pulmonary vascular disease and pleural disease Flashcards
1
Q
what is pulmonary circulation?
A
- there is a dual supply through pulmonary arteries and bronchial arteries
- low pressure system so has thin walls and a low incidence of arteriosclerosis
- pulmonary artery receives entire cardiac output so it acts as a filter
2
Q
what is pulmonary oedema?
A
- accumulation of fluid in the lungs - interstitium and alveolar spaces
- causes a restrictive pattern of disease
3
Q
what are the causes of pulmonary oedema?
A
- haemodynamic (increased hydrostatic pressure
- due to cellular injury eg alveolar lining cells and alveolar endothelium, localised = pneumoina, generalised = adult respiratory distress syndrome
4
Q
what is ARDS?
A
- diffuse alveolar damage syndrome
- also called shocked lung
- causes include sepsis, diffuse infection (virus, mycoplasma), severe trauma, oxygen
5
Q
what is the pathogenesis of ARDS?
A
- injury (eg bacterial endotoxin)
- infiltration of inflammatory cells
- cytokines
- oxygen free radicals
- injury to cell membranes
6
Q
what is the pathology of ARDS?
A
- fibrous exudate lining alveolar walls (hyaline membranes)
- cellular regeneration
- inflammation
7
Q
what is the outcome of ARDS?
A
- death
- resolution
- fibrosis (chronic restrictive lung disease)
8
Q
what is neonatal RDS?
A
- deficient in surfactant (type 2 alveolar lining cells )
- increased effort in expanding lung = physical damage to cells
9
Q
what is an embolus?
A
- a detached intravascular mass carried by the blood
- most emobli are thrombi (form within the blood stream), others include gas, fat, foreign bodies and tumour clumps
10
Q
what are the risk factors for PE/DVT?
A
- factors in vessel wall (eg endothelial hypoxia)
- abnormal blood flow (venous stasis)
- hypercoaguable blood (cancer patients, post-MI)
11
Q
why can a clinically silent small emboli be dangerous?
A
- it can be recurrent and lead to pulmonary hypertension
12
Q
what are the mechanism of pulmonary hypertension?
A
- hypoxia (vascular constriction)
- increased flow through pulmonary circulation (congenital heart disease)
- blockage (PE) or loss (emphysema) of pulmonary vascular bed
- back pressure from left sided heart failure
13
Q
what is the morphology (what does it look like) of pulmonary hypertension?
A
- medial hypertrophy of arteries
- intimal thickening (fibrosis)
- atheroma
- right ventricular hypertrophy
- extreme cases(congenital heart disease, primary pulmonary hypertension) - plexogenic change/necrosis
14
Q
what is cor pulmonale?
A
- (heart disease because of lung disease)
- pulmonary hypertension complicating lung disease
- right ventricular hypertrophy
- right ventricular dilation
- right heart failure (swollen legs, congested liver etc)
15
Q
what is the pleura?
A
- a mesothelial surface lining the lungs and mediastinum
- mesothelial cells designed for fluid absorption
- hallmark of disease is the effusion
