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Pathology of Obstructive Lung Disease Flashcards

1
Q

Lung cancer and other tumours, inhaled foreign bodies and chronic scarring diseases like bronchiectasis and secondary tuberculosis may be associated with obstruction of a large airway, (localised obstruction), are the calssed as obstructive diseases?

A

No

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2
Q

Name 3 obstructive diseases.

A

Chronic Bronchitis Emphysema Asthma

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3
Q

All 3 of these diseases have obstruction involved, is the mechanism for the obstruction the same?

A

No

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4
Q

What is chronic bronchitis and emphysema better known as?

A

COPD

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5
Q

What is FEV1?

A

The forced expiratory volume in 1 second - when blowing air out of lungs as fast as possible

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6
Q

What is FVC?

A

Forced vital capacity - the final total amount expired

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7
Q

What percent of FVC is FEV1 normally?

A

About 70/80%

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8
Q

What is normal FEV1?

A

3.5-4 litres

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9
Q

What is normal FVC?

A

5 litres

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10
Q

What is the normal ratio of FEV1 : FVC?

A

0.7-0.8

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11
Q

What type of technique uses FEV1 and FVC as measurements?

A

Spirometry

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12
Q

What else can be used to demonstrate obstructive lung disease?

A

Peak Flow metres

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13
Q

What is peak flow measured in?

A

Peak Expiratory Flow Rate (PEFR)

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14
Q

What is the normal peak expiratory flow rate (PEFR)?

A

400-600 L/min

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15
Q

What is the normal range of PEFR (as a percentage of best value)?

A

80-100%

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16
Q

What effect do obstructive lung diseases have on: PEFR FEV1 FVC?

A

PEFR - reduced FEV1 - reduced FVC - normaly stays the same but cane be reduced

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17
Q

What causes bronchial asthma?

A

Type I sensitivity in the airways

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18
Q

Bronchial asthma is driven by what?

A

Mast cell degranulation

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19
Q

What two groups of chemicals are released due to degranulation?

A

Chemotactic factors and spasmogens

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20
Q

What does bronchial asthma cause the cross-sectional area of the lumen in small bronchioles to do?

A

Causes them to reduce

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21
Q

Is bronchial asthma generally considered to be reversible or irreversible?

A

Reversibe

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22
Q

What effect does bronchial asthma have on bronchial smooth muscle?

A

Contraction and inflammation of the bronchial smooth muscle

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23
Q

Give some causes for Chronic bronchitis and emphysema/COPD

A

Smoking Atmospheric pollution Occupational pollution (e.g. asbestos) Ageing (Alpha-1-antiprotease (antitrypsin) deficiency = very rare cause of emphysema)

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24
Q

How is chronic bronchitis defined clinically?

A

A cough productive of sputum most days in at least 3 consecutive months for 2 or more consecutive years

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25
What clinically is chronic bronchitis likely to be confused with?
Chronic bronchial asthma
26
When does "complicated" chronic bronchitis arise?
When mucopurulent (acute infective exacerbation) or FEV1 falls
27
What does mucopurulent mean?
Containing both mucus and pus
28
What morphological changes occur in the large airways in chronic bronchitis?
Mucous gland hyperplasia (enlargement) Goblet cell hyperplasia Inflammation and fibrosis is a minor component
29
What morphological changes occur in the small airways in chronic bronchitis?
Goblet cells appear Inflammation and fibrosis in long standing disease
30
Define emphysema?
Increase beyond normal in the size of airspaces distal to the terminal bronchiole Arising either from dilatation or from destruction of their walls and without obvious fibrosis.
31
What type of emphysema begins with bronchiolar dilatation followed by loss of alveolar tissue?
Centri-acinar
32
What is Pan-acinar Emphysema characterised by?
Permanent destruction of the entire acinus distal to the respiratory bronchioles No obvious associated fibrosis
33
What is Bullous Emphysema characterised by?
The presence of one or more abnormally large air spaces surrounded by relatively normal lung tissue
34
What is a bulla?
An emphysematous space greater than 1cm
35
What is an acinus?
a region of the lung supplied with air from one of the terminal bronchioles - hence destruction distal to the bronchioles with pan-acinar
36
What is the term bleb often used to describe?
An emphysematous space greater than 1cm (a bulla) just underneath the pleura
37
What components of small airways have been found to respond to pharmacological intervention?
Smooth muscle tone Inflammation
38
Is airway obstruction in COPD always irreversible?
Not always, there may be a reversible component
39
What is normal PaO2 during normal pulmonary gas exchange?
10.5-13.5 kPa
40
What value of PaO2 is seen in type I respiratory failure?
Less than 8kPa
41
What is normal PaCO2 during normal pulmonary gas exchange?
4.8-6 kPa
42
What value of PaCO2 is seen in type I respiratory failure?
Remains normal or is lower than usual
43
What type of PaCO2 is seen in type 2 respiratory failure?
Over 6.5kPa PaO2 is usually low
44
What are the four abnormal states associated with Hypoxaemia?
Ventilation / Perfusion imbalance - V/Q Diffusion impairment Alveolar Hypoventilation Shunt
45
What does a ventilation/perfusion mismatch cause which contributes to COPD?
Airway obstruction
46
What does diffusion impairment cause which contributes to COPD?
Loss of alveolar surface area
47
What does alveolar hypoventilation cause which contributes to COPD?
Reduced respiratory drive
48
When does shunt occur in hypoxaemia?
Only during active ineffective exacerbation
49
What is the normal ventilation/perfusion ratio?
4/5 (0.8) Since normal breath is roughly 4L/min and normal cardiac output is roughly 5L/min
50
What is the commenest cause of hypoxaemia?
Low V/Q
51
Local alveolar hypoventilation due to some focal disease may cause what to arise in some alveoli?
Low V/Q
52
Hypoxaemia due to low V/Q responds well to small increases in what?
FiO2
53
What effect does alveolar ventilation have on PACO2 and PaCO2?
PACO2 - increases PaCO2 - increases
54
What effect does increased PACO2 have on PAO2 and PaO2?
PAO2 - decreases PaO2 - decreases
55
A fall in PaO2 due to hypoventilation is corrected by raising what?
FIO2
56
What is FIO2?
The fraction of inspired air which is oxygen
57
What does hypoxia cause in the pulmonary arterioles?
Vasoconstriction
58
Pulmonary arteriolar vasoconstriction can be a localised effect, what would cause all vessels will constrict?
Hypoxaemia
59
Why is vasoconstriction a protective mechanism?
As it stops blood being sent to alveoli that are short of oxygen
60
What is Chronic Cor Pulmonale?
Hypertrophy of the right ventricle resulting from disease affecting the function and/or structure of the lung
61
What factors cause Pulmonary Hypertension to occur in Hypoxic Cor Pulmonale?
pulmonary vasoconstriction muscle hypertrophy and intimal fibrosis in pulmonary arterioles loss of capillary bed secondary polycythaemia bronchopulmonary arterial anastamoses
62
What is the name of the most common form of emphysema?
Centriacinar
63
What is the name given to the form of emphysema that is connected to alpha-1-trypsin deficiency?
Pan-acinar
64
Emphysema can be caused by the inbalance of what?
Protease and antiprotease

Respiratory Physiology (13 decks)

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