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Systemic Pathology 2018 > Respiratory Pathology > Flashcards

Respiratory Pathology Flashcards

1
Q

Which airways have cartilage and glands in their walls?

A

Bronchi

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2
Q

What is the functions of cartilage and thick connective tissue in bronchi?

A

Cartilage maintains patency/prevents collapse

Thich connective tissue prevents infection spread into surrounding alveolar parenchyma

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3
Q

What are the consequences of chronic inflammation in the bronchi?

A

Dilation, increased resistance

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4
Q

What cells are capable of epithelial regenerative capacity in the bronchi?

A

Mucous, basal and other non-ciliated cells

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5
Q

Which airways have no cartilage or glands in their walls?

A

Bronchioles

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6
Q

How is airway patency maintained in bronchioles?

A

Tethering support if interlaveolar septa on bronchiolar wall

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7
Q

What is the consequence of having thin connective tissue in the walls of the bronchioles?

A

Allows infection to spread to surrounding alveoli

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8
Q

What is the consequence of chronic inflammation of the bronchioles?

A

Stenosis of lumen

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9
Q

What cells are capable of epithelail regenerative capacity in the bronchioles?

A

Mucous cells and non-ciliated (Clara) cells

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10
Q

What are the functions of Clara cells in the bronchioles?

A

Secretory - mucociliary clearance and protection

Rich in cytochrome monooxyegenase enzymes (CYP450) - metabolizes endogenous/xenobiotics, resulting in toxin production

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11
Q

Although resistance of individual small bronchioles is ___,

bronchioles under normal conditions is ___.

Why?

A

High; low

Total of all bronchiolar cross-sectional areas is much greater than that of the bronchial airways

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12
Q

What is a primary lobule? What is another name for it?

A

Pulmonary tissue supplies by a terminal bronchiole

“Acinus”

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13
Q

What is a secondary lobule?

A

Composed of many primary lobules; constitute grossly visible lobules

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14
Q

What are the components of the interalveolar septa?

What is their function?

A

Epithelial cells (type 1 and 2), capillary endothelium, fibroblasts, macrophages

Function: allows the development of large SA for interface and gas exchange between ventilated gases and perfusing blood

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15
Q

Describe some characteristics of type 1 epithelial cells in the interalveolar septa, including function.

Regenerative capacity?

A

Squamous

Cover large surface area, barrier - susceptible to damage

Terminally differentiated, metabolically inactive

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16
Q

Describe some characteristics of type 2 epithelial cells in the interalveolar septa, including functions.

Regenerative capacity?

A

Cuboidal

Produce surfactant/other mediators and are stem cells for repair

Metabolically active, contain CYP450 activities

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17
Q

What is the functon of the capillary endothelium in the interalveolar septa?

A

Metabolically active cells responsible for metabolizing prostaglandings, angiotensin, histamine

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18
Q

Define bronchitis and bronchiolitis

A

Inflammation of the bronchi and bronchioles

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19
Q

What are the causes of bronchitis and bronchiolitis?

A

Infectious: viral, bacterial, fungal, parasitic

Toxic: plant toxins

Hypersensitivity

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20
Q

Functional consequences of bronchitis and bronchiolitis

A

Increased airway resistance - obstruction, V/Q abnormalities (hypoxemia)

Decrease mucociliary clearance - secondary bacterial infection

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21
Q

Are bronchitis and bronchiolitis reversible?

A

Yes

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22
Q

Bronchitis and bronchiolitis sequelae

A
  1. Resolution and epithelial repair
  2. Extension to alveoli = pneumonia
  3. Chronic localized inflammation

Bronchiectasis = bronchi

Bronchiolitis obliterans = bronchioles

  1. Post-obstructive atelectasis
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23
Q

Definition of bronchiectasis

A

Dilation of the bronchi beyond normal physiological limits due to destruction of the bronchial wall

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24
Q

Bronchiectasis pathogenesis

A

Chronic infection - usually bacterial

Neutrophil-mediated destruction of glands and cartilage, fibrosis

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25
Q

Bronchiectasis morphology (grossly)

A

Dilated airway (saccular or cylindrical)

Thick wall

Luminal exudate (grey, green, or tan; thick, mucoid, or caseous)

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26
Q

Functional significance of bronchiectasis

A

Increased airway resistance d/t turbulence and luminal obstruction

Poor mucuciliary clearance

Aspiration of infective material into alveoli

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27
Q

Bronchiectasis sequelae

A

Progression of inflammation - continued damage, pneumonia

(even with abx)

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28
Q

Is bronchiectasis reversible?

A

No

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29
Q

Definition of bronchiolitis obliterans. Clinical relevance?

A

Obstruction of the bronchiolar lumen by fibrous connective tissue (no cartilage, tend to collapse and fill)

Usually clinically silent unless widespread

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30
Q

Definition of atelectasis

A

Collapse of the lung

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31
Q

Classification of atelectasis

A
  1. Neonatal - inadequate surfactant
  2. Acquired - compressive or obstructive
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32
Q

Cause of compressive atelectasis

A

Fluid, air, mass compresses lung or results in loss of negative pleural pressure

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33
Q

Cause of obstructive atelectasis

A

Obstructed large airways caused by inflammatory exudate, FB, hemorrhage, intramural masses leads to hypoventilation, pulls all N out of the air, lobules collapse

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34
Q

What is the pathological significance of atelectasis?

A

Segment of lung is under-ventilated, if wide spread will cause hypoxemia

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35
Q

Atelectasis sequelae

A
  1. Reinflation
  2. Alveolar edema
  3. Secondary bacterial pneumonia
  4. Fibrosis and irreverisble collapse
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36
Q

Is atelectasis reversible?

A

Yes, if reinflated

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37
Q

Definition and classification of pulmonary emphysema

A

Enlarged gas-filled space in the lung

Can be alveolar or interstitial

38
Q

Definition of alveolar emphysema

A

Abnormal enlargement of air spaces distal to terminal bronchioles accompanied by destruction of alveolar walls

39
Q

Is alveolar emphysema reversible?

A

No

40
Q

What is the pathological significance of alveolar emphysema?

A
  1. Decreased alveolar and capillary SA
  2. Loss of radial support of airways = early closure
  3. Decreased elastic properties, increased compliance and residual lung capacity
  4. Loss of capillary area = pulmonary hypertension and cor pulmonale (secondary HF)
41
Q

Definiton of interstitial emphysema

A

Excess gas in the pulmonary interstitium, occurs in species with extensive interlobular septa (bovine)

42
Q

Interstitial emphysema pathogenesis

A

Forced expiration against obstructed airways

Gas dissects into interstitial tissue - interlobular septa, perivascular areas, subpleural tissues

43
Q

Pathological significance of interstitial emphysema

A

Compression of lobules decreases ventilation = restrictive lung disease

44
Q

Interstitial emphysema sequelae

A
  1. Resolution
  2. Progression = mediastinum and subcutis
  3. Secondary infection of pockets
  4. Fibrosis and parenchymal loss
45
Q

Main causes of pulmonary edema

A

Increased hydrostatic P – L sided HF

Increased permeability – toxins, infectious agents

46
Q

Definition of pneumonia

A

Inflammation of the pulmonary gas exchange parenchyma

47
Q

Causes of pneumonia

A

Infectious - viral bacterial, fungal, parasitic

Toxic

Immunologic

Mixed - foreign material, HCl and bacteria in aspiration pneumonia

48
Q

Classification of pneumonia - simple morphologic and modifiers

A

Simple:

Bronchopneumonia

Interstitial

Focal or multifocal

Mixed pattern

Modifiers:

Duration - acute, subacute, chronic

Distribution - focal, multifocal, locally-extensive, diffuse

Exudate - necrotizing, fibrinopurulent, granulomatous

49
Q

Causes of bronchopneumonia

A

Bacteria, aspiration

50
Q

Pathogenesis of bronchopneumonia

A

Deposition of causative agent in terminal bronchioles and alveoli - bacteria, foreign material

Early damage in proximal acinar areas with spread into surrounding alveolar parenchyma

51
Q

Gross morphology of bronchopneumonia

A

Distribution: cranioventral

May be intercurrent fibrinous pleuritis

May spread to lobular distrubution

52
Q

Two indicators of chronicity in regards to bronchopneumonia

A

Fibrosis

Lympadenomegaly

53
Q

Microscopic morphology of bronchopneumonia

A

Abundant exudate in alveoli - neutrophils, fibrin, necrotic debris

Lesions initially airway oriented

54
Q

Pathological significance of bronchopneumonia

A

Obstructive and restrictive changes - airway obstruction, infiltrates make lung stiffer, exudate and wall thickening decrease diffusion capacity

Pleuritis may contribute to restrictive disease

55
Q

Is bronchopneumonia reversible?

A

Yes

56
Q

Bronchopneumonia sequelae

A
  1. Resolution
  2. Death
  3. Septicemia
  4. Chronicity with bronchiolitis obliterans and bronchiectasis +/- pleural adhesions
57
Q

Pathogenesis of interstitial pneumonia

A

Primary injury to elements of the interalveolar septum - epithliem, endothelium

58
Q

Causes of interstitial pneumonia

A

Infectious - viral, protozoa, some fungi, rarely bacteria

Toxic

Hypersensitivity

59
Q

Gross morphology of interstitial pneumonia

A

Distrubtion: often diffuse or locally extensive

Firm, large red with muscle or liver consistency on cut surface

60
Q

Microscopic morphology of interstitial pneumonia.

What are some markers of subacute and chronic stages?

A

Early type 1 epithelial necrosis

Subacute = type 2 epithelial hyperplasia, alveolar septal thickening, mononuclear cells

Chronic = fibrosis

61
Q

Pathological significance of interstitial pneumonia

A

Thickening and infiltration of alveolar walls marked by increased stiffness and decreased compliance = restrictive

decreased diffusion capacity = hypoxemia

62
Q

Interstitial pneumonia sequelae

A
  1. Resolution = rare
  2. Death
  3. Fibrosis of interalveolar septa and progressive restrictive lung disease
63
Q

Focal or multifocal pneumonia causes

A

Fungal:

Blastomyces - multifocal to locally extensive granulomatous or pyogran

Histoplasma - granulomatous

Coccidioides - granulomatous and pyogran

Pneumocystitis - interstitial, not granulomatous

Cryptococcus - rare unless immunosuppressed

64
Q

Pathogenesis of acute viral pneumonia

A

Viruses replicate in respiratory airway and type 2 alveolar epithelial cells

Induce inflammatory and immune response

Inflammation in parenchyma focused on interalveolar septa

Viral replication is halted before diffuse interstitial pneumonia develops

Ex: canine adenovirus 2

65
Q

Morphologic features of acute viral pneumonia

A

Virus induced epithelial injury and replication - rhinitis, tracheitis/bronchitis, bronchiolitis, patchy interstitial pneumonia

66
Q

Bronchointerstitial pneumonia morphology

A

Bronchiolitis + patchy interstitial pneumonia

67
Q

Pathogenesis of chronic viral pneumonia

A

Often assoc with viruses that replicate in macrophages and/or depress/evade antiviral immunologic defense mechansisms

Virus spreads throughout lung and induces diffuse interstitial pneumonia

Ex: ovine progressive pneumonia, canine distemper virus

68
Q

Causes of viral pneumonia in dogs

A

Canine distemper

Canine influenza

Canine adenovrius type 2

Parainfluenza type 2

Canine respiratory coronavirus

Canine herpesvirus 1

69
Q

Canine distemper respiratory lesions

A

Rhinitis, pharyngitis, tracheitis, bronchitis, bronchiolitis

Patchy to diffuse interstitial pneumonia or bronchopneumonia with secondary bacteria infection

IN and IC inclusions in epithelial cells and macrophages; syncytial cells

70
Q

Canine distemper dx at necropsy - what samples should be submitted?

A

Lung, brain, thymus, lymph node, spleen, stomach, urinary bladder

Also, PCR respiratory panel

71
Q

Canine influenza virus respiratory lesions

A

Lymphocytic or supparative rhinitis

Erosive/hyperplastic tracheitis, bronchitis, bronchiolitis

Tracheal/bronchial gland epithelial cell necrosis/hyperplasia with lymphs, neutrophils

Patchy interstitial pneumonia (bronchopneumonia)

Supparative bronchopneumonia with secondary bacterial to pneumonia

72
Q

Name two emerging viral respiratory agents in dogs

A

Canine pneumovirus

Canine bocavirus (parvoviridae)

73
Q

CAV-2 replication and pneumonia type

A

Replication in type 2 alveolar epithelial cells

Interstitial pneumonia usually around bronchioles

74
Q

Canine distemper replication and pneumonia type

A

Replication in alveolar epithelial cells and macrophages

Interstitial pneumonia

Common to have viral dissemination systemically

75
Q

Parainfluenza replication and pneumonia type

A

Infects type 2 alv cells, alv macrophages, bronchial and bronchiolar epithelium = depresses defense mechanisms

Locally extensive interstitial pneumonia

76
Q

Respiratory syncytial virus replication and pneumonia type

A

Replication in type 2 alv cells, macrophages, multinucleated syncytial cells

Patchy interstitial pneumonia with diffuse bronchiolitis

Often see terminal interstitial emphysema in dorsocaudal and other lung lobes

77
Q

Chronic progressive pneumonia (Maedi-Visna) respiratory lesions

A

Chronic, persistent infection

Interstitial pneumonia with marked interstitial accumulation of lymphocytes and macrophages

Usually see hyperplasia of type 2 epithelial cells, nonciliated bronchiolar epithelial cells, and metaplasia of smooth muscle in interalveolar septa

May be 2ry bacterial bronchopneumonia

Extrapulmonic lesions include encephalitis and arthritis

78
Q

Pathogenesis of bacterial pneumonia (pneumonic pasteurellosis due to Mannheimia haemolytica)

A

Colonization of resp tract, depression of defense mechanisms

Exponential growth of M. haemolytica with leukotoxic production

Damage to neutrophils, macrophages, release of endotoxin

Leukotoxin and endotoxin mediated tissue damage accentuated by neutrophil release of toxic molecules

79
Q

Respiratory lesions associated with pneumonic pasteurellosis

A

Severe fibrinous bronchopneumonia with fibrinous pleuritis

Cranioventral, neutrophil rich inflammation oriented around terminal bronchioles

Most severe in cranioventral areas

Abundant fibrinous and fibrinopurulent exudate in alveoli and in interlobular septa

May be large areas of parenchymal necrosis surrounded by neutrophils

80
Q

Pneumonic pasteurellosis sequelae

A

Death

Chronic bronchopneumia with bronchiolitis obliterans, bronchiectasis, pleural fibrosis

81
Q

Pathogenesis of bovine toxic interstitial pneumonia

A

Ingestion of pneumotoxin

Ruminal conversion and/or intestinal absorption

Activation of pneumotoxin by pulmonary CYP450 monooxygenase

Covalent bidning or free-radical damage by metabolites or pulmonary cell death

82
Q

Pneumotoxins in cattle

A

L-tryptophane/3-methylindole

Moldy sweet potatoes (4-ipomeanol)

Perilla mint (purple mint)

Stinkwood (Ziera arborescens)

83
Q

Pulmonary cells most susceptible to toxic injury

A

Non-ciliated bronchiolar cells

Type 1 alveolar epithelial cells

Capillary endothelial cells

84
Q

What happens if bovines survive past 24 hours after onset of toxic interstitial pneumonia?

A

Hyperplasia of type 2 alveolar epithelial cells

Repeat exposures may cause fibrosis

85
Q

Pulmonary neoplasia is more common in what species?

A

Cats and dogs

86
Q

Benign pulmonary epithelial tumors

A

Adenoma

Papilloma

87
Q

Malignant pulmonary epithelial tumors

A

Adenocarcinoma

Carcinoma

Adenosquamous carcinoma

Bronchial gland carcinoma

88
Q

Most common form of neoplasia in the lung

A

Metastatic neoplasia

89
Q

Gross distribution of pulmonary neoplasia and biological behavior of carcinomas

A

Most common in caudal lung fields - any lobe can be affected

Met local = thorax, lung, lymph node

Distant met = LN, kidney, liver, spleen, bone, brain (nail bed in cats)

90
Q
A

Systemic Pathology 2018 (12 decks)

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