Respiratory Pathology Flashcards by Amrita Nag

possible consequence of asthma

Dyspnea, coughing, wheezing, increased chance of developing other forms of COPD

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Atopic asthma

Most common
Early onset
Other allergies & genetic link
Often seasonal
Elevated serum eosinophils and IgE
Known as allergic or extrinsic asthma

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Define Chronic Bronchitis

long-term inflammation of the bronchi. Persistent productive cough that lasts for at least 3 months in at least 2 years. Common in smokers

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Define asthma

Hyper-reactive airways —> bronchospasm due to smooth muscle contraction

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Causes of chronic bronchitis

Tobacco smoke

pollution

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Consequences of chronic bronchitis

Loss of cilia
Goblet cell hyperplasia leads to increased mucus
Proliferation of smooth muscle
Thickening of bronchial walls
Chronically Inflamed airways
Airways become obstructed

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Define emphysema

Irreversible

Progressive destruction of alveolar walls without obvious fibrosis (loss of alveoli - scarring pulls apart alveoli)

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Define Bronchiectasis

Irreversible and progressive dilatation of bronchi & bronchioles

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Causes of Bronchiectasis

People with Cystic Fibrosis
Smoking
obstruction
infection

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Bronchiectasis consequences

Destruction of elastic and muscle
Chronic necrotising infection of the bronchi and bronchioles
Congenital/hereditary disease

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Emphysema symptoms

Occasional infections
Pink puffer- cannot get rid of CO2 
Weight loss
Late cough, little sputum 
Severe early dyspnea
Small heart

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Emphysema consequences

Airspaces become abnormally enlarged – over-inflation
Inflammation and loss of elasticity
Most often effects the upper lobes
Lungs can expand, but deflate poorly
Right sided heart failure, Pneumothorax—> atelectasis

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What is pneumoconiosis?

one of a group of interstitial lung disease caused by breathing in certain kinds of dust particles that damage your lungs.

Causes chronic inflammation.
Hence heals through organisation, function lost. Increased risk of mesothelioma

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Process of asthma attack

Allergen enters (usually a common/normal substance)
Response started by processing antigen
Sets up reaction to create overexaggerated response when the antigen enters in the future
Causes constriction of the airways
Goblet cells release mucus in the lumen, hence difficult to breathe
long term structural changes - increase in goblet cells, thicker muscle layer

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Factors dictating extent of pneumoconiosis

Amount inhaled

Shape/size of particles

Solubility of particles

Toxicity of particles

Additional irritants (smoking)

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3 restrictive disorders

Alveolitis pneumonitis
1. Chest wall disorders
Chronic Interstitial Lung disease –>Pneumoconiosis

Which particles are commonly implicated in Australia for causing Pneumoconiosis

Coal  Anthracnosis, excessive amounts make it toxic.

Silica  Silicosis, abscess, filled with granulation tissue, exposed in mining and renovation

Asbestos  Asbestosis, toxic particle and soluble. Damages lung and pleura

Bronchopneumonia.

Common
Often an extension of bronchitis
Opportunistic infections affecting the old, young, immuno-compromised
May become confluent and then hard to distinguish from lobar pneumonia

What is pneumonia

“Any infection of the lung”
Also “non-infectious” lung diseases
Caused by bacterial, viral and fungal infections
Reduced host defenses
Chronic diseases
Immunologic deficiency
Immunosuppressive therapy

Pathogenesis of primary cancers in lung

Squamous cell carcinoma:
Original cell —> metaplasia (cilliated epithelium to stratified squamous) —> Dysplasia —> carcinoma in situ —> invasive carcinoma

Adenocarcinoma:
Original cell—> Hyperplasia of goblet cells —> Dysplasia —> carcinoma in situ—> invasive carcinoma

Epithelium types in the respiratory system

Trachea: Pseudo-stratified ciliated columnar epithelium with goblet cells

Alveoli: simple squamous
Macrophages around the alveoli

Respiratory: Simple cuboidal ciliated, no mucous

How are the lungs affected by left ventricular failure?

Backwards effect is pulmonary congestion.
Leads to pulmonary oedema and haemorrhaging
Causes symptoms in patient relating to the lungs

Respiratory regions

-Respiratory bronchioles
- Alveolar ducts
- Alveolar sacs
- Alveoli
Very vulnerable to damage

Compliance and 3 factors that affect it

Expandibility

Loss of connective tissue (e.g. emphysema) —> Increases compliance
Surfactant levels. Decreased surfactant —> alveolar collapse during expiration —> Decreases Compliance
Musculoskeletal disorders affecting the joints/muscles of the thoracic cavity.

What is COPD and 4 types of COPD

Impaired airflow due to complete or partial obstruction at any level of the bronchial tree : Chronic Bronchitis Emphysema Bronchiectasis Bronchial Asthma

Atelectasis

a complete or partial collapse of the entire lung or area (lobe) of the lung. Caused by various respiratory pathology (COPD, fibrosis etc.)

Causes of pneumonia

Impaired clearing mechanism - Loss/suppression of cough reflex Coma, neuromusc disorders, drugs - Injury to cilia Smoking, inhalation of hot/corrosive substances, viral - Interference with phagocytic/bactericidal action of alveolar macrophages Smoke, AIDs,

Possible complications of pneumonia

1. Necrosis  Abscess 2. Fibrosis 3. Suppurative fluid in the pleural cavity (empyema) or fibrinous exudate 4. Haematological dissemination of bacteria (endocarditis, meningitis osteomyelitis or glomerulonephritis)

Tuberculosis

Cell mediated immune disorders (type 4 hypersensitivity) Immune system overreacts and kills nearby cells Necrotic form of death Two types: primary and secondary

Most common lung cancers

Adenocarcinoma, squamous cell carcinoma

Local effects of lung cancer

``` Obstruction  pneumonia, atelctasis Pleural effusions Laryngeal nerve invasion  Hoarseness Invasion of oesophagus  Dysphagia Phrenic nerve invasion  Diaphragm paralysis Chest wall invasion  pathologic fractures Pericarditis SVC syndrome & invasion of SNS ganglions ```

Name and explain some Pleural disease

1. Pleural effusions - increased HP, increased vascular permeability (loss of plasma proteins), reduced lymphatic drainage (cancer), increased intrapleural negative pressure (atelactasis) 2. Pneumothorax - marked respiratory distress, collapse, traumatic (air/gas pleural cavities) 3. Pleural Tumours - malignant mesothelioma---> increased by smoking, asbestos

Pleurisy or pleuritis

Inflammation of the pleural lining or surface of the lung. Pneumonia (pus/oedema in pleural lining/cavity).

Complications of pleurisy

Acute inflammatory exudate, containing lots of fibrin can be replaced by an in-growth of granulation tissue in pleural lining and into alveolar spaces  Fibrosis: Abscess formation Haematological dissemination of bacteria

Lobar pneumonia

``` Rare Pleural exudate common Highly virulent infections that can infect even the most healthy of individuals. > 90% strep pneumococcus Cough fever with purulent sputem ```

Intrinsic asthma

Not associated with family history Hyperirritability of bronchial tree Non-immune, normal IgE levels Common triggers: viruses, irritants, stress, exercise, cold air, aspirin

How do lung disease contribute to right ventricular failure?

COPD (increased workload), restrictive disease - pneumoconiosis, acute pulmonary syndrome (scarring) and pulmonary hypertension leads to RSHF Leads to venous congestion and oedema Causing liver, kidney and spleen disease