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Respiratory System > Pathology of Obstructive Lung Disease > Flashcards

Pathology of Obstructive Lung Disease Flashcards

1
Q

Obstructive airway diseases

A

Chronic bronchitis
Emphysema
Asthma

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2
Q

Chronic bronchitis and emphysema are better known as

A

Chronic obstructive pulmonary disease (COPD)

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3
Q

Normal FEV1

A

3.5-4 litres

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4
Q

Normal FVC

A

5 litres

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5
Q

Investigations for obstructive lung disease

A

Spirometry

Peak expiratory flow rate (PEFR)

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6
Q

Normal range of peak flow

A

80-100%

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7
Q

Moderate fall range of peak flow

A

50-80%

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8
Q

Marked fall range of peak flow

A

<50%

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9
Q

PEFR in obstructive lung disease

A

Reduced

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10
Q

FEV1 in obstructive ling disease

A

Reduced

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11
Q

FEV in obstructive lung disease

A

May be reduced

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12
Q

FEV1/FVC ratio in obstructive lung disease

A

<70%

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13
Q

Bronchial asthma is a reflection of

A

Type 1 hypersensitivity

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14
Q

Bronchial asthma

A

Bronchial smooth muscle contraction and inflammation

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15
Q

Bronchial asthma is generally considered to be

A

Reversible airway obstruction

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16
Q

Causes of chronic bronchitis and emphysema

A 
Smoking
Atmospheric pollution
Occupation - dust
Age 
Susceptibility
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17
Q

Prevalence of chronic bronchitis and emphysema

A

Men>women

Increasing in developing countries

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18
Q

Why are chronic bronchitis and emphysema more common in men than women

A

Men tend to smoke more and are occupied in jobs that are more likely to have them around atmospheric pollution

19
Q

Clinical presentation of chronic bronchitis

A

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

20
Q

Complicated chronic bronchitis when

A

Mucopurulent

21
Q

Mucopurulent

A

Excess production of mucous in the respiratory tract - result in coughing it out

22
Q

Morphological changes in large airways in chronic bronchitis

A

Mucous gland hyperplasia
Goblet cell hyperplasia
Inflammation and fibrosis - minor

23
Q

Morphological changes in small airways in chronic bronchitis

A

Goblet cells appear

Inflammation and fibrosis in long standing disease

24
Q

Emphysema

A

Increase in the size or airspace’s distal to the terminal bronchiole arising either from dilation or from destruction of their walls and without obvious fibrosis

25
Q

Acinus

A

Area of lung where gas exchange takes place

26
Q

Forms of emphysema

A 
Centriacinar
Panacinar
Periacinar
Scar 'irregular'
Bullous emphysema
27
Q

Centriacinar emphysema

A

Emphysema in the centre of the acinus, begins with bronchiolar dilation then alveolar tissue is lost

28
Q

Panacinar emphysema

A

Emphysema in entire acinus, from bronchiole to alveoli expanded, more common in lower lobes

29
Q

Periacinar emphysema

A

Emphysema adjacent to pleura and septal lines, distributed within secondary pulmonary lobule, subpleaural

30
Q

Bulla

A

Emphysematous space greater than 1cm

31
Q

Bleb

A

Bulla just underneath the pleura

32
Q

Pathogenesis of emphysema

A

Smoking
Protease-antiprotease imbalance
Ageing
Alpha-1-antitrypsin deficiency

33
Q

Apha-1-antitrypsin deficiency caused emphysema

A

Prevents production of anti-elastase (anti-protease) so too much elastase (protease) present leading to tissue destruction

34
Q

Smoking caused emphysema

A

Increases the production of inflammatory cells (macrophages and neutrophils) which produce elastase (protease) production and lead to more tissue destruction. Repair mechanisms and anti-elastase proaction are inhibited.

35
Q

Most of airflow limitation in COPD is

A

Irreversible

36
Q

Mechanisms of airway obstruction in COPD in small airways

A

Smooth muscle tone, inflammation. fibrosis, partial collapse on expiration

37
Q

Mechanisms of airway obstruction in COPD in large airways

A

Little contribution by glands and mucous

38
Q

Mechanisms of airway obstruction that respond to pharmacological intervention

A

Smooth muscle tone and inflammation (like asthma)

39
Q

Function of alveolar attachments

A

Stop alveoli from collapsing at expiration and so keep airways open

40
Q

Effect of emphysema on alveolar attachments

A

Attachments are cut resulting in loss of pull and so flopping airways and airflow limitation

41
Q

Why COPD results in hypoxaemia

A

Airway obstruction
Reduced respiratory drive
Loss of al velour surface are
Only during acute infective exacerbation

42
Q

Chronic (hypoxic) cor pulmonale

A

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

43
Q

Why does chronic (hypoxic) cor pulmonate result sin pulmonary hypertension

A

Pulmonary vasoconsriction
Loss of capillary bed
Muscle hypertrophy and intimal fibrosis of pulmonary arterioles
Secondary polychthemia

Respiratory System (20 decks)

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