Respiratory Pathology Pt. 2 Flashcards
What is the main problem in Restrictive Lung Disease?
-a volume restriction
almost always due to a fibrosing problem
What is the main problem in an Obstructive Lung Disease?
-decreased flow
due to air trapping
How is the FEV1/FVC ratio different b/w a Restrictive Lung Disease and an Obstructive Lung Disease?
Restrictive: FEV1/FVC is normal
Obstructive: FEV1/FVC is reduced
Is the FVC reduced in Restrictive Lung Disease or Obstructive Lung Disease?
Restrictive
Is total lung capacity increased in Restrictive Lung Disease or Obstructive Lung Disease?
Obstructive
Which way does the Flow-Volume Loop shift in Restrictive Lung Disease?
-to the right, and the shape remains the same
kind-of almond-shaped
Which way does the Flow-Volume Loop shift in Obstructive Lung Disease?
-to the left, and the shape looks like a “chair”
What are some of the major Obstructive Lung Diseases?
- COPD/Chronic Bronchitis
- Emphysema
- Asthma
What is the most common cause of COPD/Chronic Bronchitis?
smoking
What is typically the first clinical manifestation of a lung injury due to smoking?
chronic bronchitis
What are the requirements for a clinical diagnosis of Chronic Bronchitis?
-persistent cough w/ sputum production for 3mos out of 2 consecutive years
What would you see on histology of Chronic Bronchitis?
-thickened submucosal layer due to mucous gland hyperplasia (which causes damage to the airway epithelium)
What are some complications of Chronic Bronchitis?
-squamous metaplasia, leading to dysplasia, and potentially carcinoma (resp. epithelium changes to squamous to better tolerate the irritation)
- bronchiectasis
- death from a respiratory infection
What is the physical feature that makes emphysema an Obstructive Lung Disease?
-the alveolar ducts are compressed
What would you see on a CXR of a patient w/ emphysema?
- enlarged lungs that are abnormally dark d/t excess trapped air
- flattened diaphragm
What would you see on a physical exam of a patient with emphysema?
- barrel chest
- diminished breath sounds
- prolonged expiratory wheezing
Is Emphysema a clinical diagnosis or a pathologic diagnosis?
Pathologic: permanent enlargement and destruction of air spaces distal to the terminal bronchioles
What would you see in the typical “Blue Bloater” Chronic Bronchitis patient?
- overweight
- cyanotic
- elevated Hb
- peripheral edema
- rhonchi (rough breath sounds) and wheezing
What would you see in the typical “Pink Puffer” Emphysema patient?
- older
- thin
- severe dyspnea
- quiet breath sounds
- hyperinflated lungs and flattened diaphragm on CXR
What are the two types of Emphysema and what is dilated in each?
Centriacinar Emphysema: respiratory bronchioles (ex: as a result of COPD)
Panacinar Emphysema: Alveolar duct and alveolus (ex: as a result of alpha1-antitrypsin deficiency)
What substance is able to damage the lung in alpha1-antitrypsin deficiency?
neutrophil elastase
What area of the lung is most affected in alpha1-antitrypsin deficiency?
-the base of the lungs
basilar panacinar emphysema
Explain why a basilar panacinar emphysema is seen in alpha1-antitrypsin deficiency.
- damage is coming through the bloodstream, which surrounds the alveoli
- blood volume is greater in the base of the lungs d/t gravity
What type of clinical presentation might suggest alpha1-antitrypsin deficiency?
-a young smoker presenting w/ chronic bronchitis and emphysema at a very early age (30-40)
