Path: Pulmonary Obstructive Disease Flashcards
What are examples of obstructive diseases vs. restrictive lung diseases?
Obstructive: asthma, chronic bronchitis, bronchiectasis, emphysema
Restrictive: obesity, kyphoscoliosis, polio, pulmonary fibrosis, ARDS, penumoconiosis
Which obstructive diseases are considered in the COPD category?
Emphysema
Chronic Bronchitis
General Etiology of Emphysema.
Protease/anti-protease imbalance caused by some stimulus (smoking, genetic)
Cause and location of Centriacinar (centrilobular) emphysema.
Long-standing cigarette smoking
located in respiratory bronchioles in upper half of lungs (distal alveoli spared)
Characteristic seen in emphysema patients.
Pink puffers
-pink colored blood and vasodilation in subcutaneous tissue
Cause and location of Panacinar (Panlobular) emphysema.
Hereditary: homozygous alpha-1 antitrypsin def.
Destruction of entire alveolus in lower half of the lungs
Location and features of Paraseptal (Distal Acinar) emphysema.
Distal airways (alveolar sacs and ducts) Apical bullae are present.
Common complication with paraseptal emphysema.
Compression atelectasis caused by pneumothorax (rupture of bullae)
What is the criteria for diagnosis of chronic bronchitis?
Persistent cough with lots of sputum for at least 3 months in 2 consecutive years.
What are the 3 general types of chronic bronchitis?
- Simple: no evidence of obstruction
- Asthmatic: hyperreactive airways
- Obstructive: associated with emphysema
What is the Reid Index?
Ratio of thickness of mucus gland layer to thickness of wall between epithelium and cartilage.
Normal: 0.4
-ratio increases in obstructive disease
Major Complication of Chronic Bronchitis.
Recurrent Infection
malignancy also occurs but less frequent
What are microscopic findings in early chronic bronchitis and then late chronic bronchitis?
Early: hypertrophy of submucosa glands
Late: goblet cell hyperplasia, squamous cell metaplasia
What are the 4 types of asthma?
Atopic
Non-atopic
Occupational
Drug-Induced
Describe Atopic Asthma.
Type I Hypersenstivity Rxn
-IgE mediated in response to allergen
What is the difference between acute and late atopic asthma?
Acute: just a bronchoconstriction response
Late: airway constriction and epithelial damage
What are the major causes of non-atopic, occupational, and drug-induced asthma?
Non-atopic: respiratory infection (IgE is normal)
Occupational: repeated exposure to dust, gas, fumes
Drug-Induced: ASA
What is status asthmaticus?
Fatal asthma attack usually with complete airway obstruction. Doesn’t respond to any medications.
What are Charcot-Leyden crystals?
Precipitated proteins derived from eosinophils in patients with asthma. Visible on microscopy.
What are Curschmann Spirals?
Spiral shaped mucous plugs seen on microscopy in asthma patients. “yarn” appearance
General definition of bronchiectasis.
Permanent dilation of airways resulting in “air trapping”.
Common causes of acquired bronchiectasis.
Obstruction: tumor, foreign body, inspissated mucous
CF: mucous plugs
Most common cause of inherited bronchiectasis.
Kartegener Syndrome
-immotile cilia, situs inversus, male infertility
Primary microbe that can cause a hypersensitivity induced bronchiectasis.
Aspergillus fumigatus
- high serum IgE in response to fungus
- high Ab levels
Characteristic finding of pleural membranes in lungs with bronchiectasis.
Fused Pleura
