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enlargement of air spaces distal to terminal bronchiole with destruction of airspace walls and lack of significant fibrosis
Types of emphysema
panacinar, centrilobular, paraseptal, irregular
Panacinar emphysema
alpha 1 antitrypsin defficiency, involves entire lobule equally
Centrolobular emphysema
only central parts of acini involved, distal parts are not, in heavy smokers, usually with chronic bronchitis
Paraseptal emphysema
Distal part of acinus involved, proximal normal, underlying cause of pneumothorax in young adults
Irregular emphysema
with scarring, no specific pattern
emphysema + chronic bronchitis, may also include asthma and bronchiectasis
Epidemiology emphysema
men, heavy smokers, COPD 4th leading cause of morbidity and mortality
Pathogenesis emphysema
balance interruption between proteases and protease inhibitors, smoking accumulates PNL's and macrophages which release protease and destroy alpha 1 antitrypsin
Symptoms emphysema
dyspnea, pink puffers, weight loss, barrel chest, airflow limitation on expiration(spirometry)
what causes death in patients with emphysema
respiratory failure, CHF, pneumothorax
Chronic bronchitis
Persistent cough with sputum production for 3 months for at least 2 consecutive years
Pathogenesis chronic bronchitis
chronic irritation of bronchal mucosa (smoking, silica) , increase in goblet cells, hyper mucous secretion, small airways obstruction, infections are 2ndary (exacerbate)
Reid index
ratio of the thickness of the wall and mucous membrane to thickness of epithelium and cartilage , increases in chronic bronchitis (normal 0.4)
Clinical chronic bronchitis
cyanosis, productive cough, blue bloaters
chronic inflammatory disease characterized by paroxysmal bronchospasms, associated with bronchoconstriction and airflow limitation, reversible, attacks of dyspnea, wheezing, cough
Extrinsic asthma
hypersensitivity I, antigen mediated
Intrinsic asthma
diverse non immune mechanisms (drugs, exercise,cold)
Asthma pathogenesis
mediated by mast cell factors(leuktrienes, bradykinin, histamine, prostaglandins)
Atopic asthma
IgE mediated hypersensitivity, worse in children
drug induced assthma
aspirin causes asthmatic attack + urticaria
chronic necrotizing infection of bronchi and bronchioles leads to abnormal dilatation of airways, rare
Symptoms bronchiectasis
dyspnea, orthopnea, severe persistent cough, foul smelling sputum
Etiology bronchiectasis
CF, Kartagener synddrome, bronchial obstruction (tumor, foreign body), TB, immunodefficiency)
Kartagener syndrome
immotile cilia, situs inversus
Pulmonary infections are caused by
loss of cough reflex, decrease in IgA secretion, bronchial obstruction, pulmonary edema, loss of phagocytic function
Bacterial Pneumonia
can be bronchopneumonia and lobar pneumonia
patches of consolidation (exudative solidification of lung parenchyma)
Lobar pneumonia
suppurative exudate, large area of lobe consolidated, stages - congestion, red hepatization, grey hepat., resolution
Complication of bacterial pneumonia
Abscess (necrosis of lung parenchyma), empyema (pus in pleural space), organization (fibrosis with loss of functional lung parenchyma), bacteremia
Atypical pneumonia
viral and mycoplasmal, interstitial(within alveoli), no consolidation
Aspiration pneumonia
aspiration of gastric contents
Nosocomial pneumonia
hospital acquired pneumonia
Lung abscess
localized suppurative infiltration of the lung, can be from aspiration of bacteria, complication of bronchiectasis, lung CA, septic embolism, need to rule out CA if found, seen on x ray
non neoplstic lung reaction to inhalation of fumes, vapors, organic and inorganic particles
Hypersensitivity pneumonitis
immune mediated lung disorder caused by prolonged exposure to inhalation of organic dusts (Farmers lung)
non caseating granuloma, unknown etiology, mediastinal lymph node enlargement, skin lesions, ocular involvement (iritis), muscle involvement

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