the apices.
Histologic buzzwords for centrilobular emphysema?
“holes in the lung” - damaged areas surrounded by relatively normal alveoli.
Damage areas are “likely areas of particle/toxin deposition.”
With what disease is panlobular (panacinar) emphysema associated?
What area of the lungs does it most affect?
Alpha-1 antitrypsin deficiency.
Most affects the lower lobes.
Histologic buzzwords for panlobular emphysema
More uniform “hole” distribution in parenchyma - damaged areas aren’t surrounded by normal tissue.
What’s paraseptal emphysema?
What’s a common complication of it?
Damage happens at most distal portions of the lung - near the pleura.
It’s creates a high risk for spontaneous pneumothorax / bulla formation.
