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SD III Block 3 > PFT - Bronchitis-emphysema COPD > Flashcards

PFT - Bronchitis-emphysema COPD Flashcards

1
Q

Be able to reproduce this chart.

A

Reproduce chart

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2
Q

Why is the TLC increased in obstructive lung disease?

A

mainly due to increase in the residual volume

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3
Q

What is the shift of the pressure-volume curve for restrictive lung disease?

A

Restrictive lung disease like pulmonary edema will show a shift to the right and is more flat due to reduced compliance

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4
Q

What is the shift of the pressure-volume curve for those with obstructive lung disease?

A

Obstructive lung disease (i.e emphysema) would show a shift to the left and is more steep due to air trapping

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5
Q

What are the obstructive lung disease we listed?

A
  1. Chronic obstructive pulmonary disease (COPD)
    1. emphysema
    2. chronic bronchitis
  2. asthma
  3. bronchiectasis
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6
Q

COPD includes what two conditions that typically occur together?

A

chronic bronchitis

emphysema

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7
Q

What is the major pathogenetic mechanism by which COPD results?

A

cigarette smoking

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8
Q

Emphysema is a disease restricted to what area?

A

acinus

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9
Q

What is emphysema characterized by? What parts of the respiratory system involved? What does all this result in?

A

Abnormal Permanent Enlargement of the air spaces distal to the terminal bronchiole due to
destruction of their elastic tissue support (walls).

All or the part of the respiratory unit (respiratory bronchiole, alveolar ducts and alveoli) may be involved.

Results in: Loss of elastic recoil and enlarged air spaces.

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10
Q

What is the acinus comprised of?

A

respiratory bronchiole
alveolar duct
alveoli

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11
Q

What does this image depict?

A

lung with emphysema

centriacinar emphysema: central areas show marked emphysematous damage, surrounded by relatively spared alveolar spaces

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12
Q

What are some mechanism or etiologies/pathogenesis by which emphysema comes about?

A

protease-antiprotease mechanism

Hereditary a1 antitrypsin deficiency

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13
Q

Describe the protease mechanism of causing emphysema.

A

Protease (elastase) produced by Neutrophils and Macrophages

Antiprotease includes α 1 Antitrypsin

Imbalance between protease and antiprotease in lung.
Smoking attracts & stimulates release of elastase (protease) from neutrophil.
Oxidants in cigarette smoke and oxygen free radicals from neutrophils inhibit α 1 Antitrypsin (antiprotease).

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14
Q

What is the mechanism by which Hereditary a1 antitrypsin deficiency produces emphysema?

A

pi gene on chromosome 14

piZ allele codes for structurally abnormal protein that accumulates in the liver.

piZZ homozygous state associated with panacinar emphysema and hepatic cirrhosis

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15
Q

Neutrophil elastase is capable of digesting what organ?

A

human lung

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16
Q

What can inhibit neutrophil protease from digesting the human lung?

A

alpha 1 antirtrypsin

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17
Q

What are the 4 anatomical types of emphysema?

A

Centriacinar*
Panacinar*
Distal acinar
Irregular

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18
Q

What is the most common type of emphysema?

A

centriacinar (centre-lobular) emphysema

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19
Q

Where is the primary site of elastic tissue damage in centriacinar emphysema?

A

respiratory bronchioles

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20
Q

What part of the lobes of the lung are typically associated with centriacinar emphysema?

A

upper lobes

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21
Q

What part of the lobes do Panacinar emphysema usually affect?

A

lower lobes?

22
Q

Which emphysema is characterized by uniform destruction and enlargement of respiratory unit – whole acinus (respiratory bronchiole, alveolar duct and alveoli)?

A

Panacinar emphysema

23
Q

Which type of emphysema is usually associated with hereditary alpha 1 antitrypsin deficiency?

A

Panacinar emphysema - emphysema develops at in early age?

24
Q

Why is panacinar emphysema acquired in smokers?

A

chemicals in smoke inactivate alpha 1 antitrypsin

25
Q

What type of emphysema is depicted here?

A

centriacinar emphysema - central areas show marked emphysematous damage, surrounded by relatively spared alveolar spaces

26
Q

What type of emphysema is depicted here?

A

Panacinar emphysema - involving entire pulmonary architecture

27
Q

Which type of emphysema mainly involves the alveolar ducts and the alveoli sparing the proximal part of respiratory unit.

A

distal acing (paraseptal) emphysema

28
Q

Distal acing (paraseptal) emphysema appears as large air filled spaces found where?

A

located beneath the pleura

29
Q

If air filled spaces of distal acing emphysema are >1cm in diameter what are they called?

A

bullae

30
Q

Rupture of bull in distal acinar emphysema gives rise to what?

A

pneumothorax

31
Q

What does this image depict?

A

distal acing (paraseptal) emphysema - a more localized form of emphysema is known as paraseptal, or distal acing, emphysema, which can follow focal scarring

Seen here are 2 small bull just beneath pleura

32
Q

What condition is show here and explain.

A

Emphysema

Thinning and destruction of alveolar walls
Adjacent alveoli fuse > large airspaces
Loss of alveolar capillaries

33
Q

Because of loss of elastic recoil small airways will do what during expiration when a person has emphysema?

A

small airways collapse - trapping the air

34
Q

What are clinical finding os a person with emphysema?

A

Progressive Dyspnea and Hyperventilation

Patients work hard at breathing against pursed lips:
To prevent respiratory bronchioles from collapsing.

Diminished breath sounds due to lung hyperinflation.

Increased TLC

Change in the shape of chest : Barrel chest

Overventilation  Well oxygenated blood  pink puffers.

Decreased FEV 1sec/FVC ratio

35
Q

What would a chest radiograph show of one with emphysema?

A

hyperluscent lung fields

increased AP diameter

depressed diaphragm

36
Q

Can corpulmonale develop in late stages of emphysema?

A

yes

37
Q

How will a typical patient with emphysema appear?

A

Barrel-chested and dyspneic with prolonged expiration.

Sitting forward in a hunched over position

Attempting to squeeze air out of the lungs with pursed lips .

= Pink puffers

38
Q

What is the most common form of COPD?

A

chronic bronchitis

39
Q

Chronic bronchitis has a clinical definition requiring what?

A
  1. persistent cough and sputum production
  2. Present for at least 3 months
  3. Present for at least 2 consecutive years
40
Q

What is the etiology of chronic bronchitis/ most important factors causing chronic bronchitis.

A 
Strong association with cigarette smoking and 
Urban residence (air pollution).

Most important factors:

chronic irritation by inhaled substance:
cigarette smoke and air pollutants

41
Q

In pure chronic bronchitis what happens to the large airways?

A

Large airways (trachea,bronchi)
Inflammation
Mucus gland hyperplasia
Mucus hypersecretion

42
Q

In pure chronic bronchitis what happens to the small airways?

A 
Small airways (T.bronchioles)
Inflammation
Goblet cell metaplasia
Mucus plugs
SMC hypertrophy
43
Q

What are the effects of cigarette smoke and air pollutants when one has bronchitis?

A

Changes in Bronchi:
Inflammation
Mucous gland hypertrophy and hyperplasia which results in an increased Reid Index.
Reid’s Index
Ratio of the thickness of submucosal mucous glands to entire submucosa.
Increased in CB
Goblet cell hyperplasia.
Result: excessive mucous production.

Changes in Terminal bronchioles:
 Inflammation and fibrosis 
 Goblet cell metaplasia and Mucous plugs
 Smooth muscle hypertrophy
    Result: Narrowing  airflow obstruction.
44
Q

What are these 2 histological image showing?

A

mucous gland hyperplasia as seen in chronic bronchitis

45
Q

What is the pathogenesis of chronic bronchitis?

A

Chronic irritation by inhaled substances >

- Hyperplasia of submucosal glands resulting in
   - Hypersecretion of mucus in bronchi.

Obstruction to airflow in the terminal bronchioles.

46
Q

What are the C/F of chronic bronchitis ?

A

Persistent cough productive of copious sputum.
Dyspnea
Frequent infections
Weight gain.
Hypercarbia (CO2 retention)  Cyanosis (blue).
Patients called as blue bloaters.

47
Q

Chronic bronchitis contributes to airway obstruction through what?

A

mucous hypersecretion leading to airway plugging

airway edema and inflammation

48
Q

What is the net effect of COPD?

A

to make it difficult to get air out of lungs

49
Q

What does pulmonary hypertension is COPD result from?

A

Combination of:

pulmonary vasoconstriction (induced by hypoxia

Loss of pulmonary vasculature surface area and

increased blood viscosity (due to polycythemia induced by chronic hypoxia)

50
Q

In COPD once the heart develops right ventricular hypertrophy what can occur?

A

right ventricular failure and for pumonale

51
Q

T/F. Pulmonary hypertension leads to damage to branches of the pulmonary vein with intimal and medial hypertrophy narrowing the lumen and further aggravating the problem.

A

False. Leads to damages of branches of pulmonary artery

52
Q

What term is used to describe this individual?

A

blue bloater

SD III Block 3 (14 decks)

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