Respiratory Pathology Flashcards
What 3 M’s define respiratory pathology
morbidity, mortality, money.
What 2 parts make up the lungs and respiratory system
conducting portion- trachea to terminal bronchioles.
Respiratory portion- respiratory bronchioles, alveolar ducts, sacs and alveoli
What type os epithelium lines the conducting part of the reparatory system
Pseudo stratified ciliated columnar (mucus secreting)
What types of cells line the alveoli
Flat type 1 pneumocytes (gas exchange) and type 2 pneumocytes (surfactant production)
Problems in what 3 functions can lead to respiratory failure
ventilation
perfusion
gasexchange
define type 1 respiratory failure
low oxygen but co2 is normal (
define typ 2 respiratory failure
low oxygen and high co2 (>6.3kPa)
hypercapnic drive
signs and symptoms which indicated a respiratory problems
sputum cough stridor-proximal airway obstruction. wheeze- distal airway obstruction. pleuritic pain dysponea cyanosis clubbing weight loss.
signs on respiratory examination
Auscultation-crackles, wheeze, bronchial breathing, pleural rub
Percussion
dull (consolidation or effusion), hyperresonanat (pneumothorax or emphysema)
Are most primary lung tumours benign or malignant
90% are malignant.
what are the risk factors of primary lung tumours.
smoking, secondary cigarette smoke, asbestos, lung fibrosis, nickel, hematite, arsenic and mustard gas
define asbestosis
pulmonary interstitial fibrosis cause by asbestos.
Is asbestos related disease occupational
yes if proven to have a history of over 5 years in a high absestos exposure job.
what are benign primary lung tumours called
adenochondroma
what is the most common type of malignant primary tumour
non-small cell carcinoma.
what type of tumours are carcinoid tumours
malignant primary tumours
low grade, neuroendocrine epithelial tumours.
what type of lung tumour is the commonest
secondary lung tumour (usually from a primary source)
How do you distinguish between a primary and a secondary lung tumour.
histology, morphology, antigen expression
what antigens are expressed in lung non-mucinous adenocarcinoma and small cell.
cytokeratin and thyroid transcription factor postivie.
most common sites of lung carcinoma
central, main or upper lobe bronchus (bronchogenic).
are adenocarcinomas found centrally or peripherally.
peripherally.
what type of epithelium does respiratory epithelium become after metaplastic change.
pseudostratified columnar epithelium – stratified squamous type which may keratinize.
what irritant causes metaplastic change to occur in the epithelium
smoke
define dysplasia.
One metaplastic cell undergoes irreversible genetic changes (a series of sequential somatic mutations of oncogenes & anti-oncogenes) producing the first neoplastic cell
define neoplasm
An abnormal tissue that grows by cellular proliferation more rapidly than normal and continues to grow after the stimuli that initiated the new growth cease
define metaplastic
change from 1 cell type to another.
Why does squamous cell carcinoma cause hypercalcaemia
parathyroid hormone related peptide.
how does sqaumous cell carcinoma metasize
nfiltrate lymphatic and blood vessel
what common respiratory condition does bronchioalveolar carcinoma mimic
pneumonia
Is bronchioalveolar carcinoma invasive.
No.
How are neuroendocrine cells detected in lung tumours
immunochemistry
neural cell adhesion molecule
neurosecretory granule protein.
What cells are associated with typical carcinoid tumours
bland cells
what syndrome is typical carcninoid tumour associated with
multiple endocrine neoplasia syndrome type 1
which is more aggressive atypical or typical carcinoid tumours
atypical
What is a common peptide hormone secreted by small cell carcinoma.
Neurosecretory granules with peptide hormones such as ACTH
can carcinomas have multiple differentiation
NSCLC, small cell carcinoma.
What common factor do large cell carcinomas express
thyroid transcription factor
common paraneoplastic effects of lung carcinomas
- Cachexia
- Skin
- Hypertrophic pulmonary osteoarthropathy.
- Coagulopathies.
- Encephalomyelitis, neuropathies & myopathies
- Endocrine effects
what is acanthosis nigricans
hyperpigmentation of the skin- thick dark patches
thickening of palms and soles
New drug which has been introduced to treat lung cancer.
epidermal growth factor receptor tyrosine kinase inhibitors
How does this drug work
– Inhibition of EGFR TK mediated protein phosphorylation and activation of the mitotic cycle
What does ALK gene stand for
anaplastic lymphoma kinase-
Important gene in cell maturation and differentiation
rearrangements in this gene can lead to tumours.
what drug inhibits ALK
crizotinib
Types of pleural diseases
Pneumothorax Pleural effucison Haemothorax Chylothorax-lymph empyema-pus
what is a common fusion gene which results in respiratory cancer
ALK-EML
what are the inflammatory causes of pleural effusion
serous/fibrinous exudate
what causes non inflammatory pleural effusion
congestive cardiac failure
transduate
what conditions can affect the pleura
– inflammation (pleurisy, pleuritis)
• collagen vascular diseases
• pneumonia, tuberculosis
• lung infarct, usually secondary to pulmonary embolus
• lung tumour
– asbestos
• effusion, fibrous plaques, diffuse fibrosis
Are pleural tumours likely to be benign or malignant
malignant
benign e.g. fibroma is rare.
common pleural tumour
malignant mesothelioma.
what chemical is malignant mesothelioma associated with
asbestos
how long is the latency period for malignant mesothelioma
15-60 years
How does malignant mesothelioma progress
1-nodule and effusion
2-invades chest wall and lung.
3-nodal and distal metastases less common than with carcinomas.
which pleura does early malignant mesothelioma effect
parietal pleura
where are fibrous pleural plaques typically found and what chemical are they associated with
lower thoracic wall & diaphragmatic parietal pleura and asbestos
What condition is PE secondary to
DVT
Risk factors of PE
virchow’s triad (stasis, hypercoagubale blood, endothelial wall injury), recent surgery, low flow, reduced mobility
what syndrome is a result of cillary dysmotility
Kartageners syndrome
what causes acute bronchitis
– Viral (RSV), H. influenzae, Strep. pneumoniae
2 clinical signs associated with cute bronchiolits
– Croup- viral infection which causes swelling of the windpipe
– Exacerbations of COAD-chronic obstructive airway disease.
define bronchiolitis obliterans
bronchioles compressed and narrowed.
what 2 main factors lead to respiratory infections
mucocillary escalator problem
immunity problem e.g. hypogammaglobulinaemia
what is pneumonia
• Inflammatory exudate (seeped out of blood or organ) in alveoli & distal small airways - consolidation
what are the 4 main classifications for pneumonia
clinical
Aetiology
Anatomical
reaction
what are 2 main types of respiratory infections.
primary
secondary- compromised defences
is bronchopneumonia caused by a primary or secondary infection
secondary infection
what causes bronchopnemonia
low virulence bacteria or occasionally fungi
is lobarpneumoniae primary or secondary
primary
which type of pneumonia affect full lobes and which type has a pathcy distribution
full lobes-lobarpneumoniae
pathcy-bronchopneumoniae
most common atypical pneumonia’s in the non-immunosuppressed.
- Viral - flu, varicella, RSV, rhino, adeno, measles
- Mycoplasma pneumoniae - Mild, chronic, fibrosis
- Chlamydia (psittacosis), Coxiella burnetti (Q-fever)
- Legionella pneumophilla - Systemic, 10- 20% fatal
clinical signs and symptoms of atypical pneumonia
– Intersitial lymphocytes, plasma cells, macrophges
– Intra-alveolar fibrinous cell-poor exudate
– Diffuse alveolar damage (DAD)
most common atypical pneumonia in the immunsuppressed patient
• Opportunistic infections by low virulence or non-virulent organisms
– Fungi - candida, aspergillus, Pnumocystis carinii
– Viruses - CMV, HSV, measles
3 types of non-infective pneumonias
aspiration pneumonia
lipid pneumonia
Cryptogenic organising pneumonia and bronchiolotis obliterans organising pneumonia
what causes pulmonary TB
Mycobacterium tuberculosis
what vaccine is used to prevent TB
BCG
primary Tb reaction symotomatic or asymtomatic
aymptomatic
where does reactivation of TB typically occur
apically.
effects of TB on the lungs
Primary infection: Asymptomatic, Ghon complex in peripheral lung & hilar nodes, usually resolves
Scarring - fibrous calcified scar.
Granulomas with multinucleated Langhans’ giant cells & caseous necrosis
3 conditions which cause pulmonary vasculitis.
- Necrotising granulomatous vasculitis - Wegener’s granulomatosis (kidneys & nose, elevated serum ANCA) Churg-Strauss syndrome (eosinophilia & asthma)
- Goodpasture’s syndrome - Anti-glomerular basement membrane antibody, Intra-alveolar haemorrhage & glomerulonephritis
- Microvascular damage - ARDS & DAD, SLE
common causes for emboli to forms
DVT, fat, air amniotic fluid, tumour, foreign bodies.
define obstructive pulmonary disease.
localised of diffuse obstruction of air flow.
causes of obstructive pulmonary disease
tumour or foreign body
distal alveolar collapse
distal retention pnemonitis
distal bronchiectasis
define bronchiectaisis
• Permanent dilation of bronchi and bronchioles caused by destruction of the muscle and elastic tissue
cause of brochiectasis
• Results from chronic necrotizing infection
signs and symptoms of bronchiectais
Cough, fever, copious amounts of foul smelling sputum
Chronic Obstructive Pulmonary Disease is a combination of what 2 conditions
chronic bronchitis & emphysema
pathology of chronic bronchitis
Mucus gland hyperplasia and hypersecretion, secondary infection by low virulence bacteria, chronic inflammation
define emphysema
Abnormal permanent dilation of airspaces distal to the terminal bronchiole, with destruction of airspace wall, without obvious fibrosis
how do we classify emphysema
– Centrilobular (centiacinar) Coal dust, smoking
– Panlobular (panacinar) - >80% a1 antitrypsin deficient (rare, autosomal dominant) , severest in lower lobe bases
– Paraseptal (distal acinar) - Upper lobe subpleural bullae adjacent to fibrosis. Pneumothorax if rupture
pink puffer and blue bloater describe which 2 conditions
emphysema-pink puffer
brochioloits- blue bloater
is asthma reversible
yes
which hyper of hypersensitivity reaction is asthma
type 1 -caused by an allergen
what chemical initiates bronchoconstriciton and mucus production is asthma
histamine initiated bronchoconstriction and mucus production obstructing the airways.
what are the main changes to the airways in asthma.
– bronchiolar wall smooth muscle hypertrophy
– mucus gland hyperplasia
– respiratory bronchiolitis leading to centrilobular emphysema
Is intersitial lung disease more commonly restrictive or obstructive
restrictive.
signs of chronic interstitial disease
- Dyspnoea increasing for months to years
* Clubbing, fine crackles, dry cough
what does the lung look like in chronic interstitial disease
honeycomb
example of chronic interstitial disease
– idiopathic pulmonary fibrosis,
– many pneumoconioses (dust diseases)
– sarcoidosis,
– collagen vascular diseases-associated lung diseases
Idiopathic pulmonary fibrosis
is also known as
cryptogenic fibrosing alveolitis
what lobes of the lungs are effected more in Idiopathic pulmonary fibrosis
lower
what do the lungs look like in idiopathic pulmonary fibrosis
– Interstitial chronic inflammation & variably mature fibrous tissue
– Adjacent normal alveolar walls
– Similar pattern of fibrosis in collagen vascular disease associated interstitial lung disease and in asbestosis
• Bosselated (“cobblestone”) pleural surface due to contraction of interstitial fibrous tissue accentuates lobular architecture
what structure is typically involved in sarcoidosis
• Hilar nodes
what other organs are typically affected in Sarcoidosis
skin, heart, and brain.
are the granulomas caseating or non-caseating in Sarcoidosis
non-caseating
what chemical in the body is elevated in sarcodoisis
calcium (hypercalcaemia)
Pneumonconises are also known as
the dust diseases
what causes pneumoconioses
inhalation of mineral dusts
common 3 Pneumonconises
coal-workers
silicosis
asbestosis
what condition that silicosis reactivate
tuberculosis
what is the pathology of silicosis
Kills phagocytosing macrophages
which pneumonconises increase the occurrence of lung cancer
Asbestosis, Silicosis
what is hypersensitivity pnemonitis also known as
extrinsic allergic alveolitis
what type of hypersensitivity reaction is pnemonitis
Type 3
what condition are
– farmers’ lung - actinomycetes in hay
– pigeon fanciers’ lung - pigeon antigens
associated with
hypersensitivity pneumonitis
define CF
• An inherited multiorgan disorder of epithelial cells affecting fluid secretion in exocrine glands and the epithelial lining of the respiratory, gastrointestinal and reproductive organs
What cause CF
• Mutation in CFTR gene
Is CF recessive or dominant condition
recessive
what are the main organs which CF affects
lungs, pancreas and bowel
treatments for CF
- Mucolytics
- Heart/lung transplants
- Not genre therapy currently.
- Physiotherapy
diagnosis test for CF
- Part of Newborn screening in UK
- Sweat test
- Genetic testing
How does CF affect the lungs
- Bronchioles distended with mucus
- Hyperplasia mucus secreting glands
- Multiple repeated infections
- Severe chronic bronchitis and bronchiectasis
How does CF affect the pancrease
- Exocrine gland ducts plugged by mucus
- Atrophy and fibrosis of gland
- Impaired fat absorption, enzyme secretion, vitamin deficiencies ( pancreatic insufficiency)
common symptoms of CF
reccurent chest infections
are hypersensitive pneumonitis granuolomas caveating or non caveating
poorly formed non-caseating granulomas extends alveolar walls
what type of inflammation occurs in hypersensitivity pneumonitis
• Peribronchiolar inflammation
coal workers’s pneumoconiosis is also known as
• Anthracosis
Coal workers’ pneumoconiosis is associated with causing which respiratory condition
COPD
via ling fibrosis
2 main types of Coal workers’ pneumoconiosis
- Simple (macular) CWP
* Nodular CWP
4 main types of inhaled dust are
- inert
- fibrogenic
- allergenic
- oncogenic
