Respiratory tract neoplastic & non-neoplastic disease Flashcards
Viral infection can go anywhere in the respiratory system. What causes congestion?
virus cause inflammation of the mucosal layer
What is the definition of pneumonia?
inflammation of the lung parenchyma
What are the causes of pneumonia?
infectious agents
inhalation of chemicals
chest wall trauma
What are the two stages of pneumonia?
- CONSOLIDATION of the affected part
- EXUDATE with inflammatory cells and fibrin in the alveolar spaces
Most pneumonias are caused by bacteria, what is the most common bacterial cause in community acquired pneumonia?
Streptococcus pneumoniae
What are the clinical features of pneumonia?
- fever rigours SOB pleuritic chest pain (pain on breathing) purulent sputum (green) cough chest x-ray or cough changes increase WCC
Pneumonia can be split in to categories on where it affects. The main ones are lobar and multifocal (bronchopneumonia). What do each one affect?
- lobar just one lobe
- multifocal - multiple places
hospital acquired pneumonia is also known as nosocomial pneumonia. How long does a person have to be in hospital before it is classed as hospital acquired?
48-72 hours after admission
- normally gram negative and staph aureus
- most common cause of death in ICU
aspiration pneumonia develops after inhalation of foreign material. Who is this common in?
- elderly, stroke, dementia, anaesthetic
- the symptoms can often be silent
Where does aspirated pneumonia normally occur?
- usually right middle and right lower lobe
An obstructive disease is characterised by partial or complete obstruction at any level from trachea to respiratory bronchioles. What are examples of obstructive diseases?
- asthma
- COPD
- broncectisis
In COPD emphysema what happens to the alveolar wall?
become bigger holes in them which reduces surface area
large aplical bullae or blebs
What are the symptoms of COPD emphysema ?
- dyspnoea (SOB)
- cough
- wheezing
- weight loss due to using accessary muscles to breathe)
- cor pulmonale (right sided heart failure)
- can develop congestive heart failure and pneumothorax
What should you be careful giving people with COPD if they are short of breath
oxygen! could stop respiratory drive
What is the definition of (in copd) chronic bronchitis?
- persistent cough with sputum production
- for at least 3 months in at least two consecutive years
- without any other identifiable cause
What are the 2 main causes of chronic bronchitis?
- smoking
- inhalation of dust, grain, cotton
- chronic irritation
what changes in the anatomy in chronic bronchitis?
- hypertrophy of submucousal glands in trachea and bronchi, increase in goblet cells
- narrowing of the bronchioles causing mucus plugging
Asthma is a chronic inflammatory disorder of the airways. they have a recurrent episodes of wheezing, breathlessness, chest tightness and cough particularly at night and in the early morning. What are the hallmarks of asthma?
- increased airway responsiveness
- episodic bronchoconstriction,
- inflammation of bronchial walls
- increased mucus production
What are the clinical signs of asthma?
- chest tightness
- wheezing
- dyspnea (SOB)
- status asthmatics ( does not respond to treatments)
- increase in airflow obstruction (difficulty with exhalation)
What is bronchiectasis?
- permentant destruction and dilation of the airways
- associated with servere infections or obstructions
- leads to narrowing of the lumen
- can occur with COPD
What are the clinical signs for bronchiectasis?
- persistent cough
- Purulent sputum ++
- haemoptysis (coughing up blood )
Restrictive disease are characterised by inflammation and fibrosis of the pulmonary connective tissue. Where do restrictive disease tend to occur in the lung?
- interstitium of the alveolar walls
- this becomes a problem because this increases the alveolar space and therefore increase the distances from the blood vessels so resicrits gas exchange
What are the main causes of restrictive diseases?
- Sarcoidosis
- occupational / environmental (asbestosis exposure)
What is the morphology of restrictive lung disease?
- bilateral infultrative lesions
- on Xray shows small nodules, irregular lines, ground glass shawdows
- scarring and gross destruction of the lung
- end stage = honeycomb lung
What are the clinical features of restrictive lung disease?
- dyspnea (SOB)
-tachypnea (increased resp rate) - eventually cyanosis
reduction in gas diffusing capacity, lung volume and compliance - may lead to secondary pulmonary hypertension and right sided heart failure with car pulmonale
- increased risk of developing pneumonia
Pulmonary embolism (PE) is the main vascular disorder. What is
Blockage of a main or branch pulmonary artery by an embolus
- usual source of emboli are deep venous thrombi of the leg.
- respiratory compromise and haemodynamic compromise
- associated with people that are bed bound for a long time (why stockings and stuff are used)
- also associated with pregnancy, long operations and long flights
What are the clinical appearances of pulmonary embolism?
- abrupt onset pleuritic chest pain
- SOB
- hypoxia
- increased pulmonary vascular pulmonary vascular resistance - right ventricular failure
What is pulmonary oedema and its causes?
- Accumulation of fluid in the air spaces and parenchyma of the lungs
Causes: - increased venous pressure (eg. ventricular failure)
- haemodynamic (heart failure)
- secondary to kidney problems (eg. nephrotic syndrome )
- oedema due to alveolar injury/ infection
initially pulmonary oedema happens at the bottom of the lungs and then makes its way up. What are the clinical feature of pulmonary oedema?
- SOB
- pink frothy sputum
- x-ray shows hasieness
- heavy wet lungs
- granular pink
What is a Pneumothorax? And what diseases is it associated with?
- air in the throric/ pleural cavity
- causes lungs to collapse
- it is reversible
its associated with emphysema, asthma, TB, trauma, idiopathic
What is a tension pneumothorax?
- normally in pneumothorax can get chest drain to get air out and lung with expand
- in tension pneumothorax every time patient takes a breath in the air in pleural space expands. medical emergency and causes cardiac arrest
What is atelectasis?
- incomplete expansion of lungs
- reduces oxygenation and predisposes to infection.
- this is revisable
In type 1 hypoxia with a normal or low PCO2 what is type 2?
hypoxia with high co2. normally in obstructive disease.
There is a linear correlation between smoking and epithelial changes what are these?
- metaplasia
- then dyslasia,
- carcinoma in situ leading to
- invasive carcinoma
What are the most common clinical complaints of lung cancer ?
- cough
- weight loss
chest pain - SOB
Some lung cancers will have metastasis what are the most common places fro these to go?
adrenal
liver
brain
bone
Paraneoplastic syndrome is ectopic hormone secretion by tumours. What are the most common hormones and effects?
ACTH( adrenocorticotrophic hormone) - causing cushing syndrome
ADH (antidiuretic hormone) causing hyponatraemia
Calcitonin - causing hypercalcaemia
small cell carcinoma has a strong relationship to smoking. they grow and metasises very early and so not generally curable to with surgery. they are most responsive to _____
most responsive to chemotherapy. but worst prognosis as relapses early.
For diagnostic purposes when staining small cell carcinomas what does it show?
- chromogranin
- CD56
- TTF1
- synaptophysin
Squamous cell cancer mostly effect men, with high correlation with smoking. Where do they normally arise?
arise close to HILUM (centrally located), usually in area of squamous metaplasia.
What is a common marker for squamous cell carcinomas?
keratinisation and or intercellular bridges
adenocarcinomas are most common in women and tend to be peripherally located. How do they grow in comparison to squamous cell carcinomas?
- grow more slowly but
- metastasize early and widely
What are adenocarcinomas sometimes associated with?
scarring e.g healed TB. people that have had old TB might get adenocarcinoma occurring
What is a large cell carcinoma?
- undifferentiated malignant epithelial tumour
- undifferentiated SCC and adenocarcinoma with no discernible features
- associated with neuroendocrine variant (highly malignant tumour, granular cytoplasm, central necrosis, peripheral palisading)
When finding lung metastases (these are the most common) where are the primary tumours most likely to be?
bowel
prostate
breast
kidney
In a lung cancer normally positive for CK7 and negative for CK20. What is different in metastatic colorectal adenocarcinoma?
negative for CK7
positive for CK20.
Which cancer normally causes cancer after asbestos exposure?
malignant mesothelioma
it is a pleural tumour
- associated with extensive pleural effusion and direct invasion of thoracic structures.
Patients with mesothelioma present with chest pain, SOB, pleral effusion (abnormal amount of fluid around lungs) and it can alsoarise in peritoneum, pericardium and genital tract. What is the treatments?
extra-pleural pneumonectomy, chemo, radiotherapy
- doesn’t often improve prognosis
