SM 167c Lung Pathology and Obstructive Lung Disease Flashcards
How do obstructive lung diseases effect the lungs?
Decreased airflow in large and small airways leading to increased lung volumes
What two diseases are classified as COPD?
Emphysema and Chronic Bronchitis
What diseases are classified as obstructive lung disease?
COPD, Asthma, Bronchiectasis
What factor tends to precipitate COPD?
Long term damage from smoking
Why are Emphysema and Chronic Bronchitis lumped together under COPD?
The two diseases have different processes but tend to occur together
What pathophysiology underlies Emphysema?
An imbalance between proteases and anti-proteases, leading to elevated protease activity
Where in the lungs does Emphysema have the greatest effect?
Emphysema results from the destruction of elastic tissue in the alveolar spaces, and has minimal involvement of the bronchi and bronchioles
What sets Emphysema apart from the other Obstructive Lung Diseases?
Emphysema has only minimal involvement of the Bronchi and Bronchioles
How does Emphysema lead to airway space collapse if it primarily effects the Alveoli?
Emphysema involves widespread loss of elastic tissue, leading to the loss of connective tissue throughout the lung, including Alveoli and the airspaces, which predisposes airway collapse
How does Emphysema appear on gross pathology?
More holes than normal, and more towards the periphery
Would pure Emphysema involve inflammation?
No, only protease mediated destruction
What are “floating septae”?
Alveolar walls that are not tethered to anything on Pathology, which act as a tell tale sign for Emphysema due to the destruction of elastic tissue
How does Emphysema appear on pathology?
Floating septae and large alveoli
What are the variants of Emphysema?
Centriacinar (Smoking), Distal Acinar (Scarring), and Paracinar (A1AT) Emphysema
What could cause Centriacinar Emphysema?
Smoking
What could cause Paracinar Emphysema?
A1AT deficiency
What could cause Distal Acinar Emphysema?
Scarring
How is Chronic Bronchitis diagnosed?
Based on clinical picture, and not pathology
What factor could cause Chronic Bronchitis?
Like Emphysema, the other form of COPD, Smoking can cause Chronic Bronchitis
What is required for a clinical diagnosis of Chronic Bronchitis?
Productive cough for most days in 3 consecutive months for 2 consecutive years
Where does Chronic Bronchitis affect the airways?
Chronic Bronchitis affects the larger airways
How does Chronic Bronchitis differ from Emphysema in terms of the affected areas of the respiratory system?
Chronic Bronchitis affects the larger airways while Emphysema affects the Alveolar space
How does Chronic Bronchitis alter the lungs?
Chronic airway inflammation and mucus gland hypertrophy
What does Chronic Bronchitis predispose?
Superinfection
What is the Reid Index and what does it measure?
The Reid index is a measure of the mucus gland size to distance from epithelium to cartilage, and is elevated in Chronic Bronchitis
Which has more inflammation, Chronic Bronchitis or Emphysema?
Chronic Bronchitis
Which results in mucus hypersecretion, Chronic Bronchitis or Emphysema?
Chronic Bronchitis
What is Bronchiectasis?
Irreversible dilation of the airways that occurs in a vicious cycle
What is the vicious cycle of Bronchiectasis?
Obstruction, infection, and bronchial wall destruction
What can cause Bronchiectasis?
Cystic Fibrosis, repeated infections
How does Bronchiectasis present?
Chronic productive cough with foul smelling sputum
How does Bronchiectasis appear on pathology?
Dilated bronchi that are plugged with mucus made of inflammatory cells
How do airways compare to vessels in the setting of Bronchiectasis?
Airways»_space;> Vessels in Bronchiectasis
What happens to airways during Bronchiectasis?
Airways lose smooth muscle and glands during Bronchiectasis due to repeated infections and inflammation
What 3 traits define Asthma?
Reversible episodic obstruction, airway hyperreactivity, and chronic inflammation
What underlies airway obstruction in Asthma?
Smooth muscle contraction, mucosal edema, and mucus secretion
What causes chronic inflammation in Asthma?
Leukotrienes, Th2 Lymphocytes, and Eosinophils
What are the two types of Asthma?
Atopic and Non-atopic
What is Atopic Asthma?
Asthma due to Type I Hypersensitivity to an antigen
What is non-Atopic Asthma?
Asthma due to cold weather or something else that isn’t an antigen
What makes up the early phase of Asthma?
Airway obstruction, vascular permeability, and edema formation mediated by Leukotrienes and Histamine
What makes up the late phase of Asthma?
Recruitment of inflammatory cells by Eosinophils
What can be seen on pathology during an Acute Asthma attack?
Charcot-Leyden Crystals, Mucus Plugging, and Churchman’s Spirals
What can be seen on pathology in the setting of Chronic Asthma?
Basement membrane thickening and smooth muscle hypertrophy
How does Asthma causes airway remodeling?
Longstanding asthma results in smooth muscle hyperplasia, mucus gland hyperplasia, and epithelial damage that predisposes obstructive lung disease physiology
Why does the basement membrane thicken in Chronic Asthma?
Chronic Asthma = chronic inflammation
What are Charcot-Leyden Crystals?
Crystals composed of Eosinophils that form during Acute Asthma attacks
