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Respiratory Physiology > Pathology of Obstructive Lung Disease > Flashcards

Pathology of Obstructive Lung Disease Flashcards

1
Q

Name 3 chronic obstructive diseases

A
  • Chronic bronchitis
  • Emphysema
  • Asthma
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2
Q

How do chronic bronchitis, emphysema and asthma differ?

A

The method that they obstruct the airway is different

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3
Q

What is the collective term for chronic bronchitis and emphysema?

A

COPD

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4
Q

What does FEV1 stand for?

A

Forced Expiratory Volume in 1 second

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5
Q

What does FVC stand for?

A

Forced Vital Capacity

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6
Q

What are the normal values for the FEV1/FVC ratio?

A
  • FEV1 usually 70-80% of FVC
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7
Q

What does spirometry test?

A

If the airways are obstructed

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8
Q

What test do asthmatics use at home to test their airways?

A

Peak flow

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9
Q

What is normal peak flow range?

A

80-100% of best recorded value

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10
Q

What results of peak flow, FEV1 and FVC do you expect to see with obstructive disease?

A
  • Low peak flow
  • FEV1 reduced
  • FVC possible reduced
  • FEV1 less than 70% of FVC
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11
Q

What causes bronchial asthma?

A
  • Type 1 hypersensitivity in the major airways
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12
Q

What causes the bronchial constriction in the airway?

A
  • Degranulation of mast cells

- Release of histamine and other chemotactic factors

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13
Q

What two ways can bronchial asthma be reversed?

A
  • On it’s own

- Through treatment

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14
Q

What 3 environmental factors can result in COPD?

A
  • Smoking
  • Pollution
  • Occupational dust
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15
Q

What can a deficiency in alpha 1 antitrypsin lead to?

A

Emphysema

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16
Q

What happens to a persons FEV1 curve when they stop smoking?

A
  • Damage is already done

- FEV1 keeps declining but now only at the same rate as a normal person

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17
Q

What is the clinical definition of chronic bronchitis?

A

A sputum producing cough in 3 months for 2 years

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18
Q

During chronic bronchitis what morphological changes do the large airways undergo?

A
  • Mucous gland hyperplasia
  • Goblet cell hyperplasia
  • Inflammation and fibrosis
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19
Q

Pathological definition of emphysema?

A
  • Increase in size of distant bronchioles

- Size increases from either breakdown of walls or dilation

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20
Q

What is the terminal bronchiole?

A
  • Last conducting bronchiole
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21
Q

Where is centriacinar emphysema located?

A

Proximal resp bronchioles (apex of upper and lower lobes)

22
Q

Progression of centriacinar emphysema?

A
  • Bronchiolar dilation

- THEN loss of alveolar tissue

23
Q

What is a bulla?

A
  • Space greater than 1cm in the distal airways caused by emphysema
24
Q

What is a bleb?

A

Bulla directly underneath the pleura

25
Q

What happens when a bleb bursts?

A

Pneumothorax

26
Q

What should be apparent on a chest X ray of a person with emphysema?

A

Hyperinflation of the lungs

27
Q

What does inflammation in the lungs release which can end up being a problem?

A
  • Elastases (proteases) which can break down the walls between bronchioles
28
Q

What normally happens to elastase?

A

There is an equilibrium between elastase and anti-elastase

29
Q

What does smoking do to the equilibrium of elastase and anti elastase?

A

Fucks it up

30
Q

Which aspect of the equilibrium does smoking fuck up?

A
  • Reduces anti elastase levels
  • Increases elastase levels
  • Increases neutrophils and macrophages
31
Q

What is the most important development in emphysema?

A
  • Loss of alveolar attachments
32
Q

Why is it impossible to completely exhale your entire residual volume?

A

Small airways close

33
Q

What are the 4 abnormal states that can result in hypoxaemia?

A
  • V/Q mismatch
  • Shunt
  • Alveolar hypoventilation
  • Inability to diffuse
34
Q

How does the V/Q mismatch lead to hypoxaemia?

A
  • Some alveoli not ventilated well
  • Occasionally blood gets through that is not oxygenated
  • The more non ventilated alveoli the worse the effects
35
Q

How does alveolar hypoventilation lead to hypoxaemia?

A

Reduces the respiratory drive

36
Q

How does inability to diffuse result in hypoxaemia?

A

Loss of alveolar surface area

37
Q

What conditions show a V/Q mismatch?

A
  • Bronchitis

- Bronchopneumonia

38
Q

When would shunt be seen?

A
  • Severe bronchopneumonia
39
Q

Why does a lot of blood need to not be oxygenated for shunt?

A
  • Has to be enough so a lot of unoxygenated blood mixes with oxygenated blood
  • Large area of lung has to be non ventilated to mean that no gas exchange occurs
40
Q

What is normal ventilation?

A

4L/min

41
Q

What is normal cardiac output?

A

5L/min

42
Q

What is normal V/Q?

A

4/5 so 0.8

43
Q

How can hypoxaemia due to low V/Q be countered?

A
  • Increasing FIO2

- Usually through breathing oxygen

44
Q

When will treating hypoxaemia due to V/Q not help?

A

When it is a result of shunt

45
Q

How can you tell shunt is pathological?

A
  • AV malformations
  • Congenital heart disease
  • Pulmonary disease
46
Q

What does FIO2 stand for?

A

Fraction of inspired air that is oxygen

47
Q

What does hypoventilation result in?

A
  • Increases PACO2

- Decreased PAO2

48
Q

Why is it important to monitor someone with COPD placed on oxygen?

A
  • Respiratory centre becomes oblivious by the effects of CO2 and H ions and therefore lose their resp. drive
  • Rely on hypoxia to breathe
  • If hypoxia is reduced then they will stop breathing
49
Q

What is chronic cor pulmonale?

A
  • Right ventricular heart failure due to pulmonary hypotension secondary to a pulmonary vascular disease
50
Q

What can occur on a chest x ray to the heart of COPD sufferers

A

Increase in right ventriclular muscle

Respiratory Physiology (16 decks)

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