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SYSTEMIC PATHOLOGY > Respi - obstructive and restrictive lung diseases > Flashcards

Respi - obstructive and restrictive lung diseases Flashcards

1
Q

obstructive diseases

+ examples

A

limitation of airflow
total lung capacity remains, reduced expiratory flow rate (problem w/ ventilation)
exhalation requires more effort + obstruction -> wheezing

e.g: COPD, bronchiectasis, asthma, emphysema

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2
Q

obstructive sleep apnoea (OSA)

+ more common in who

A

episodic - partial/complete closing of upper airways during sleep
pt need to wake up and gasp for air

more common in men who are obese: jaw and tongue fall backwards and obstruct the airways

effect: hypoxemia and poor sleep (cause need to keep waking up for air) -> daytime somnolence, fatigue

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3
Q

Asthma

- causes (atopic vs non-atopic)

A

obstructive
chronic, affects bronchioles
recurring episodes of bronchospasms and excessive production of mucus

atopic (allergy) causes: foods/drugs/animal antigens
- IgE mediated response: activation of mast cells -> recruitment of eosinophils -> bronchoconstriction/ vascular permeability/ mucus secretion

non-atopic causes: hypersensitive airways/ irritants

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4
Q

asthma complications

- treatment

A
  • repeated episodes: over-reactivity -> remodelling of airways
  • severe: bronchospasms + mucus plugging -> resp failure

treatment
- treat bronchospasm and chronic inflammation

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5
Q

structural changes in asthma

A
  • hyperactivity and hypertrophy of bronchus SM
  • hypersecretion of mucus
  • mucosal edema
  • infiltration of bronchial mucosa by inflammatory cells
  • collagen deposition in epithelium
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6
Q

COPD

A

common in chronic smokers

irreversible effects, progressive disease

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7
Q

COPD pathology

A
  • emphysema - effect on alveoli
  • chronic bronchitis
  • bronchiolitis
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8
Q

emphysema pathogenesis

A

caused by a1 antitrypsin (protects body from immune complexes formed) def
- Destruction of airspaces -> reduced surface area for gas exchange (like the destructed alveoli not able to be ventilated) = ventilation defect
- destruction of alveolar walls -> airway elastic tissue destruction -> loss of elastic recoil -> airways cannot be kept open -> premature closure and air trapping
causes pink puffers COPD

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9
Q

chronic bronchitis pathogenesis

A

chronic cough w/ sputum for >2 yrs
- Mucus plugs in airways -> narrow lumen -> alveolar hypoventilation -> V/Q mismatch (shunt)
- premature closure of airways in expiration -> air trapping
- Airway obstruction -> stasis -> increased risk of infection
- Squamous metaplasia -> reduced mucociliary clearance -> risk of LRTI
causes blue bloaters COPD

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10
Q

bronchiolitis

A

inflammation in small bronchioles

  • airway walls filled w/ macrophages & lymphoid cells
  • causes scarring and narrowing of airways
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11
Q

risk factors of COPD

A
  • prolonged smoking
  • childhood infection
  • occupational exposure to dust / poor air quality
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12
Q

COPD: pink puffers

mainly cause by

A

pink complexion
main cause is EMPHYSEMA**
hyperventilation compensation - so dh CO2 retention

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13
Q

COPD: blue bloaters
mainly caused by
+ treatment considerations

A

main cause: CHRONIC BRONCHITIS**
no hyperventilation compensation
poor ventilation -> hypoxemia, hypercapnia
right heart tries to pump harder to perfuse the lung -> RHF

too much oxygen can reduce rate of ventilation further - monitor closely

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14
Q

COPD treatment

A

treat infection
O2
bronchodilators
ventilation equipment

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15
Q

restrictive diseases

A

total lung capacity reduced, expiratory rate normal

usually chest wall disorders
diffuse parenchymal lung / lung scarring -> cause stiffness and poor compliance of lungs

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16
Q

examples of restrictive disease

A
  • ARDS
  • atypical pneumonia
  • sarcoidosis
  • allergy - hypersensitivity pneumonitis (organic)
  • external factors: drug-induced/ radiation/ smoking/ inorganic dusts (pneumoconiosis)
  • idiopathic pulmonary fibrosis - most common chronic restrictive disease
17
Q

diffuse parenchymal lung

A

inflammatory in the interstitium -> edema and fibrosis of alveolar walls
reduce lung compliance
reduced gas exchange

18
Q

diffuse parenchymal lung microscopy

A
  • hemorrhage and fibrin exudation into alveoli
  • edema and inflammation of interstitium
  • macrophage accumulation in alveoli
  • fibrosis
19
Q

ARDS

+ x-ray appearance

A

acute respiratory distress syndrome
caused by diffused alveolar and capillary damage
- systemic sepsis, trauma, inhalation of toxins
-> injury to pneumocytes and endothelium
-> more inflammatory and pulmonary damage
high mortality (70%)

appears diffused, w/ interstitial markings??

20
Q

ARDS phases + microscopy features

A
  1. acute exudative phase
    pink hyaline membranes (w/ fibrin rich fluid and necrotic epithelial cells)
    interstitial edema and high protein exudation into alveoli
  2. late organisation phase (recovery)
    organisation of hyaline membranes w/ fibrosis
    regeneration of type 2 alveolar lining
21
Q

honeycomb lung

A

end stage pulmonary fibrosis

leads to chronic resp impairment + reduced diffusion capacity

looks like honeycomb cause loss of normal alveoli tissue, replaced by fibrosis

22
Q

histological patterns of restrictive diseases

i think dn to know for ca2?

A

acute:
- DAD (diffuse alveolar damage)

chronic:

  • UIP (usual interstitial pneumonia) : idiopathic pulmonary fibrosis
  • NSIP
  • COP
  • RB-ILD
  • DIP
23
Q

idiopathic pulmonary fibrosis

A

most common chronic restrictive disease
progressive
UIP pattern

24
Q

hypersensitivity pneumonitis

A

inhaled organic antigens (animal droppings/ fungi/ hay)
acute exposure: type 3 hypersensitivity
repeated exposure: type 4 hypersensitivity -> can progress to chronic pulmonary fibrosis

25
Q

pneumoconiosis

A

inhalation of INorganic (compared to hypersensitivity)
- silica/ coal dust/ asbestos
worsened w/ smoking
cause inflammation: release cytokines + stimulate fibrosis

26
Q

asbestos

A

for buildings/ fire resistant materials
can cause diseases:
- pleural plaques
- pleural effusions
- asbestosis (progressive chronic lung fibrosis)
- malignant mesothelioma (unique to asbestos) = malignant tumour
- lung carcinoma

27
Q

Emphysema appearance

A

ballooning of air spaces (hyperinflation)
enlarged
blebs and bullae (air entering pleural cavity forming pneumothorax)

28
Q

causes of emphysema

A
  • cigarette
  • environmental pollution
  • pneumoconiosis
  • a1-AT (protects lung) def - inherited
29
Q

emphysema complications

A
  • cor pulmonale leading to RV failure
  • respiratory failure
  • pneumothorax (air in pleural cavity)
  • hypercapnia (decreased gaseous exchange) -> risk of peptic ulcer - why??
30
Q

differentiating COPD from asthma

A
  • COPD caused by smoking/ environmental hazards/ infection
    asthma usually seen in childhood days
  • COPD: chronic persistent cough
    asthma: wheezing and breathlessness
  • asthma relieved by bronchodilators but not COPD
31
Q

COPD gross and micro appearance

A

gross: ballooning of air spaces (hyperinflation), enlarged lung, alveoli filled with mucus and inflammatory cells
Microscopy: chronic inflammation – macrophages

SYSTEMIC PATHOLOGY (27 decks)

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