Pathology of the Lung Flashcards
What is Atelectasis?
Incomplete Expansion of the lung or collapse of previously inflated lung. Usually reversible, hypoxia, predisposes to infection
What are the types of Atelectasis?
Resorption
Compression
Patchy
Contraction
What is the cause of Pulmonary Congestion and Edema?
Hemodynamic Disturbances
Edema coused by Microvascular injury.(capillaries of alveolar septa)
What causes hemodynamic pulm edema?
Inc Hydrostaic Pressure(Left sided CHF)
What are the different obstructive lung diseases?
Emphysema
Chronic Bronchitis
Asthma
Bronchiectasis
Where does Bronchitis occurr vs EMphysema
Br: Large Airways, Small airways
Em: Acinus
Which volume is increased in obstructive lung disease?
Residual Volume
What happens to FEV1/FVC ratio in Obstructive vs Restrictive Diseases?
Obs: Dec FEV1 and FEV1/FVC ratio
Rest: Dec TLC but FEV1/FVC normal
At what point are symptoms appreciated in Emphysema?
1/3 of pulmonary parenchyma incapacitated
What is definition of emphysema?
Irreversible enlargement of airspaces distal to terminal bronchioles, no obvious fibrosis
How does smoking cause emphysema?
Stimulates release of elastase (macrophage elastase not inhibited by a1-AT
Cigarettes inhibit antiproteases
What is the genotype of a1-AT deficiency?
PiMM normal
PiMZ carrier
PiZZ affected
What are the different types of Emphysema?
Centriacinar
Panacinar
Paraseptal: Adjacent to areas of fibrosis, scarring or atelectaisis
Irregular: Associated with Scarring
What area of the lung is associated with panacinar Emp?
Basilar Portions of the lung
With Centriacinar emp.
What area of the lung is associated with Distal Acinar Emp?
Adjacent to Pleura and scarring
Associated with Spontaneous pneumothorax
What is the associated dangerous pathology associated with bullous Emp?
Pneumothorax
What is the usual cause of death in Emphysema?
Resp acidosis and Coma
Right sided HF
Massive collapse of lungs 2/2 pneumothorax
What is the Tx of Emp?
Bronchodilators, steroids, bullectomy, lung volume reduction surgery, lung transplant, subs of a1-AT
What is Chronic Bronchitis?
Persistent cough with production of sputum for at least 3 months of the year for 2 consec years
Chron irritation by inhaled subs (smoking)(middle aged male smokers)
What is the Morphologic Change seen in Chron Bronchitis?
Goblet Cell Metaplasia
Hypertrophy of submucosal glands of trachea and bronchi (reid index >.4)
What are cancerous changes associated with CB?
Squamous metaplasia/dysplasia
What Bacterial and Viral infections are associated with CB?
Bact: H. Influenzae, Strep Pneumo
Vir: Adenovirus, RSV
What are the different types of asthma?
Atopic (Extrinsisc) Asthma
Non-Atopic Asthma
Which Cytokines are released by TH2 Cells in Allergic asthma?
IL-4, IL-5
What is the observed morphology in asthma?
Ovrdistended, hyperinflated lungs, some atelectaisis
Curchmann spirals
Charcot-Leyden Crystals
What is Bronchiectaisis?
Permanent dilation of Bronchi and bronchioles caused by destruction of muscle and elastic supporting tissue.
What are the 2 required causes of Bronchiectaisis?
Obstruction and Chronic Persistent infection
What are the congenital conditions that can cause Bronchiectaisis?
Cystic Fibrosis
Immunodeficiency, and immotile cilia syndrome
What infections can cause bronchiectasis?
S Aureus, Klebsiella, Post TB
What is Kartagener Syndrome?
Loss of radial spokes in cilia. Decreased Motility
Leads to situs inversus, and Dextrocardia
Infertile males
What are the clinical Features of Bronchiectaisis?
Chronic Productive Cough, hemoptysis, foul smelling sputum
Dyspnea and hypoxemia, pneumonia, lung abcess
Non-specific systemic symptoms
What are the complications related to bronchiectasis?
Pulm HTN
Brain Abcess
Cor Pulmonale (rare)
Amyloidosis
