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The Respiratory System > Pathology and Histology > Flashcards

Pathology and Histology Flashcards

1
Q

What is pneumonia?

A

Infection involving the distal aspects of the respiratory tree including localised oedema

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2
Q

What is lobar pneumonia?

A

Pneumonia involving a complete lung lobe

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3
Q

What are the different types of pneumonia (based on where infection was acquired)?

A
  1. Community acquired
  2. Hospital aquired
  3. Aspiration
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4
Q

During a classical acute inflammatory response what are the main stages in a pneumonia?

A
  1. Exudation - emission of fibrin-rich fluid through pores or wounds
  2. Infiltration by neutrophils
  3. Infiltration by macrophages
  4. Resolution
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5
Q

Why is pneumonia potentially able to cause long term damage?

A

Organisation of tissues during healing can cause fibrous scarring

Abcesses can form

Bronchiestasis can occur - abnormal dilation of bronchi

Empyema - collection of pus in body cavity most commonly the pleura

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6
Q

What is bronchopneumonia?

A

This is when infection causing pneumonia starts in the airways and proceeds to infect the alveolar lung

This is common when the patient has pre-existing disease

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7
Q

Which pathogens can cause bronchpneumonia?

A

Strep. pneumoniae, Haemophilius influenza, S. aureus, anaerobes and coliforms

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8
Q

What is an abscess?

A

A local collection of pus

Can cause chronic malaise and fever

Caused by aspiration of pathogens

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9
Q

What is bronchiestasis?

A

Fixed dilatation of bronchi

This is due to fibrous scarring after infection, or chronic obstruction

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10
Q

Which pathogen is most likely to cause Tb?

A

Mycobacterium tuberculosis

(M.bovis can also cause Tb)

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11
Q

What is a key sign of Tb?

A

Granuloma formation

Caseating “cheesy” necrosis

This is due to a delayed hypersensitivity (type IV) reaction

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12
Q

What is primary Tb?

A

The first exposure to Tb

The pathogen is phagocytosed and taken to hilar lymph nodes which provokes an immune reaction leading to a granulomatous response

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13
Q

What is secondary Tb?

A

This is a secondary encounter with Tb and involves reinfection and reactivation

A degree of immunity will be present

Generally the disease will still remain localised to the lung apices

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14
Q

Describe the tissue changes in primary Tb

A

Small focuses (Ghon focuses) occur which are small lesions caused by the mycobacterium

Large hilar nodes will develop due to the granulomas forming

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15
Q

Describe the tissue changes in secondary Tb

A

Fibrosis and cavitating of apical lesions will occur

This worsens the damage already present

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16
Q

Why may reactivation with Tb occur?

A

Decrease in T cell function due to:

  • Age
  • Immunosuppression due to disease (HIV)
  • Immunosuppression due to therapy - steroids, chemo
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17
Q

How may a patient be diagnosed with Tb?

A
  • History
  • Broncho-alveolar lavage - bronchoscope is passed into the lungs and squirts fluid into the lungs which is subsequently collected for study
  • Biopsy
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18
Q

What is the pulmonary interstitium

A

This is where gas exchange occurs

Contains alveolar type I and II cells as well as thin connective tissue high in elastin

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19
Q

How does ILD commence?

A

Any form of injury that leads to alveolitis - inflammation of the alveoli

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20
Q

What are the two umbrella causes for ILD?

A
  1. Environmental - minerals (asbestos), drugs, radiation
  2. Idiopathic
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21
Q

How can ILD be diagnosed?

A
  • Transbronchial biopsy
  • Thoracoscopic biopsy - more invasive - thoracoscope enters through an incision between ribs allowing for visual inspection of the lungs
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22
Q

What are some forms of ILD?

A
  • Fibrosing alveolitis
  • Sarcoidosis
  • Extrinsic allergic alveolitis (hypersensitivity pneumonitis)
  • Pneumoconiosis - occupational lung disease
  • Connective tissue disease
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23
Q

What is fibrosing alveolitis?

A

A type of idiopathic pulmonary fibrosis

Inflammation is usually associated with the condition

Finger clubbing is a common symptom

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24
Q

What is the pathology of fibrosing alveolitis?

A

A sub-pleural and basal fibrosis occurs due to inflammation

In the terminal stages the lung structure becomes composed of large dilated spaces surrounded by fibrous walls - this is honeycombing

These thick walla and dilated spaces hinder gas exchange

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25
What is extrinsic allergic alveolitis?
Chronic inflammation due to a type III and type IV hypersensitivity reaction Airways become small and granulomas can be formed from collections of activated macrophages
26
What are some causes/forms of extrinsic allergic alveolitis?
1. Thermophilic bacteria - Farmer's lung 2. Avian proteins - Pigeon fancier's lung 3. Fungi - Malt worker's lung
27
How can extrinsic allergic alveolitis diagnosed?
The presence of antibodies called precipitins can be detectable in the blood serum which indicate hypersensitivity reactions Biopsies can be utilised to diagnose more difficult conditions
28
What is sarcidosis?
A multisystem granulomatous disorder commonly affecting the pulmonary system
29
In what ways can sarcoidosis manifest itself?
* Uveitis - inflammation of iris * Erythema nodosum - inflammation of fat cells under the skin causing red patches * Lympthadenopathy * Hypercalcaemia
30
What effects can connective tissue diseases have on the pulmonary system?
* Interstitial fibrosis * Pleural effusions * Rheumatoid nodules - local swelling or lumps most often associated with rheumatoid arthritis
31
What is pneumoconiosis?
An umbrella term for "dust diseases" Characterised by inalation of "dust", inflammation and fibrosis
32
What are three types of pneumoconiosis?
1. Asbestosis 2. Coal worker's lung 3. Silicosis
33
What does the severity of pneumoconiosis depend on?
* Particle size (1-5microns) - larger get trapped, smaller can be breathed in and out * Reactivity of particle * Clearance of particle * Host response
34
Asbestosis is a ________ and can have _________ (curved) or _________ (straight) fibres. Of the two, _________ fibres are far more dangerous
Silicate Serpentine Amphibole Serpentine
35
What are consequences of asbestosis exposure?
* Parietial pleural plaques * Interstitial fibrosis (asbestosis) * Bronchial carcinoma * Mesothelioma
36
What is pulmonary oedema?
Fluid build up in the lung interstitium
37
Pulmonary oedema is a type of __________ lung disease
Restrictive
38
What is the most common cause of pulmonary oedema?
Left ventricular heart failure and backflow pressure which causes the release of tissue fluid into the lungs The heart cannot pump blood out of the lungs fast enough so pressure builds and fluid is deposited.
39
Why is pulmonary oedema bad for gas transfer?
By occupying space in the alveoli, the fluid increases the distance oxygen must diffuse to enter the blood stream so less oxygen will diffuse This is not a problem for carbon dioxide to exit since it is 20 times more soluble than oxygen
40
What is ARDS?
Adult respiratory distress syndrome
41
What is the pathology of ARDS?
* Inflammatory cells enter a region of injury in the lungs due to bacterial endotoxin * Cytokines are released * Oxygen free radicals are released * Collateral damage occurs to cell membranes due to the inflammatory response
42
ARDS can cause?
* Sepsis * Severe trauma
43
How is ARDS characterised?
* Fibrous exudate lining alveolar walls * Evidence of cell regeneration * Inflammation
44
Why does neonatal RDS occur?
Premature infants produce inadequate surfactant between pleura There is reduced surface tension and breathing is difficult and may cause damage to cells
45
What is an embolus?
A detached intravascular mass carried by the blood to a site in the body far from its origin Emboli can be thrombi, gas, fat, foreign bodies or tumour
46
What is the source of most pulmonary emboli?
Deep venous thrombosis of the lower limbs
47
Virchow's triad describes the risk factors for developing a thrombus as with DVT for example, what is this triad?
1. Stagnant blood flow 2. Hypercoaguable blood 3. Endothelial injury/abnormality
48
What is primary pulmonary hypertension?
This is hypertension due to abnormalities within the lungs
49
What is secondary pulmonary hypertension?
Hypertension associated with another condition such as emphysema, COPD, lupus etc
50
Primary pulmonary hypertension is most common in ________ \_\_\_\_\_\_\_\_
Young women
51
What is cor pulmonale?
This the alteration in the structure and or functio of the right ventricle due to a primary disorder of the respiratory system Often this is due to primary hypertension
52
The pleural is lined with that type of epithelium?
Squamous
53
What are the two types of pleural effusion?
1. Transudate - cardiac failure, low protein levels 2. Exudate - high protein levels, Tb, pneumonia, malignancy, connective tissue disease
54
What is a purulent effusion?
An empyema
55
Tumours in the lungs can be of which two categories?
Primary - malignant mesothelioma, benign Secondary - adenocarcinomas, undergone metastasis
56
Mesothelioma is characterised by _________ the lung by affecting all of the pleura
Surrounding
57
The differentiation of both __________ and ___________ cells are involved in mesothelioma
Epithelial Mesenchymal
58
What is present under the ethmoid bone that is specialised for the sense of smell?
An area of olfactory epithelium
59
The vestibule of the nasal cavity is lined with what for protection?
Keratinised stratified squamous epithelium
60
Further into the nasal cavity, how does the epithelium change
It becomes respiratory epithelium (pseudostratified ciliated columnar epithelium with goblet cells)
61
Where are basal cells located and what do they function to do?
Located at basal lamina and will replace epithelium - they are a type of stem cell
62
What is the lamina propria?
A thin layer of connective tissue below the epithelium to which it connects collectively becoming the mucosa It contains seromucous glands
63
The oropharynx and epiglottis have which type of epithelium?
Respiratory epithelium without goblet cells (Non-keritinised stratified squamous epithelium)
64
What epithelium coats the larynx?
The cartilage ad muscle is coated with respiratory epithelium The vocal folds are coated in stratified squamous epithelium for strength due to vocal cord collisions during sound production
65
What is the carina?
The point of bifurcation of the trachea
66
What are seromucous glands?
Glands in which serous and mucous secretory cells are present
67
The walls of the trachea have what lining?
Respiratory epithelium (with basal lamina and lamina propria - contains elastic fibres) There is also a layer of submucosa containing seromucous glands
68
What is present within the bronchi that allows for the mucociliary rejection current?
Cilia
69
How does the cartilage in bronchi differ from that in the trachea?
Bronchi - irregularly shaped in plates Trachea - "C" shaped
70
When is the transition from bronchi to bronchioles defined?
When there are no longer cartilage plates
71
The lamina propria in bronchioles is composed of what 3 main consititutes?
1. Smooth muscle 2. Elastic fibres 3. Collageous fibres
72
What are terminal bronchioles?
The smallest bronchioles that still lack respiratory function
73
What is present down the bronchial tree after terminal bronchioles?
Respiratory bronchioles
74
What innervates the smooth muscle of bronchioles?
The parasympthetic nervous system This can inititiate contraction
75
Terminal bronchial epithelia are lined with what types of cell?
Cuboidal ciliated epithelium and non-ciliated club cells (Clara cells)
76
Non-ciliated club cells have which roles?
* Stem cells * Detoxification * Immune modulation * Surfactant production
77
Describe respiratory bronchiole walls
It is discountinous squamous epithelium with type 1 aveoli within their walls - as opposed to low cuboidal epithelium
78
What are pneumocytes?
Alveolar cells
79
Type 2 alveoli are covered in what?
Microvilli
80
The cytoplasm of type II alveoli contains what?
Lamellar bodies | (release surfactant by exocytosis)
81
What are dust cells?
Macrophages found in alveloli which remove pathogens and foreign material that bypasses the mucociliary escalator
82

The Respiratory System (16 decks)

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