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Respiratory block > Pathology of obstructive lung disease > Flashcards

Pathology of obstructive lung disease Flashcards

1
Q

What are the three main obstructive airway diseases ?

A

Asthma
Chronic bronchitis (COPD)
Emphysema (COPD)

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2
Q

What are the normal values for FEV1, FVC and the ratio between them ?

A

Normal FEV1 - 3.5-4L
Normal FVC - 5L
Ratio FEV1:FVC - 0.7-0.8

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3
Q

What is used to predict FVC ?

A

Age
Sex
Height

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4
Q

Besides FEV1/FVC ratio, how else can an obstructive lung disease be demonstrated ?

A

Peak expiratory flow rate (PEFR)

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5
Q

What are the normal values for PEFR ?

A

Normal 400 – 600 litres/min

Normal range is 80-100% of best value

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6
Q

What is PEFR moderate fall ?

A

50-80% of best

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7
Q

What is PEFR marked fall ?

A

<50-80% of best

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8
Q

What is FEV1, FVC, and PEFR in obstructive lung diseases ?

A 
Airflow limitation
PEFR is reduced
FEV1 is reduced
FVC may be reduced
FEV1 is less than 70% of FVC
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9
Q

What type of hypersensitivity is bronchial asthma ?

A

Type 1 hypersensitivity in the airways

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10
Q

What causes the decrease in diameter size in bronchial asthma ?

A

Degranulation of mast cells and smooth muscle contraction

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11
Q

What physical substances obstruct airways in chronic asthma ?

A

Oedema
Mucus
Plasma exudation

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12
Q

What can ease bronchial constriction ?

A

Use of drugs, or spontaneously

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13
Q

What is COPD ?

A

Chronic and irreversible small airway obstruction

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14
Q

What is chronic bronchitis ?

A

Chronic and irreversible small airway obstruction with mucus production and inflammation

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15
Q

What is emphysema ?

A

Chronic and irreversible small airway obstruction with permenant enlargement of air spaces distal to terminal bronchiole and alveolar wall destruction

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16
Q

What is the aetiologies of COPD ?

A

SMOKING
Atmospheric pollution
Occupational- dust

17
Q

What is a rare cause of emphysema ?

A

Alpha-1-antiprotease deficiency

18
Q

What is the mechanisms of obstruction in large airways in COPD ?

A

Little contribution by glands and mucous

18
Q

What is the mechanisms of obstruction in small airways in COPD ?

A

Smooth muscle tone
Inflammation
Fibrosis
Partial collapse of airway wall on expiration

In emphysema- loss of alveolar attachments

19
Q

What portion of COPD is reversible ?

A

Smooth muscle tone
Inflammation

Respond to pharmacological intervention

20
Q

What is chronic bronchitis defined as clinically ?

A

Cough production of sputum most days in at least 3 consecutive months for 2 or more consecutive years

21
Q

What is complicated chronic bronchitis ?

A

When sputum turns mucopurulent (acute infective exacerbation)
FEV1 falls

22
Q

What does chronic bronchitis exclude ?

A

TB
Bronchiectasis
These may be confused with asthma

23
Q

What are the morphological changes in the large airways in COPD ?

A

Mucous glands hyperplasia
Goblet cell hyperplasia
Inflammation and fibrosis- minor component

24
Q

What are the morphological changes in the small airways in COPD ?

A

Goblet cells appear

Inflammation and fibrosis in long standing disease

25
Q

What is the pathological definition of emphysema ?

A

Increase beyond the normal in the size of airspaces distal to the terminal bronchiole arising from wither dilation or from destruction of their walls without obvious fibrosis
Loss in alveolar tissue, more space between alveoli.

26
Q

What is an acinus ?

A

A region of the lung supplied with air from one of the terminal bronchioles

27
Q

What is centiacinar emphysema ?

A

Loss of lung tissue is concentrated at middle of acinus
Then alveolar tissue is lost
Predominates in the upper part of the lungs

28
Q

What is panacinar emphysema ?

A

Emphysema affecting all parts of the secondary pulmonary lobule, typically involving the inferior part of the lung and often associated with a α1-antitrypsin deficiency

29
Q

What is periacinar emphysema ?

A

Tissue loss around edges of acinus

30
Q

What is a bulla ?

A

Emphysematous space greater than 1cm

31
Q

What is a bleb ?

A

A bulla just underneath the pleura

32
Q

What is the pathogenesis of emphysema ?

A

Smoking (protease-antiprotease imbalance)
Ageing
Alpha-1-antitrypsin deficiency

33
Q

Why is there hypoxaemia in COPD ?

A

Airway obstruction
Reduced respiratory drive
Loss of alveolar surface area
Shunt- only during severe acute infective exacerbation

34
Q

What causes physiological pulmonary vasoconstriction ?

A

When alveolar oxygen tension falls

35
Q

How is Physiological pulmonary arteriolar vasoconstriction protective ?

A

Do not send blood to alveoli short of oxygen

36
Q

What is Cor pulmonale ?

A

Hypertrophy of the RV resulting from disease affecting the function or structure of the lung

Except where pulmonary alterations are the result of diseases primarily affecting the left side of the heart or congenital heart disease

37
Q

What causes pulmonary hypertension ?

A

Pulmonary vasoconstriction

Pulmonary arterioles- muscle hypertrophy and intimal fibrosis

Loss of capillary bed

Secondary polycythaemia

Bronchopulmonary arterial anastomoses

Respiratory block (38 decks)

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