Saroj 1 Flashcards
which bronchi is more susceptible to aspiration
right main stem due to vertical orientation
What does bronchioles not have
cartilage
submucosal glands
what is pathway for air
bronchi
bronchioles
terminal bronchioles
acinus
What does Acinus contain
respiratory bronchioles –> alveolar ducts –> alveolar sacs
almost entire respiratory tree is lined by what? exceptions?
ciliated pseudostratified tall columnar epithelium
- vocal cord: stratified squamous epithelium
what are 2 types of alveolar epithelium
Type I pneumocytes: alveolar surface majority
Type II pneumocytes: surfactant and repair
what supplies the lung
pulmonary and bronchial arteries
nasal clearnce
sneezing or blowing
tracheobronchial clearance
epithelial mucociliary action
alveolar clearance
phagocytosis in alveolar macrophages
how can alcohol and smoking impact clearance mechanism
interfere with phagocytic action of alveolar macrophages
what is restrictive pulmonary disease
reduced expansion of lung parenchyma
what numbers are impacted for restrictive pulmonary disease
decreased total lung capacity
normal FEV1
what are 2 categories for restrictive disease
- chest wall disorder with normal lungs
2. acute or chronic interstitial and infiltrative
define diffuse interstistial disease
inflammation and fibrosis of lung connective tissue or delicate alveolar septal interstitium
what is decreased in diffuse interstitial disease
diffusion capacity
lung volumes
compliance
clinical features of diffuse interstitial disease
dyspnea
tachypnea
cyanosis
what do advanced lesions on diffuse interstitial look like
honeycomb lung
name 2 granulomatous diseases
Sarcoidosis
Hypersensitivity pneumonitis
Idiopathic pulmonary fibrosis (IPF) is the same thing as
UIP
usual interstitial pneumonia
what is a probable cause for IPF UIP
- repeated cycles of epithelial activation/injury
- fibroblastic/myofibroblastic proliferation = FIBROBLASTIC FOCI
What is a probable genetic cause of IPF and UIP
TERT and TERC gene
telomerase
What is a second mechanism of pathogenesis for IPF UIP
- caveolin 1 inhibits TGF- beta1
decreased caveiolin-1 in IPF
- abnormal repair
idiopathic pulmonary fibrosis usually occurs where in the lung
subpleural regions in lower lobes
microscopically what do you see in Idiopathic pulmonary fibrosis (IPF
- fibroblastic foci initially
- later dense fibrosis and cystic spaces - HONEYCOMB
- abrupt transition between fibrosis and normal lung
- temporal heterogeneity
later clinical features of Idiopathic pulmonary fibrosis (IPF)
cyanosis and clubbing
microscopically what does nonspecific interstitial pneumonia look like
cellular - interstitial inflammation
fibrosing patterns without temporal heterogeneity if UIP
no fibroblastic foci or honeycomb lung
how is nonspecific interstitial pneumonia treated
steroids
another name for cryptogenic organizing pneumonia
Bronchiolitis obliterans organizing pneumonia (BOOP)
cryptogenic organizing pneumonia is associated with what
viral and bacterial pneumonias
what is the histo for cryptogenic organizing pneumonia
- polypoid plugs or loose organizing fibroconnective tissue ( MASSON BODIES)
- connective tissue plugs all the same age
what does X-ray show for cryptogenic organizing pneumonia
- Subplerual or peribronchial area of consolidation
how is cryptogenic organizing pneumonia treated
steroid therapy for greater than 6 months
What are 3 pneumoconioses
coal worker
silicosis
asbestos
what does cigarette smoke affect? amplies?
- affects mucociliary apparatus
- amplies effect of all inhaled dusts in obstructive and restrictive diseases
what size are the most dangerous cigarette particles
1-5 um
Is there cellular reaction in anthracosis of coal workers
no
morphology of simple CW coal workers
- coal macules: composed of carbon laden macrophages
- coal nodules, larger, collagen fibers
where does simple CW coal workers occur in the lung
upper lobes
upper zones of lower lobes
for simple CW coal workers macules and nodules are adjacent to
respiratory bronchioles
what can simple CW coal workers cause
centrilobular emphysema
clinical presentation for coal workers pneumonia
usually benign
- milder forms of complicated CWP exist without lung function abnormalities
what is Caplan syndrome coal workers
pneumoconiosis plus rheumatoid arthritis
what is the most prevalent chronic occupational disease worldwide
silicosis
what causes silicosis
inhalation of crystalline silicon dioxide
when does disease present for silicosis
decades after exposure
what forms in the lung for silicoisis
- crystalline ( more fibrosis, quartz most common) and amorphous forms
Silica causes activation and release of what
mediators within macrophages
-IL1, TNF, derived free radicals, fibrogenic cytokines
what does histo look like for silicosis
discrete pale to dark nodules
‘ eggshell calcifications’
- concentric layers of collagen
where does silicosis usually occur in lung
upper lung zones
Silicosis is associated with increased susceptibility to
tuberculosis
what are 2 forms of asbestos
serpentine
amphibole
both are fibrogenic
what is serpentine asbestos look like
soluble curly flexible fibers
compare serpentine and asmphibole
amphibole less prevalent but more pathogenic
describe amphibole
stiff brittle fibers
where does initial injury occur in asbetsosis
bifurcations of small airways and ducts
asbestosis can act as what? by what?
tumor promoter by free radical generation
what is seen in histo for asbestos
asbestos bodies: golden brown fusiform
what are asbestos fibers coated with
iron-containing proteinaceous material
where in the lung does asbestos occur
lower lobes
in asbestos what is a macro feature
honeycombing
what is the most common manifestation of asbestos ? what does it not have
pleural plaques
- does not contain asbestos bodies
when do symptoms occur for asbestois
20 years of more after exposure
asbestosis with lung or pleural cancer =
grim prognosis
Bleomycin
directly damage lung tissue
Amiodarone
causes penumonitis
radiation
pneumonitis occurs in 10-20% of patients 1-6 months after therapy
