Pulmonary: Atelectasis + Obstructive Flashcards
What is atelectasis
Collapse of airway spaces
What is resorption atelectasis
Occlusion of a bronchus
What is compression atelectasis
Due to a mass or bleeding
What is contraction atelectasis due to
Scarring in the lung like silicosis
What is obstructive lung disease?
Limitation of airflow due to partial or complete obstruction
Lung volumes in obstructive?
What is the problem?
Normal
Hard to get air out (FEV1 done)
What forms of obstructive are reversible?
Just asthma
What is asthma?
Episodic reversible bonrchospasm from stimuli with underlying chronic inflammatory state
Asthma on histo?
Inflammatory cells
Eosinophils
Symptoms of asthma?
- Episodic dyspena
- Chest tightnesss
- Cough
Extrinsic asthma initiated by what?
Timing in life
Type 1 hypersenstivity
Early in life (kids)
Asthma Ig?
Cells (2)
IgE
Mast and Eosinophils
Atopic asthma?
Kids with red rash from hay fever
Occupational asthma?
Something from work place
Allergic bronchopulmonary asthma is due to what?
Aspergillus growing in airways
Intrinsic asthma is triggered by what?
When in life?
Non-immune triggers like asthma, cold exposure, exercise
Later in life
Main cells in all asthmas? 2
- Eosinophils
2. Th2 lymphocytes
Substances involved in early phase of asthma? (5)
- Leukotrienes
- Prostglandings
- Platelet-activating factor
- Histamine
- Mast cell tryptase
Substances involved in late phase of asthma? (5)
- WBC chemotactic factors
- Leukotreine B
- IL-4 and IL-5
- Platelet activating factor
- Tumor necrosis factor
Morpho changes
- Mucus plugs (obstructive
- Edema
- Hyperemia
- Goblet cells increase
- Hypertrophy of bronchial muscle
What is hyperemia
Dilated vessels that give tissues a red color
COPD affects what % of US population
Reversible or irreversible?
10%
Irreversible
Two forms of COPD
Which is more common?
Emphysema
Chronic bronchitis
Combination of the two
Mechanism of emphysema
Alveolar sacs dilate and lose elastic recoil
What is the change in the lung in emphysema?
The walls are destroyed
How are chronic bronchitis and emphysema
- Emphysema is defined by morphologic changes
2. Emphysema Restricted to the acini
Emphysema is more common in which sex?
Which form especially?
Men
Centriacinar
Emphysema has a clear association with what two factors?
- Smoking
2. Alpha-1-antitrypsin deficiency
Two imbalances in emphysema and their effect
- Protease-antiprotease imbalance: ( Destruction of elastic fibers –> Permanent dilation of air sacs (Smoking & alpha-1-AT deficiency)
- Oxidant-antioxidant imbalance: Oxidative damage –> Tissue destruction (Smoking)
First symptom of emphysema
Speed of disease
Dyspena
Slow
PFT's of emphysema show what? FEV1? FVC? FEV1-FVC ratio O2 levels
FEV1 down
FVC normal
FEV1/FVC down
O2 normal
Pure emphysema individuals are described how?
Why?
Pink puffers
Barrel chest
Exhale against pursed lips (Back pressure against)
Thin
Chronic bronchitis patients are described how?
Why?
Blue bloaters
Overweight
Hypoxic/Cyanosis
What do emphysema patients gradually acquire? (End-Stage)
Why?
Pulmonary hypertension
Loss of capillary surface –> Increases resistance –> Pulmonary HTN
Centroacinar emphysema
Locations spared?
Upper or lower lobes
Associated with what?
Distal parts of acini
Upper lobes
Cigarette smoke
Panacinar
Location
Upper or lower
Associated with what?
All of the acini
Lower lung
Alpha-1-antitrypsin
Normal alpha-1-AT genotype?
Bad one?
What else happens with bad one?
MM
ZZ
Liver disease/Cirrhosis
Distal/paraceptal
Location
Location in lungs (2)
Type of patient:
Distal portions of acini
Pleural surface AND upper half
Spontaneous pneumothorax in young adults
False emphysemas
- Compensatory emphysema
- Senile emphysema
- Obstructive overinflation
- Mediastinal emphysema
Compensatory emphysema cause
Dilatation due to loss of lung substance elsewhere
Senile emphysema definition
Overdistended lungs in elderly due to change in lung geometry (NO tissue destruction)
Obstructive overinflation definition?
Problem?
Lung expansion due to obstruction with air trapping
Serious lifethreatening if too much lung is compressed
Mediastinal emhysema definition
What is it secondary to?
Entrance of air into soft tissues of the lung, mediastinum and subcutis.
High intra-alveolar pressures, ventilators, and chest wall trauma
Chronic bronchitis is diagnosed how?
Clinically: persistent productive cough for at least 3 consecutive months in at least 2 consecutive yeras
Define chronic bronchitis
Bronchial mucus hypersecretion secondary to inflammation, fibrosis, and narrowing of bronchioles
Simple chronic bronchitis is defined how?
Cough with mucoid sputum (no obstruction)
Chronic mucopurulent bronchitis is defined how?
Production of purulent sputum secondary to associated infections
Chronic asthmatic bronchitis is defined how?
Best treatment?
Hyperresponsive airways giving episodes of asthma
Bronchodilator
Single most important cause of chronic bronchitis?
Cigarette smoke
Inflammation cells in chronic bronchitis?
- CD8 T cells
- Neutrophils
- Macrophages
What is a secondary problem with chronic bronchitis?
Microbial infections
CB patients are described how?
Why?
Blue bloaters
- Overweight
- Cyanotic
Progression of chronic bronchitis (2)
- Pulm HTN
2. Cardiac failure
Bronchiectasis definition
Inflammatory destruction of bronchi walls –> Dilated and floppy with purulent secretions
Predisposing bronchiectasis hereditary conditions
- Cystic fibrosis (pseudomonas)
2. Kartagener syndrome (ciliary dysfunction)
Nonhereditary predisposing bronchiectasis conditions? 2
- Necrotizing pneumoniae (Klebsiella, S. aureus)
2. Suppurative pneumonias
How do cultures of bronchiectasis present?
Mixed: lots of bugs
Symptom of bronchiectasis
- Persistent cough with sputum
- Episodic and worsened by URI’s
- Clubbing of finger tips
- Metastatic brain abscesses
- Reactive amyloidosis
