Respiratory Pathology Flashcards
What parts of the respiratory tract are included in the conducting airway?
Trachea L and R main bronchi Segmental and smaller bronchi Bronchioles Terminal bronchioles
What parts of the respiratory tract are included in the gas exchange (lung acini)?
Respiratory bronchioles
alveolar ducts
alveolar sacs
alveoli
What is the respiratory tract split into?
Conducting airways
gas exchange
What types of cells are present in the conducting portion of the RT?
Pseudostratified cilliated columnar mucus secreting epithelium
What types of cells do alveoli mostly contain?
Type I pneumocytes = gas exchange
Type II pneumocytes = surfactant production
What is Type I respiratory failure classified as?
Low PaO2
Normal CO2
What is Type II respiratory failure classified as?
PaCO2>6.3kPa
Hypercapnic respiratory drive
What is the name of a benign primary lung tumour?
adenochrondroma
What are the risk factors for lung carcinomas?
cigarettes
asbestos exposure
lung fibrosis
radon etc
What specifically does asbestos cause to the body?
asbestosis - pulmonary interstitial fibrosis
What are the types of malignant primary cell tumours?
Carcinomas - small cell and non small cell
Carcinoid
Others - lymphomas, sarcomas, carcinosarcomas
What are the different types of non small cell carcinomas?
Squamous carcinomas
adenocarcinoma
large cell neuroendocrine carcinoma
undifferentiated large cell carcinoma
Which category of malignant primary lung tumours are all neuroendocrine?
small cell carcinomas
what are carcinoid tumours?
low grade neuroendocrine epithelial tumours
What factors can be tested for in lung non mucinous adenocarcinoma and small cell tumours?
cytokeratin factor
thyroid transcription factor
What are the features of squamous carcinomas?
desosomes linked cells like epidermis
with our without keratinisation
cental
hypercalcaemia due to parathyroid related peptide secreted by tumour cells
what cells are the bronchial epithelium lined with?
pseudostratified columnar epithelium with ciliated and mucus secreting cells
what is squamous metaplasia and why does it happen?
reversible change from pseudostatified columnar cells to (keratinised) stratified squamous cells
caused by irritants such as smoke
What are the features of adenocarcinomas?
glandular cells
serous or mucus vacuoles
in acinar, tubular, solid or papillary structures
central and peripheral
Thyroid transcription factor (TTF) expressed
What are the features of bronchioalveolar carcinomas?
spread of well differentiated mucinous/non mucinous neoplastic cells on alveolar wall
not invasive
mimics pneumonia
What are the cell proteins produced by neuroendocrine carcinomas?
neural cell adhesion molecule (CD56)
Chromogranin
synaptophysin
what are the features of typical carcinoid tumours?
grow in and occlude a bronchus bland cells, no necrosis not associated with smoking associated with multiple endocrine neoplasia syndrome type 1 not benign - may invade lymphatic nodes
what are the features of atypical carcinoid tumours?
more atypia nucleoli, otherwise typical
necrosis
more aggressive
What are the features of large cell neuroendocrine carcinomas?
eosinophilic granular cytoplasm
antigen expression
severe atypia nucleoli necrosis
associated with smoking
what are the features of small cell carcinomas?
rapidly progressive
malignant
neurosecretory granules with peptide hormones
mainly in smokers
What are the requirements for a mixed neuroendocrine carcinoma?
need 10% of a component for classification
adenosquamous
What are the requirements for a combined small cell carcinoma?
Any proportion of small cell carcinomas and NSCLC
What are the features of large cell carcinomas?
no specific squamous/glandular morphology
some express thyroid transcription factor
can be neuroendocrine
What is used for the staging of lung malignancies?
TNM
What is a pneumothorax?
air in the pleural cavity
What is a pleural effusion (hydrothorax)?
exudate in the pleural cavity
What is a haemothorax?
blood in the pleural cavity
What is a chylothorax?
lymph in the pleural cavity
What is a empyema (pyothorax)?
Pus in the pleural cavity
What are the causes of pleural effusion?
inflammatory - exudate, infection, inflammation
Non inflammatory - congestive cardiac failure
What is malignant mesothelioma?
cancer in the pleura
over 90% associated with asbestos exposure
may produce pleural effusion
mixed spindal cells and epitheloid cells, may be fibrous
treat symptomatically
fatal in 1-3 years
What are fibrous pleural plaques?
on lower thoracic wall and disphragmatic parietal pleura
associated with low level asbestos exposure
not premalignant
What are primary infections?
obtaining an infection when previously healthy
What are secondary infections?
obtaining an infection when immune system is already weakened
What are examples of situations where you are more likely to get secondary infections?
tumour, foreign cough reflex doesnt work kartageners syndrome CF hypogammaglobulinaemia immunsupressive drugs AIDS smoking, hypoxia pulomary oedema
What are examples of acute bronchitis?
Viral (RSV), H. influenza, strep. pneumoniae
croup
exacerbations of COAD
What are examples of bronchiolitis?
primary acute in infants, RSV
broncopneumonia - follicular/bronchiolitis obliterans
What is pneumonia?
inflammatory exudate/consolidation in alveoli and distil small airways
What are pneumonias classified into?
Clinical - primary/secondary
Aetiological - bacterial, viral, fungal
Antatomical - lobular/bronchopneumonia
Reaction - purulent/fibrinous
What are the features of bronchopneumonia?
secondary often low virulence bacteria/fungi common patchy bronchocentric - destructive, granulomatous lesion of the bronchi and bronchioles resolves/heals with scarring
What are the features of lobular pneumonia?
primary typically males 20-50 years old strep. pneumoniae uncommon congesstion resolves without scarring
What are the features of atypical pneumonias?
severity mild to fatal
interstitial lymphocytes, plasma cells, macrophages
poor exudate
diffuse alveolar damage
What organisms cause atypical pneumonias?
viral - flu, RSV, rhino, adeno, measles Mycoplasma pneumoniae chalmydia coxiella burnetti legionella pneumophilla
What are examples of non infective pneumonias?
Aspiration pneumonias - produces abscesses
lipid pneumonias - endogenous and exogenous
cryptogenic organising pneumonia
bronchiolotis obliterans organising pneumonia
What organism causes pulmonary tuberculosis
Mycobacterium tuberculosis
What is the vaccine called to protect against TB?
Bacille Calmetta-Guerin (BCG)
What are the symptoms of the primary infection in TB?
Asymtomatic
Ghon complex in lung and hilar nodes
How does TB symptoms progress?
empyema
pneumonia
spread to other organs
scarring
What are the features of pulmonary tuberculosis?
Granulomas with multinucelated Langhans’ giant cells
caseous necrosis
intense immune reaction
Type 4 hypersensitivity
When are you likely to get pulmonary vasculitis?
necrotising granulomatous vasculitis’s e.g. Wegeners granulomatosis
goodpastures syndrome - rare autoimmune disease in which antibodies attack the basement membrane
Microvascular damage
What causes localised obstruction of air flow in obstructive pulmonary disease?
Tumour/forign body distil alveolar collapse/over expansion distil retention pneumonitis brochoneumonia distil bronchiesctasis
What is bronchiectasis?
permanent dilatation of bronchi/bronchioles caused by destruction of the muscle and elastic tissue
results from chronic necrotising infection
what are the symptoms of bronchiectasis?
cough
fever
foul smelling sputum
What are predisposing conditions to bronchiectasis?
CF
Kartngners syndrome
Bronchial obstruction
lupus, RA, IBS, GVHD
Name some examples of diffuse obstructive pulmonary disease.
COPD
Asthma
What two conditions is COPD a combination of?
chronic bronchitis
emphysema
What are the symptoms of chronic bronchitis?
cough and sputum for 3 months in each of 2 consecutive years
What are the causes of chronic bronchitis?
chronic irritation
smoking
air pollution
What is chronic bronchitis?
mucus gland hyperplasia/hypersecretion
chronic inflammation of small airways - wall weakness and destruction therefore emphysema
What is emphysema?
abnormal permanent dilation of airspaces
destruction of airspace wall without obvious fibrosis
What are the 3 classifications of emphysema?
Centrilobular (centiacinar)
panlobular (panacinar)
paraseptal
What are the symptoms of emphysema?
Dysponea - progressive and worse
What are the common features of predominantly bronchitis COPD?
40-45 years old mild dyspnea, late in disease early cough infections common 'blue bloater'
What are the common features of predominantly emphysema COPD?
50-75 years old severe early dyspnea late cough infections rare 'pink puffer'
What is asthma?
chronic inflammatory disorder of the airways
What are the symptoms of asthma?
wheeze
cough
variable bronchoconstriction that is partially reversible
What type of hypersensitivity reaction is atopic asthma?
type I
What are the triggers for atopic asthma?
allergens
cold, exercise, respiratory infections
What are the irriversible changes of atopic asthma?
bronchiolar wall smooth muscle hypertrophy
mucas gland hyperplasia
respiratory bronchiolitis
centrilobular emphysema
What is interstitial lung disease?
disease of pulmonary connective tissue - increased tissue in alveolar capillary wall via inflammation and fibrosis
restrictive
What is acute interstitial disease?
diffuse alveolar damage
death of type I pneumocytes - form hyaline membranes lining alveoli
type II pneumocyte hyperplasia
leads to adult respiratory distress syndrome
What are the symptoms of chronic interstitial lung disease?
dyspnoea clubbing fine crackles dry cough interstitial fibrosis&chronic inflammation 'honeycomb lung'
What are example of chronic interstitial lung disease?
idiopathic pulmonary fibrosis
pneumoconiosis
sarcoidosis
collegen vascular disease-associated lung diseases
What is idiopathic pulmonary fibrosis?
chronic inflammation and fibrous tissue
normal alveolar wall
‘cobblestone’
What is sarcoidosis?
perilymphatic pulmonary granulomas fibrosis effects hilar nodes, other organs e.g. heart hypercalcaemia typically young females
What is pneumoconioses?
non neoplastic lung disease due to inhalation of dusts, fumes and vapours
What is hypersensitivity pneumonitis?
Type III hypersensitivity reaction to organic dusts
farmers lung
inflammation with non caseating granulomas
leads to fibrosis
What is Cystic fibrosis?
inherited disorder
epithelial cells fluid secretion effected as well as linings of the respiratory, GI and reproductive tract
Autosomal recessive
CF is a mutation in which gene?
CFTR - encodes for transmembrane proteins
What are the clinical presentations of CF?
infancy
viscous mucous secretions
recurrent lung infections/intestinal obstruction
pancreatic insufficiency
