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Path 15 Lung


Bronchioles distinguished from bronchi by... lack of cartilage and submucosal glands w/in their walls
flattened, platelike, cover 95% of alveolar surface Type 1 pneumocytes
rounded, synthesize surfactant, repair alveolar epithel and give rise to type 1 cells Type 2 pneumocytes
permit passage of bacteria and exudate b/w adjacent alveoli pores of Kohn
Obstruction of airway-> resorption of oxygen trapped in dependent alveoli, w/o impaired bloodflow. mediastinum shifts toward atelectatic lung. Found w bronchial asthma, chronic bronchitis, bronchiectasis, postop states, aspiration of bods Resorption atelectasis
pleural cavity is filled by fluid exudate, tumor, blood, air, or caused by tension pneumothorax. air pressure impinges on and threatens the func of lung and mediastinum. Mediastinum shifts away Compression atelectasis
fibrotic changes in lung or pleura prevent full expansion. not reversible Contraction atelectasis
Most common hemodynamic cause of pulmonary edema increased hydrostatic pressure - as in left-sided congestive heart failure = which has hemosiderin laden macrophages (heart failure cells)
abrupt onset of significant hypoxemia and diffuse pulmonary infiltrates in the absence of heart fail. inflamm-associated increase in pulm vasc permeability and epithel and endothel cell death -> diffuse alveolar damage (DAD), lungs heavy, firm, red, boggy Acute lung injury (ALI) - w/o underlying etiology = Acute Interstital Pneumonia (AIP) - severe ALI= Acute Resp Distress Synd (ARDS)
Decreased max airflow during forced expiration (FEV1 decreased) Obstructive disorders
Reduced total lung capacity (TLC) and a normal expiratory flow rate Restrictive diseases - chest wall disorders: polio, obesity, kyphoscoliosis - chronic interstit and infiltrat diseases: pneumoconioses, interstit fibrosis
irreversible enlargement of airspaces distal to term bronchiole w destruction of walls. asso w heavy smoking, women, and blacks. barrel chest, prolong expiration, hunched over, pursed lips. pink puffers Emphysema - Centriacinar: prox parts of acini affected, distal alveoli spared. more severe in upper lobes. smokers - Panacinar: acini are uniformly enlarged. more common in lower zones, more severe at bases. Alpha1-antitrypsin deficiency, ZZ homozyg
persistent cough w sputum prod for 3 months in 2 consec yrs. smokers (also grain, cotton, silica dust). Hypersecretion of mucus early. Infx and cor pulmonale common. Reid index increased (ratio of mucus layer thickness to thickness of wall). Blue bloaters Chronic Bronchitis
recurrent wheezing, breathlessness, chest tightness, and cough, at night and/or in early morning. Increased airway responsiveness-> bronchoconstrict, inflamm of bronch walls, increased mucus secrete. Curschmann spirals, Charcot-Leyden crystals Asthma - Atopic: most common, type 1 IgE hypersense, triggered by environ allergens - Non-atopic: no allergen sensitization, viral resp infx are common triggers.
permanent dilation of bronchi/oles d/t destruction of muscle and elastic tissue, from chronic necrotizing infx and obstruction. distal lower lobes B/L, dilated airways. presents w severe persistent cough, foul/bloody sputum Bronchiectasis - With cystic fibrosis, Kartagener synd, allergic bronchopulm Aspergillosis
TGF-Beta1 is driver of this process-> decreased caveolin-1. pleural surfaces are cobblestoned. Honeycomb fibrosis. begins insidiously with increasing dyspnea on exertion and dry cough. 40-70 y/o. Hypoxemia, cyanosis, clubbing late. Idiopathic Pulm Fibrosis
polypoid plugs of loose organizing connect tissue (Mason bods). no interstitial fibrosis or honeycomb lung Cryptogenic organizing pneumonia
most prevalent occupational disease in the world. nodules in upper zones of lungs. increased risk of TB. eggshell calcification Silicosis
diffuse pulm interstit fibrosis beginning in lower lobes and pleural plaques (parietal and over domes of diaphragm) w increased risk of mesothelioma and lung carcinomas. golden brown fusiform/beaded rods. ship builders and work on old houses Asbestosis - Serpentine chrysotile is most common, but Amphibloe is more pathogenic (mesothelioma)
idiopathic systemic disease w rounded well defined Noncaseating Granulomas and bilateral hilar lymphadenopathy. Black women. Increased CD4+ T cells, IL-2, IFN-Gamma, IL-8, TNF Sarcoidosis
bilateral patchy asymm pulm opacifications and accumu of acellular surfactant in intra-alveolar and bronchiolar spaces. turbid fluid exuded. present w cough and sputum that contains chunk of gelatinous material Pulmonary Alveolar Proteinosis (PAP) - Acquired is most common: d/t anti-GM-CSF - Congenital causes immediate neonatal resp distress: d/t mutant ABCA3
Familial is caused by BMPR2 mut. Medial hypertrophy of muscular and elastic arteries, atheromas of pulmonary artery, and RVH. Idiopathic is common in women 20-40 Pulmonary Hypertension
Kidney and lung injury caused by antibods against collagen IV of basement membranes. teens to 20 y/o males. asso w HLA. linear Ig deposits along basement memb of septal walls. present w hemoptysis and focal pulm consolidations, then glomnephritis Goodpasture synd
Most common cause of community-acquired acute pneumonia. gram+ lancet shaped diplococci. Strep pneumo (Pneumococcus)
Gram- major cause of life-threatening lower resp tract infx and meningitis in young children (unvaccinated). can also produce otitis media, sinusitis, bronchopneumonia. And is most common bacterial cause of COPD exacerbation Haemophilus influenzae
Gram+ catalase/coagulase + cause of secondary bac pneumo. w lung abscess and empyema. IV drug users w endocarditis. Staph aureus
Most freq cause of Gram- bac pneumo. debilitated and malnourished people (chronic alcoholics). thick/gelatinous sputum. Klebsiella pneumoniae
Enterobacteriaceae, Pseudomonas, and S. aureus are most common causes of this type of pneumonia Hospital-Acquired Pneumonia
malignant epithelial tumor w glandular differentiation or mucin production by tumor cells. most common type of lung cancer in women and nonsmokers. lesions are peripheral. positive for thyroid transcription factor-1 (TTF-1) and KRAS mut. Grow slow Adenocarcinoma
lung cancer with growth along preexisting structures w/o destruction of alveolar architecture (lepidic). Bronchioloalveolar carcnioma - nonmucinous: rare aerogenous spread - mucinous: spread aerogenously->satellite tumors
lung cancer most common in men (especially smokers). Keratinization (pearls) and intercellular bridges. high freq of p53 mut, and overexpress EGFR. centrally located. releases PTHrP -> Hypercalcemia Squamous cell carcinoma
ill defined cell borders, finely granular nuclear chromatin (salt and pepper) and absent/inconspicuous nucleoli. most aggressive and metastat widely. centrally located. neuroendocrine derived. release ACTH (Cushings), ADH (SIADH),(Lambert-Eaton). p53, RB1 Small cell Carcinoma
Created by: Jakphooey