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Respiratory Physiology > Pathology of Obstructive Lung Disease > Flashcards

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
Q

What clinically is chronic bronchitis likely to be confused with?

A

Chronic bronchial asthma

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26
Q

When does “complicated” chronic bronchitis arise?

A

When mucopurulent (acute infective exacerbation) or FEV1 falls

27
Q

What does mucopurulent mean?

A

Containing both mucus and pus

28
Q

What morphological changes occur in the large airways in chronic bronchitis?

A

Mucous gland hyperplasia (enlargement) Goblet cell hyperplasia Inflammation and fibrosis is a minor component

29
Q

What morphological changes occur in the small airways in chronic bronchitis?

A

Goblet cells appear Inflammation and fibrosis in long standing disease

30
Q

Define emphysema?

A

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
Q

What type of emphysema begins with bronchiolar dilatation followed by loss of alveolar tissue?

A

Centri-acinar

32
Q

What is Pan-acinar Emphysema characterised by?

A

Permanent destruction of the entire acinus distal to the respiratory bronchioles No obvious associated fibrosis

33
Q

What is Bullous Emphysema characterised by?

A

The presence of one or more abnormally large air spaces surrounded by relatively normal lung tissue

34
Q

What is a bulla?

A

An emphysematous space greater than 1cm

35
Q

What is an acinus?

A

a region of the lung supplied with air from one of the terminal bronchioles - hence destruction distal to the bronchioles with pan-acinar

36
Q

What is the term bleb often used to describe?

A

An emphysematous space greater than 1cm (a bulla) just underneath the pleura

37
Q

What components of small airways have been found to respond to pharmacological intervention?

A

Smooth muscle tone Inflammation

38
Q

Is airway obstruction in COPD always irreversible?

A

Not always, there may be a reversible component

39
Q

What is normal PaO2 during normal pulmonary gas exchange?

A

10.5-13.5 kPa

40
Q

What value of PaO2 is seen in type I respiratory failure?

A

Less than 8kPa

41
Q

What is normal PaCO2 during normal pulmonary gas exchange?

A

4.8-6 kPa

42
Q

What value of PaCO2 is seen in type I respiratory failure?

A

Remains normal or is lower than usual

43
Q

What type of PaCO2 is seen in type 2 respiratory failure?

A

Over 6.5kPa PaO2 is usually low

44
Q

What are the four abnormal states associated with Hypoxaemia?

A

Ventilation / Perfusion imbalance - V/Q Diffusion impairment Alveolar Hypoventilation Shunt

45
Q

What does a ventilation/perfusion mismatch cause which contributes to COPD?

A

Airway obstruction

46
Q

What does diffusion impairment cause which contributes to COPD?

A

Loss of alveolar surface area

47
Q

What does alveolar hypoventilation cause which contributes to COPD?

A

Reduced respiratory drive

48
Q

When does shunt occur in hypoxaemia?

A

Only during active ineffective exacerbation

49
Q

What is the normal ventilation/perfusion ratio?

A

4/5 (0.8) Since normal breath is roughly 4L/min and normal cardiac output is roughly 5L/min

50
Q

What is the commenest cause of hypoxaemia?

A

Low V/Q

51
Q

Local alveolar hypoventilation due to some focal disease may cause what to arise in some alveoli?

A

Low V/Q

52
Q

Hypoxaemia due to low V/Q responds well to small increases in what?

A

FiO2

53
Q

What effect does alveolar ventilation have on PACO2 and PaCO2?

A

PACO2 - increases PaCO2 - increases

54
Q

What effect does increased PACO2 have on PAO2 and PaO2?

A

PAO2 - decreases PaO2 - decreases

55
Q

A fall in PaO2 due to hypoventilation is corrected by raising what?

A

FIO2

56
Q

What is FIO2?

A

The fraction of inspired air which is oxygen

57
Q

What does hypoxia cause in the pulmonary arterioles?

A

Vasoconstriction

58
Q

Pulmonary arteriolar vasoconstriction can be a localised effect, what would cause all vessels will constrict?

A

Hypoxaemia

59
Q

Why is vasoconstriction a protective mechanism?

A

As it stops blood being sent to alveoli that are short of oxygen

60
Q

What is Chronic Cor Pulmonale?

A

Hypertrophy of the right ventricle resulting from disease affecting the function and/or structure of the lung

61
Q

What factors cause Pulmonary Hypertension to occur in Hypoxic Cor Pulmonale?

A

pulmonary vasoconstriction muscle hypertrophy and intimal fibrosis in pulmonary arterioles loss of capillary bed secondary polycythaemia bronchopulmonary arterial anastamoses

62
Q

What is the name of the most common form of emphysema?

A

Centriacinar

63
Q

What is the name given to the form of emphysema that is connected to alpha-1-trypsin deficiency?

A

Pan-acinar

64
Q

Emphysema can be caused by the inbalance of what?

A

Protease and antiprotease

Respiratory Physiology (13 decks)

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