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Respiratory Medicine Midterm > The Lung Part 1 > Flashcards

The Lung Part 1 Flashcards

1
Q

Development of the respiratatory system

A
  • Respirtatory system is an outgrowth from the ventral wall of the foregut
  • Midline trachea develops two lateral outpocketings–the lung buds which divide into lobar bronchi (3 on right, two on left)
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2
Q

Bronchi composition

A
  • firm cartilaginous walls for mechanical support
  • Lined with columnar ciliated epithelium with abundant subepithelial glands that produce mucus that prevents entry of microbes
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3
Q

Aspirated foreign material tends to enter which side of the lung more often (left or right)?

A

-Right

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4
Q

Arterial supply to the lungs

A

-Pulmonary and bronchial arteries

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5
Q

Difference between brochi and bronchioles

A
  • Bronchi has cartilage

- Bronchioles are branches of bronchi and LACK cartilage and submucosal glands in their walls

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6
Q

Order of branching of lungs

A

-Bronchi–>bronchioles–>terminal bronchioles–>acinus (made of respiratory bronchioles, alveolar ducts and alveolar sacs)

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7
Q

Sites of gas exchange

A

Alveoli

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8
Q

What is a pulmonary lobule?

A

-A cluster of 3-5 terminal bronchioles, each with its appended acinus

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9
Q

Vocal cords vs. respiratory tree epithelium

A
  • vocal cords covered by stratified squamous
  • the rest of resp tree (larynx, trachea, and bronchioles) lined by PSEUDOSTRATIFIED, tall, COLUMNAR, CILIATED epithelial cells
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10
Q

Bronchial mucosa contains what kind of cells? What do these cells do?

A
  • neuroendocrine cells

- Have neurosecretory type granules and release serotonin, calcitonin and gastrin releasing peptide (bombesin)

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11
Q

Where are mucus secreting goblet cells and submucosal glands located?

A

-dispersed throughout the walls of trachea and bronchi (but NOT THE BRONCHIOLES!!!)

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12
Q

Microscopic structure of alveolar walls/alveolar septa consist of

A
  • network of anastomosing capillaries lined with endothelial cells
  • Basement membrane and surrounding interstitial tissue
  • Alveolar epithelium
  • Alveolar macrophages–loosely attached to alvoelar epithelium or free within alveolar spaces
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13
Q

Basement membrane and surrounding interstitial tissue of alveolar walls

A
  • separate endothelial cells from alveolar lining epithelial cells
  • thin portion of septum–BM of epithelium and endothelium are fused
  • Thick portion of septum–separated by interstitial space (pulmonary interstitium) containing elastic fibers, collagen, smooth muscle cells, mast cells and rare lymphocytes and monocytes
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14
Q

Alveolar epithelium composition

A
  • Continuous layer of two cell types:
  • flattened platelike type 1 pneumocytes covering 95% of alveolar surface
  • Rounded type II pneumocytes
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15
Q

surfactant

A
  • forms a very thin layer over the alveolar cell membranes
  • involved in repair of alvolar epithelium through their ability to give rise to type I cells
  • Produced by type II pneumocytes!!
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16
Q

Pores of Kohn

A
  • The alveolar walls are perforated by pores of Kohn

- permit the passage of bacteria and edudate between adjacent alveoli

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17
Q

Are developmental anomalies of the lung common or rare? Which are the ones most commonly seen?

A
  • RARE!
  • The more common of these include:
  • Pulmonary hypoplasia
  • Foregut cysts
  • Pulmonary sequestration
18
Q

Less common congenital abnormalities include

A
  • tracheal and bronchial anomalies (atresia, stenosis, tracheesophageal fistula)
  • vascular anomalies
  • congenital pulmonary airway malformation
  • congenital lobar overinflation (emphysema)
19
Q

Pulmonary hypoplasia

A
  • defective development of both lungs (one may be more affected than the other)
  • decreased weight, volume and acini for body weight and genstational age
  • caused by abnormalities that compress the lung or impede normal lung expansion in utero
  • severe hypoplasia is fatal in early neonatal period
20
Q

Abnormalities that compress the lung or impede normal lung expansion in utero leading to pulmonary hypoplasia

A
  • congenital diaphragmatic hernia

- Oligohydramnios

21
Q

Foregut cysts arise from

A
  • abnormal detachments of primitive foregut
  • most often located in hilum or middle mediastinum
  • can be bronchogenic, esophageal or enteric
22
Q

Bronchogenic cysts

A

-rarely connected to tracheobronchial tree
lined by ciliated pseudostratified columnar epithelium
-wall contains bronchial glands, cartilage and smooth muscle
-present due to compression of nearby structures or are found incidentally

23
Q

Pulmonary sequestration

A
  • discrete area of lung tissue that:
  • lacks any connection to airway system and
  • has abnormal blood sypply arising from aorta and branches
24
Q

Extralobar vs. intralobar sequestrations

A
  • Extralobar: external to lung; seen in INFANTS as MASS LESIONS
  • Intralobar: occur within lung; present in OLDER children, due to recurrent localized infection or bronchiectasis
25
Q

Atelectesis

A
  • incomplete expansion of lungs (neonatal) or collapse of previously inflated lung creating areas of airless pulmonary parenchyma
  • 3 types: Resorption, compression or contraction atelectasis
26
Q

Resorption atelectasis

A
  • Complete obstruction of airway
  • over time, air resorbed from dependent alveoli, which collapse
  • lung volume decreased so mediastinum shifts TOWARDS the atelectatic lung
27
Q

What causes airway obstruction (resorption atelectasis)?

A
  • excessive secretions (mucus plugs)
  • exudates within smaller bronchi (bronchial astma, chronic bronchitis, bronchiectasis and postoperative states)
  • Aspiration of foreign bodies and fragments of bronchial tumors may also lead to airway obstruction and atelectasis
28
Q

Compression atelectasis

A
  • results from accumulation of lots of volume of fluid (transudate, exudate, blood), or tumor or air (pnemothorax) in the pleural cavity
  • mediastinum shifts AWAY from the affected lung
29
Q

Contraction atelectasis

A

-focal or generalized pulmonary or pleural fibrosis prevents full lung expansion

30
Q

Consequences of atelectasis

A

-reduces oxygenation and predisposes to infection

31
Q

Atelectasis is reversible or irreversible?

A

-reversible except for cases caused by CONTRACTION

32
Q

Pulmonary edema

A
  • Leakage of excessive interstitial fluid which accumulates in alveolar spaces
  • caused by hemodynamic disturbances (hemodynamc or cardiogenic pulmonary edema) or from increases in capillary permeability from microvascular injury
  • produces heavy wet lungs
33
Q

Hemodynamic pulmonary edema is due to

A
  • Increased hydrostatic pressure (left sided CHF)
  • Fluid accumulates at basal regions of lower lobes bc hydrostatic pressure greatest here (dependent edema)
  • Alveolar capillaries engorged and intra-alvolar transudate appears as finely granular pale pink material
  • see alveolar microhemorrhages and hemosiderin-laden macrophages (heart failure cells)
  • in longstanding pulmonary HTN (mitral stenosis), hemosiderin laden macrophages abundant and fibrosis and thickening of alveolar walls cause lungs to be firm and brown (brown induration)
  • impairs respiratory function and predisposes to infection
34
Q

Causes of hemodynamic edema

A
  • Increased hydrostatic pressure–most common cause!
  • Decreased oncotic pressure
  • Lymphatic obstruction
35
Q

Causes of Increased hydrostatic pressure leading to hemodynamic edema

A
  • left sided heart failure
  • volume overload
  • pulmonary vein obstruction
36
Q

Causes of decreased oncotic pressure leading to hemodynamic edema

A
  • Hypoalbuminemia
  • Nephrotic syndrome
  • Liver disease
  • Protein-losing enteropathies
37
Q

Causes of edema due to alveolar wall injury (microvascular or eptihelial injury)

A

-Direct injury

Indirect injury

38
Q

Causes of direct injury leading to edema due to alveolar wall injury

A
  • Infections: bacterial pneumonia
  • Inhaled gases: high concentration of oxygen, smoke
  • Liquid aspiration: gastric contents, near-drowning
  • Radiation
39
Q

Causes of indirect injury leading to edema due to alveolar wall injury

A
  • Septicemia
  • Blood transfusion related
  • Burns
  • Drugs and chemicals: chemotherapeutic agens (bleomycin), other medications (methadone, amphotericin B), heroin, cocaine, kerosene, paraquat
  • Shock, trauma
40
Q

Causes of edema of undetermined origin

A
  • High altitude

- Neurogenic (central nervous system trauma)

41
Q

Edema caused by microvascular (alveolar injury)

A
  • Noncardiogenic pulmonary edema
  • injury to alveolar septa
  • Primary injury to vascular endothelium or damage to alveolar epthelial cells (with secondary microvascular injury) produces inflammatory exudate that leaks into interstitial space and alveoli
  • In most cases of pneumonia, edema is localized but when diffuse, alveolar edema contributes to fatal condition–acute respiratory distress syndrome (ARDS)

Respiratory Medicine Midterm (17 decks)

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