Respiratory Pathology Flashcards
possible consequence of asthma
Dyspnea, coughing, wheezing, increased chance of developing other forms of COPD
Atopic asthma
Most common Early onset Other allergies & genetic link Often seasonal Elevated serum eosinophils and IgE Known as allergic or extrinsic asthma
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
Define asthma
Hyper-reactive airways —> bronchospasm due to smooth muscle contraction
Causes of chronic bronchitis
Tobacco smoke
pollution
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
Define emphysema
Irreversible
Progressive destruction of alveolar walls without obvious fibrosis (loss of alveoli - scarring pulls apart alveoli)
Define Bronchiectasis
Irreversible and progressive dilatation of bronchi & bronchioles
Causes of Bronchiectasis
- People with Cystic Fibrosis
- Smoking
- obstruction
- infection
Bronchiectasis consequences
- Destruction of elastic and muscle
- Chronic necrotising infection of the bronchi and bronchioles
- Congenital/hereditary disease
Emphysema symptoms
Occasional infections Pink puffer- cannot get rid of CO2 Weight loss Late cough, little sputum Severe early dyspnea Small heart
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
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
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
Factors dictating extent of pneumoconiosis
Amount inhaled
Shape/size of particles
Solubility of particles
Toxicity of particles
Additional irritants (smoking)
3 restrictive disorders
- Alveolitis pneumonitis
- 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
- Necrosis Abscess
- Fibrosis
- Suppurative fluid in the pleural cavity (empyema) or fibrinous exudate
- 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
- Pleural effusions - increased HP, increased vascular permeability (loss of plasma proteins), reduced lymphatic drainage (cancer), increased intrapleural negative pressure (atelactasis)
- Pneumothorax - marked respiratory distress, collapse, traumatic (air/gas pleural cavities)
- 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 sputemIntrinsic 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
