Pahtology
Terms
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- Emphysema
- 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
- COPD
- 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
- Asthma
- 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
- Bronchiectasis
- 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
- Bronchopneumonia
- 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
- Pneumoconiosis
- 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)
- Sarcoidosis
- non caseating granuloma, unknown etiology, mediastinal lymph node enlargement, skin lesions, ocular involvement (iritis), muscle involvement