Pathology Flashcards
URI
Viruses + S/s
Flu, echo, rhino, coxackievirus
S/s : mucosal inflammation, edema, congestion
URI
Bacterial S/s
Viral s/s + PUS , ULCERATIONS
Middle RI
How? Who?
URI extension = young children
Middle RI
S/s
Laryngitis, epiglottitis
Mucosal swelling w/ laryngospasm
Epiglottitis cause
H. Influenza B
Strep Group A
Strep Pneumo
Histology
Alveolus , Bronchiole, Bronchi
Alveolus = 1 cell thick
Bronchiole = cilia Bronchi = cilia, mucus
Pleural effusion
effect on lung
collapses lung (atelectasis)
Pleural effusion
Transudate seen in…
- CHF
- Nephrotic Syndrome
- Cirrhosis
Pleural effusion
Exudate seen in…
- Inflammatory
- Infectious
- Reactive (embolus, diaphragm)
- Malignant
Pneumothorax
Parietial pleura …
- Trauma
* Needle/catheter insertion
Pneumothorax
Visceral pleura…
- subpleural rupture
* subpleural lung necrosis
Pleuritis
Fluid effusion
Empyema
Pus effusion
Fibrothorax
Connective tissue
Obstructive lung disease
examples
Chronic bronchitis Emphysema Asthma Bronchiectasis Small Airway dz
Obstructive dz
s/s
- airflow limitation
- progressive
- not reversible
- possible inflammation
- Neutrophils, CD8 T cells, macrophages
Restrictive Dz
ex
- interstitial inflammation
- Interstitial fibrosis
- fibrosing alveolitis
- Pneumoconioses
- collagen/vascular dz
- Drug/radiation
Emphysema
Interstitial fibrosis?
NO
Bullous Emphysema
s/s
- Subpleural emphysema
- bullous change
- pneumothorax (no elasticity, so will break)
Emphysema
S/S
- Dyspnea
- late cough
- Minimumal sputum (NO inflammation)
- NO infection
- loss of elastic recoil + hyperinflation
Emphysema
Complications
- Resp insufficiency
- Resp acidosis
- Pulm HTN, RVH
- Pneumothorax/collapse
Emphysema
Mech
- protease-antiprotease mech
- inflammatory-mediated elastase activity + suppressed anti-elastase = from noxious stimuli on Neutrophils/macro
- alpha-1 AT deficiency
Chronic Bronchitis
path
proximal airway w/o parenchymal injury
*mucus/squamous metaplasia = obstruction
Emphysema vs Bronchitis
EMPHYSEMA
- Dyspnea>cough
- few infection
- low elastic recoil
BRONCHITIS
- Cough>Dyspnea
- Infection
- Cor Pulmonale
- Normal elastic recoil
BODE index
- Body Mass index
- Obstruction of airflow (FEV1)
- Dyspnea
- Exercise-capacity = 6 minute walk test
Immune Types 1-4!!!
- Type I = IgE (asthma)
- Type II = Cytotoxic, IgG
- Type III = Immune complex
- Type IV = Cell-mediated
Status asthmaticus
- marked mucus plugging
- air trapping
- dyspnea + death
Asthma
path
Sensitization =
- Type I IgE-mediated
- CD4 T cells = release IL-4/5 cytokines—> IgE—> mast cell + eosinophil recruitment
UP histamine, prostaglandins, leukotrienes
Bronchiectasis
s/s
abnormal dilation from obstrucion
- infxn, cough, purulent sputum
- inflammed mucosa
- abscess
- mucus plugs
Bronchiectasis
from
- CF,
- obstruction
- immunodeficiency
- necrotizing bronchopneumonias
Interstitial lung Dz
path
RESTRICTIVE
- parenchyma
- inflammation/fibrosis (collagen) in interstitium
- Alveoilitis, intra-avleolar macrophages, interstitial inflammation, interstitial fibrosis
- Pneumocyte type I loss, type II proliferation
Interstitial lung Dz
Clinical/Xray
- progressive dyspnea
- low O2
- CXR = interstitial thickening
- restrictive
- AIP, UIP, NSIP, RBILD/DIP
- Pneumoconiosis
- Collagen-vascular + rheumatologic dz
- sarcoidosis + systemic
- hypersenstivity pneumonitis
- Drug/radiation therapy
RESTRICTIVE DZ
Interstitial lung Dz
Honeycomb lung
- End stage scarred, retracted, shrunken
- dilation + scarring
- pleura bumpy from interstitial retraction
Respiratory Bronchiolitis
Interstitial Lung Disease RBILD/DIP
From
- Smoking
- Inflammation in terminal bronchioles + alveolar ducts
- desquamation of alveolar pneumocytes + macrophages
Sarcoidosis
Inflammatory systemic dz
*Foci = non-caseating granulomas
*Lymphatic distribution (peribronchial,
interstitial, and subpleural)
* Coalescent interstitial granuloma with
extention to pleura and interstitial fibrosis
Pneumoconiosis
path
- nodules w/ pigmented macrophage in collogen next to respiratory bronchioles
- progressive fibrosis
Asbestos-related Dz
- asbestos pleural effusion
- Pleural plaques (hyalinized) /fibrosis
- Asbestosis
- lung cancer
- Mesothelioma
Hypersensitivity pneumonitis
Path
- Type 3 + 4 reaction
- immunologic (mold, animal protein, etc.)
- Bronchioloitis w/ interstitial lymph infiltration –> interstitial granuloma
- farmer’s lung, etc.
Pumonary edema
Transudate vs. exudate
Transudate - CHF, LV dysfunction
Exudate - alveolar capillary injury
ARDS
path
SUDDEN ONSET
Alveolar capillary membrane damage (DAD -diffuse alveolar damage)
Protein exudate/inflammatory into alveolus (NON CARDIOGENIC)
SHUNTING
ARDS
CXR
bilateral interstitial edema
Bronchopneumonia
Bronchial + parenchyma
Lobar pneumonia
just PARENCHYMA
Pneumonia complication
- pleural fibrosis
- Empyema
- Abscess
- Bronchiectasis
- Interstitial fibrosis
- cysts
TB
Primary localized
Granuloma (Ghon lesion) drains to hilar lymph node –> granulomatous caseous necrosis (Ghon complex)
TB
Primary disseminated
Immunocompromised
TB w/ caviation + miliary lung pattern
Lung cancer (local)
Presentation
Cough Hemoptysis Chest pain Wheeze Dysnpea
Lung cancer (systemic)
Presentation
Effusion Pancoast SVC Paraneoplastic Metastases
Lung cancer recurs as
distant
Pleural Malignancies
- Primary lung adenocarcinoma
- Metastatic carcinoma (breast, GI)
- malignant mesothelioma
Diffuse Mesothoma
*Histochemistry
Mucin negative
*Immunohistochemistry
Keratin +, CEA -,
Calretinin +
*Electron microscopy
Long thin microvilli
