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Respiratory: Pathology > Pulmonary vascular disease and Plural disease > Flashcards

Pulmonary vascular disease and Plural disease Flashcards

1
Q

What are the features of pulmonary circulation?

A
  • Dual supply - pulmonary arteries, bronchial arteries
  • Low pressure system
  • Pulmonary artery receives entire cardiac output (a filter)
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2
Q

What features arise from the fact that the pulmonary circulation is a low pressure system?

A
  • Thin walled vessels
  • Low incidence of atherosclerosis
    (at normal pressures)
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3
Q

What is pulmonary oedema?

A
  • Accumulation of fluid in the lung (interstitium, alveolar spaces)
  • Causes a restrictive pattern of disease
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4
Q

What are causes of pulmonary oedema?

A
  • Haemodynamic ( increased hydrostatic pressure)

* Due to cellular injury e.g. alveolar lining cells, alveolar endothelium

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5
Q

What is the most common cause of pulmonary oedema?

A

Haemodyanamic - cardiac failure i.e. increased hydrostatic pressure in the lungs due to left heart failure

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6
Q

What types of pulmonary oedema are there?

A
  • Localised – occurs in pneumonia

* Generalised – occur sin adult respiratory distress syndrome (ARDS)

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7
Q

What is lung consolidation?

A

Inflammatory exudation with fluid

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8
Q

What are features of ARDS?

A
  • Diffuse alveolar damage syndrome (DADS)

* Shock lung (causes include sepsis, diffuse infection (virus, mycoplasma), severe trauma, oxygen)

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9
Q

What are causes of shock lung in ARDS?

A

Causes include sepsis, diffuse infection (virus, mycoplasma), severe trauma, oxygen - important to monitor oxygen

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10
Q

What is the pathogenesis of ARDS?

A
  • Injury caused by, for example, bacterial endotoxin
  • Causes infiltration of inflammatory cells
  • Inflammatory cells release cytokines and oxygen free radicals
  • Causes injury to cell membranes
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11
Q

What is the morphology of ARDS?

A
  • Fibrinous exudate lining alveolar walls (hyaline membranes) - leads to poor gas exchange and acute respiratory failure
  • Cellular regeneration
  • Inflammation
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12
Q

What is the outcome of ARDS?

A
  • Death
  • Resolution (ITU with respiratory support provides best chance of resolution)
  • Fibrosis (chronic restrictive lung disease)
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13
Q

What individuals are affected with neonatal RDS?

A

Premature infants

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14
Q

What is neonatal RDS?

A
  • Deficient in surfactant (type 2 alveolar lining cells)

* Increased effort in expanding lung causes physical damage to cells

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15
Q

What is an embolus?

A

A detached intravascular mass carried by the blood to a site in the body distant from its point of origin

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16
Q

What are examples of emboli?

A

Most emboli are thrombi – others include gas, fat, foreign bodies and tumour clumps

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17
Q

What is a pulmonary embolus?

A

An important cause of sudden death and pulmonary hypertension

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18
Q

What are clinical presentations of pulmonary emboli?

A

Often subclinical – become breathless (acute dyspnoea) so not obvious it is caused by embolus

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19
Q

What type of emboli are involved in PE?

A

95% + of emboli are thromboemboli

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20
Q

What is the source of most PE?

A

Deep venous thrombosis (DVT) of lower limbs

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21
Q

What are the risk factors for PE?

A

The same as risk factors for DVT

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22
Q

What are the risk factors for DVT/PE?

A

Virchow’s Triad

  • Factors in vessel wall (e.g. endothelial hypoxia)
  • Abnormal blood flow (venous stasis)
  • Hypercoaguable blood (cancer patients, post-MI etc)
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23
Q

What are the effects of PE?

A
  • Sudden death
  • Severe chest pain/dyspnoea/haemoptysis
  • Pulmonary infarction
  • Pulmonary hypertension
24
Q

What do the effects of PE depend on?

A
  • Size of embolus
  • Cardiac function
  • Respiratory function
25
Q

What are the effects of large emboli?

A
  • Death
  • Infarction
  • Severe symptoms
26
Q

What are the effects of small emboli?

A
  • Clinically silent

* Recurrent pulmonary hypertension

27
Q

What is the definition of an infarct?

A

Infarct = Ischaemic necrosis (necrosis of tissue due to lack of blood supply)

28
Q

What are causes of pulmonary infarct?

A
  • Embolus necessary but not always sufficient (lots of people get embolus but not infarct)
  • Bronchial artery supply compromised (e.g. in cardiac failure) – likely to get infarct
29
Q

What is a common cause of pulmonary infarct other than thromboembolism?

A

Tumour embolus - caused by cancer metastasis

30
Q

What are the different types of pulmonary hypertension?

A
  • Primary (rare, young women)

* Secondary – almot always due to lung disease

31
Q

What are the mechanisms of pulmonary hypertension?

A
  • Hypoxia (vascular constriction)
  • Increased flow through pulmonary circulation (congenital heart disease)
  • PE
  • Emphysema
  • Back pressure from left sided heart failure
32
Q

What is the morphology of pulmonary hypertension?

A
  • Medial hypertrophy of arteries (become thicker)
  • Intimal thickening (fibrosis)
  • Atheroma
  • Right ventricular hypertrophy (can see on x-rays, ECG, cardiac function tests)
  • Extreme cases (congenital heart disease, primary pulmonary hypertension) – plexogenic change/necrosis
33
Q

What is the main cause of right ventricular hypertrophy?

A

Pulmonary hypertension

34
Q

What is Cor Pulmomale?

A

Heart disease due to lung disease e.g. COPD

35
Q

What are effects of Cor Pumonale?

A
  • Right ventricular hypertrophy
  • Right ventricular dilatation
  • Right heart failure (swollen legs, congested liver etc)
36
Q

What will appear on a CXR of a patient with pulmonary hypertension?

A
  • Cardiomegaly
  • Right ventricular dilation
  • Right ventricular hypertrophy
37
Q

What are signs of right heart failure?

A
  • Right ventricular dilation

* Right ventricular hypertrophy

38
Q

What are pleura?

A

Mesothelial surface lining the lungs and mediastinum

39
Q

What are pleural cells?

A

Mesothelial cells designed for fluid absorption

40
Q

What is the hallmark of pleural disease?

A

Pleural effusion

41
Q

What are types of pleural effusion?

A

Transudate (low protein)

  • Cardiac fialure
  • Hypoproteinaemia

Exudate

  • Pneumonia
  • TB
  • Connective tissue disease
  • Malignancy (primary or metastatic)
42
Q

What is exudation?

A

Exudation is active process – inflammatory process due to pneumonia, TB, connective tissue disease or malignancy

43
Q

What is transudate?

A

A passive process

44
Q

What is purulent pleural effusion?

A

Empyema - fluid is filled with acute inflammatory cells (pus)

45
Q

What is pneumothorax?

A

Air in the pleural space

46
Q

What can cause pneumothorax?

A
  • Trauma - accident or iatrogenic

* Rupture of bulla

47
Q

What are bullae?

A

Air-filled sacs on the surface of lung

48
Q

What is an example of an incident that can lead to spontaneous pneumothorax?

A

Rupture of large bullae

49
Q

What are the 2 types of pleural neoplasia?

A

Primary and secondary

50
Q

What is primary pleural neoplasia?

A

Can be:-

  • benign (rare)
  • malignant mesothelioma
51
Q

What is secondary pleural neoplasia?

A
  • Common -(adenocarcinomas - lung, GIT, ovary)

* Always malignant as they have metastasised

52
Q

What is mesothelioma?

A

Asbestos-releated primary pleural neoplasia

53
Q

What is the differentiation of mesothelioma?

A
  • Mixed epithelial/mesenchymal differentiation

* Can appear like sarcoma or carcinoma

54
Q

How does mesothelioma kill?

A

Kills by strangulation of the lung - lungi unable to expand and patient becomes increasingly respiratory distressed

55
Q

What are methods used to diagnose malignant effusions?

A
  • Cytology, biopsy (tissue sample)

* Immunohistochemistry for lineage-specific antigens may help

Respiratory: Pathology (4 decks)

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