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RS Pathology
Respiratory System Pathology - COPD (Emphysema)
| Question | Answer |
|---|---|
| The major diffuse obstructive disorders are: | 1) Emphysema 2) Chronic Bronchitis 3) Bronchiectasis 4) Asthma |
| Expiratory obstruction may results from either: | 1) Anatomic narrowing, like asthma 2) Loss of elastic recoil, like emphysema |
| There may be overlapping between which obstructive disorders? | Emphysema, bronchitis, and asthma |
| How does one differentiate between emphysema and chronic bronchitis? | Chronic bronchitis is defined on the basis of clinical features Emphysema is morphologic |
| Which part of the lung does chronic bronchitis involve? | Large airways |
| Which part of the lung does emphysema involve? | The acinus (Bronchioles, alveoli) |
| Can emphysema and chronic bronchitis exist separately? | Yes, but they usually coexist |
| What is the major cause of chronic bronchitis and emphysema? | Heavy tobacco exposure |
| What category of disease do emphysema and chronic bronchitis fall under? | COPD (Chronic obstructive pulmonary disease) |
| What is Emphysema? | Abnormal permanent enlargement of the air distal to the terminal bronchioles accompanied by destruction of their walls without fibrosis, with destruction of the alveolar septa |
| What is the acinus? | The structure distal to terminal bronchioles Cluster of three to five acini is called a lobule |
| What are the major types of emphysema? | 1) Centracinar 2) Panacinar 3) Distal acinar 4) Irregular |
| What is the centriacinar emphysema? | The central or proximal parts of the acini, formed by respiratory bronchioles are affected, while distal alveoli are spared |
| How can you characterize this disease? | Both emphysematous and normal air spaces exist within the same acinus and lobule |
| Which lesions are more commonly/severly affected in this type of emphysema? | The upper lobes |
| What is the pathogenesis of this disease? | *Exposure to tobacco smoke and pollutants induces ongoing inflammation (neutrophil, macrophage, and lymphocyte accumulation) *Neutrophils release elastases, cytokines, and oxidants causing epithelial injury and proteolysis of the ECM |
| What is panacinar emphysema? | Emphysema in which the acini are uniformly enlarged from the respiratory bronchioles to the alveoli |
| Which lung zones are more likely to be affected? | The lower lung zones |
| What is the main cause of paracinar emphysema? | a1 antitrypsin deficiency |
| What is distal acinar emphysema also known as? | Paraseptal emphysema |
| What part of the lung does this emphysema involve? | The distal part of the acinus (proximal part is normal) More striking adjacent to the pleura, along the connective tissue septa Adjacent to areas of fibrosis |
| What is the characteristic finding of distal acinar emphysema? | Multiple, contiguous, enlarged air spaces Ranging from less than 0.5 mm to more than 2 cm with bullae |
| What is the most common cause of distal acinar emphysema? | Pneumothorax in young adults |
| What is irregular emphysema? | *The acinus is irregularly involved *Almost invariably associated with scarring *Clinically asymptomatic *may be the most common form of emphysema. |
| The cycle of inflammation and ECM proteolysis continues unless: | checked by antielastases |
| Example of antielastases: | A1 antitrypsin |
| What percentage of patients with congenital a1 antitrypsin deficiency develop panacinar emphysema? | 80% |
| Which genetic polymorphisms control the response to injury after smoking? | 1) TGFB influences susceptibility to COPD by regulating mesenchymal cell response to injury (signalling is reduced, inadequate elastin repair) 2) MMP-9 and MMP-12 |
| Morphology of lungs in panacinar emphysema: | Pale, voluminous lungs that obscure the heart |
| Morphology of lungs in centriacinar emphysema: | Lungs are less voluminous, and the upper two thirds are more severely affected |
| Histologic examination shows: | 1) Destruction of alveolar wall without fibrosis 2) Enlarged air spaces 3) Number of alveolar capillaries is diminished |
| Clinical features of emphysema: | 1) Dysnpnea 2) Weight loss - may suggest malignancy 3) Barrel chested patient 4) Prolonged expiration 5) Hunched over position |
| Blood gas values are : | Normal |
| Prominent dyspnea and adequate oxygenation of hemoglobin leads to these patients being called: | Pink puffer |
| When the emphysemic patient also has chronic bronchitis: | Dyspnea usually is less prominent, with diminished respiratory drive, so the patient retains carbon dioxide, becomes hypoxic, and often is cyanotic |
| These patients are called: | Blue bloaters *They tend to be obese for unknown reasons |
| These patients seek medical help after the onset of: | 1) Cor pulmonale 2) Associated edema |
| What is cor pulmonale? | Right sided heart failure due to abnormalities in the lung |
| In all cases, what condition develops? | Secondary pulmonary hypertension |
| Death from emphysema is due to: | 1) Pulmonary failure with respiratory acidosis, hypoxia, and coma 2) Right sided heart failure (cor pulmonale) |
| Conditions related to emphysema are: | 1) Compensatory Emphysema 2) Obstructive overinflation 3) Bullous emphysema 4) Mediastinal (interstitial) emphysema |
| Why are these conditions more properly referred to as overinflation, rather than emphysema? | They only resemble emphysema superficially |
| What is compensatory emphysema? | The compensatory dilation of alveoli in response to loss of lung substance |
| When can this occur? | In residual lung parenchyma, after surgical removal of a diseased lung or lobe |
| What is obstructive overinflation? | The condition in which the lung expands because air is trapped within it |
| What is a common cause of obstructive overinflation? | Subtotal obstruction by a tumor or foreign object |
| When can it become life threatening? | If the affected portion extends sufficiently to compress the remaining normal lung |
| What is bullous emphysema? | Any form of emphysema that produces large subpleural blebs or bullae |
| What are bullae? | Spaces greater than 1 cm in diameter in the distended state |
| These blebs represent: | Localized accentuations of any form of emphysema |
| Most of the time, the blebs are where? | Subpleural |
| If these blebs rupture, it will leads to: | Pneumothorax |
| What is Mediastinal (interstitial) emphysema? | Condition resulting when air enters the connective tissue stroma of the lung, mediastinum, and subcutaneous tissue |
| What are the causes of mediastinal emphysema? | 1) Sudden increase in intra alveolar pressure (violent coughing or vomiting/ children with whooping cough) 2) Patients on respirators who have partial bronchiolar obstruction 3) Patients suffering a perforating injury (fractured rib) |
| What effect does a fracture rib have? | Goes to the neck The head, neck, and chest, swell up and there is crackling crepitation all over the chest (like bubble wrap) |
| If the site of entry is sealed: | The air is resorbed spontaneously |
Created by:
Ulaisl
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