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The Respiratory System > The Pathology of Parenchymal Lung Disease > Flashcards

The Pathology of Parenchymal Lung Disease Flashcards

1
Q

What are the mechanical defence mechanisms of the lungs

A
  • Ciliated epithelium
  • Mucus
  • Cough
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2
Q

What is the role of ciliated epithelium

A

To move mucus upwards and out of the respiratory tract.

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3
Q

What are the immunological defence mechanisms of the lungs

A
  • IgA and antimicrobials in mucus
  • Resident alveolar macrophages and dendritic cells
  • Innate and adaptive immune responses.
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4
Q

What happens to gas exchange if the alveolar space is filled

A

Gas exchange is impaired

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5
Q

In what situation may the alveolar spaces be filled

A

Due to bacteria in pneumonia.

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6
Q

How can the interstitium impair gas exchange

A

If the interstitium is diseased, gas exchange will be slower.

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7
Q

What is the parenchyma

A

The parts of the lungs involved in gas transfer.

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8
Q

Which structures are part of the parenchyma

A
  • Alveoli
  • Interstitium
  • Blood vessels
  • Bronchi
  • Bronchioles
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9
Q

What do parenchymal lung diseases affect

A

Everything but the large tubes - the trachea.

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10
Q

What is an example of an acute inflammatory condition of the parenchyma

A

Pneumonia

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11
Q

What are the 5 types of pneumonia

A
  • Community acquired
  • Hospital acquired/healthcare associated
  • Aspiration pneumonia
  • Pneumonia in the immunocompromised host
  • Necrotising pneumonia
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12
Q

What are the two commonest pathogens that cause community acquired pneumonia

A
  • Streptococcal pneumonia

- Haemophilus influenzae

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13
Q

What are all the pathogens which can case community acquired pneumonia

A
  • Streptococcal pneumonia
  • Haemophilus influenza
  • Morarxella catarrhalis
  • Staphylococcus aureus
  • Klebsiella pneumonia
  • Pseudomonas aeruginosa
  • Mycoplasma pneumoniae
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14
Q

What pathogens cause hospital acquired pneumonia

A
  • Gram negative rods
  • Enterobacteriae
  • Pseudomonas
  • Staph Aureus
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15
Q

What pathogens cause aspiration pneumonia

A
  • Anaerobic oral flora

- Aerobic bacteria

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16
Q

What pathogens cause pneumonia in the immunocompromised host

A
  • Cytomegalovirus
  • Pneumocystis jiroveci
  • Mycobacterium
  • Invasive aspergillosis
  • Invasive candidiasis
  • USUSUAL BACTERIAL, VIRAL AND FUNGAL ORGANISMS
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17
Q

What pathogens cause necrotising penumonia

A
  • Anaerobes
  • Staph Aureus
  • Klebsiella
  • S.pyogenes.
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18
Q

Why is knowing the type of pneumonia important

A

This directs treatment.

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19
Q

What are the 5 pillars of inflammation

A
  • Pain
  • Swelling
  • Redness
  • Heat
  • Loss of function
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20
Q

What are two inflammatory cells involved in the cellular response to infection

A

Neutrophils and macrophages.

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21
Q

What is the action of neutrophils

A

Neutrophils reach the site of infection by chemotaxis. They then degranulate to release reactive oxygen species which try and get rid of the initial pathogen.

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22
Q

What happens if the alveolar space is filled with degranulation products from the neutrophils

A

This impairs gas exchange

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23
Q

What is the clinical presentation of pneumonia

A
  • Cough
  • Sputum
  • Pyrexia (temperature)
  • Pleuritic chest pain (worsens on inhalation)
  • Haemoptysis (coughing up blood)
  • Dyspnoea (difficulty breathing)
  • Hypoxia (low oxygen)
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24
Q

What are the general risk factors for pneumonia

A
  • Chronic diseases
  • Immunologic deficiency
  • Immunosuppresive agents
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25
Q

What are the local risk factors for pneumonia

A
  • Loss or suppression of cough reflex
  • Injury to the mucociliary apparatus
  • Accumulation of secretions
  • Impaired alveolar macrophages function
  • Pulmonary congestion and oedema.
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26
Q

What are the two different appearances of pneumonia

A
  • Bronchopneumonia

- Lobar pneumonia

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27
Q

What is bronchopneumonia

A

Inflammation around the bronchi

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28
Q

Which is more common, broncho- or lobar pneumonia

A

Bronhcopneumonia

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29
Q

What is a classic feature of an area of pneumonia

A

Consolidation

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30
Q

In what group does bronchopneumonia normally arise

A

The elderly with comorbidities such as cancer, heart failure, renal failure etc.

31
Q

What is a classic sign of lobar pneumonia

A

Rust coloured sputum

32
Q

What is the organism which most commonly causes lobar pneumonia

A

Strep pneumoniae

33
Q

What is the appearance of the lungs in lobar pneumonia

A

Consolidation of a large portion of a lobe or of an entire lobe.

34
Q

What is the possible positive outcome of both broncho-and lobar pneumonia

A

Effective clearance and resolution with nothing to show that anything was ever wrong.

35
Q

What are the local complications of pneumonia

A
  • Abscess formation
  • Parapneumonic effusion
  • Empyema (pus in the pleural cavity)
36
Q

What is the issue with abscess formation in pneumonia

A

It does not result in effective clearance due to excessive tissue damage and incomplete resolution.

37
Q

What are the systemic complications of pneumonia

A
  • Sepsis
  • Acute respiratory distress syndrome
  • Multi-organ failure (due to bacteria or hypoxia).
38
Q

What factors are diagnostic of acute respiratory distress syndrome

A

Hypoxia and non-cardiogenic pulmonary oedema.

39
Q

What are the direct causes of acute respiratory distress syndrome

A
  • Pneumonia
  • Aspiration
  • Hyperoxia
  • Ventilation
40
Q

What are the indirect causes of acute respiratory distress syndrome

A
  • Sepsis
  • Trauma
  • Pancreatitis
  • Acute hepatic failure.
41
Q

What is an example of a condition which causes chronic inflammation in the parenchyma

A

Bronchiectasis

42
Q

What is bronchiectasis

A

The permanent dilatation of one or more large bronchi.

43
Q

Which part of the bronchi does it normally affect

A

The 2nd to the 8th segmental bronchi. The largest central bronchi are more robust as they are surrounded by rings of cartilage.

44
Q

How does airway dilatation in bronchiectasis occur

A

The airways are injured and this results in inflammation (with or without infection). There is destruction of the airway wall, loss of elastic tissue and fibrosis which leads to airway dilatation. There can also be distal lung changes with fibrosis.

45
Q

What does cough do in bronchiectasis

A

Increases the pressure in the airways and causes airway dilatation.

46
Q

What is traction bronchiectasis

A

Dilatation of the airways due to parenchymal fibrosis.

47
Q

How does traction bronchiectasis occur

A

There is inflammation which leads to new collagen formation. The collagen contracts and there is loss of lung volume. This results in a pulling open of airways and airway dilatation.

48
Q

What are the four different patterns of bronchiectasis and what are these based on

A

The pattern is based on the imaging appearances. the four different patterns are -

  • Cylindrical
  • Sacular
  • Varicose
  • Cysitic
49
Q

What are the two classifications of bronchiectasis

A
  • Localised bronchiectasis

- Diffuse/multi-factorial bronchiectasis.

50
Q

What is localised bronchiectasis

A

This is bronchiectasis in one part of the lung.

51
Q

What normally causes localised bronchiectasis

A

A mechanical factor obstructing the bronchi such as a foreign body or a neoplasm.

52
Q

What are all the causes of localised bronchiectasis

A
  • Bronchial obstruction
  • Infection
  • Gastric acid aspiration
  • Traction bronchiectasis
  • Idiopathic
53
Q

What are the causes of diffuse bronchiectasis

A
  • Infection
  • Hereditary conditions such as cystic fibrosis
  • Immunodeficiency conditions such as HIV
  • Connective tissue disorders
  • Inflammatory bowel disease
  • Idiopathic
54
Q

What are the three main causes of diffuse bronchiectasis

A
  • Infection
  • Idiopathic
  • Cystic fibrosis
55
Q

What are the local complications of bronchiectasis

A
  • Distal airway damage and lung fibrosis
  • Pneumonia
  • Pulmonary abscess formation
  • Haemoptysis
  • Aspergilloma
56
Q

What are the physiological complications of bronchiectasis

A
  • Respiratory failure

- Cor pulmonale (right heart failure as a result of respiratory failure).

57
Q

What are the systemic complications of bronchiectasis

A
  • Metastatic abscess

- Amyloid deposition.

58
Q

Why is infection more common in people with bronchiectasis

A

Because there is impaired clearance of the airways due to the altered anatomy and thickened mucus. There is also impaired immune cell function.

59
Q

Which pathogens can colonise in those with bronchiectasis

A
  • Psuedomonas auriguinosa
  • Klebsiella
  • Moraxella
  • S.pneumoniae
  • H.influenzae
60
Q

What is an example of a condition causing granulomatous inflammation

A

Tuberculosis

61
Q

What happens in primary tuberculosis

A

M.tuberculosis multiplies inside alveolar macrophages. It is carried to regional lymph nodes inside these macrophages and from there into the circulation.

62
Q

What is the result of primary tuberculosis in most immunocompetent people

A

It is arrested de to the onset of cellular immunity and delayed hypersensitivity which eventually results. However few bacilli may survive dormant.

63
Q

What happens in progressive primary tuberculosis

A

The infection is not arrested. This happens in the minority and is normally only in children and the immunocompromised.

64
Q

What happens in tuberculosis bronchopneumonia

A

The infection spreads via the bronchi and the result is diffuse bronchopneumonia. Well developed granulomas do not form in this case.

65
Q

What happens in miliary tuberculosis

A

The infection spreads via the blood stream affecting multiple organs such as the lungs, liver, spleen, kidneys, meninges and brain.

66
Q

What is secondary tuberculosis

A

The re-activation of old, often subclinical infection. There is more damaged caused by this than primary TB because of the established hypersensitivity reaction.

67
Q

What are fibrosing diseases of the lung classified as

A

Restrictive chronic lung disease.

68
Q

What are some of the symptoms of fibrosing lung disease

A
  • Dyspnoea
  • Cough
  • Tachypnoea
  • Crepitations
  • Cyanosis.
69
Q

What is one example of a fibrosing lung disease

A

Usual interstitial pneumonitis.

70
Q

How do fibrosing lung diseases come about

A

there is persistent injury of the epithelium. This leads to the innate and adaptive immune responses which release pro-fibrogenic factors for healing. There is proliferation and collagen production resulting in fibrosis.

71
Q

What does asbestos cause

A

An occupational lung disease with a latent phase of up to 40 years.

72
Q

How does asbestos cause inflammation

A

It is inhaled and then does not move but stimulates an inflammatory response.

73
Q

What are the name of some conditions which can be caused by asbestos exposure

A
  • Asbestosis
  • Mesothelioma
  • Adenocarcinoma
74
Q

What is hypersensitivity pneumonitis

A

It is a type III hypersensitivity reaction in which antigen-antibody complexes are deposited in the lung. Chronic hypersensitivity results when the antigen is not removed.

The Respiratory System (20 decks)

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