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WEEK 18:
Lung pathology- Pneumonia and TB:
| Question | Answer |
|---|---|
| pneumonia | inflammatory reaction of alveoli and interstitium of the lung caused by an infectious agent |
| pneumonia characterised by (3) | inflammatory exudate in alveolar space that consolidates, inflammation of alveolar septa, and features of acute inflammation |
| how does pneumonia differ from bronchitis | bronchitis is the invasive infection of lower respiratory system (bronchi) but pneumonia is in the alveoli |
| red hepatization (only in lobar pneumonia) | lung becomes firm and red like a liver when neutrophils and fluid in alveoli accumulate and capillaries are congested |
| routes of infection for pneumonia (3) | aspiration, inhalation of pathogen, or contamination from systemic circulation |
| classification of pneumonia (3) | pathogen, setting, or anatomically |
| lobar pneumonia | (alveoli-alveoli) in poor health adults/alcoholic where organisms access alveoli and rapidly spread via alveolar pores to adjacent alveoli |
| types of anatomical classification of pneumonia | lobar pneumonia and bronchopneumonia |
| bronchopneumonia | (bronchi-alveoli) in young/ elderly/ immobile people where organisms colonise bronchi and spread to alveoli. Affected areas consolidate locally at first in lobules then eventually whole lobes |
| clinical classification of pneumonia (7) | community acquired, hospital acquired (nosocomial), pneumonia in immunocompromised patients, aspiration pneumonia, chronic pneumonia, and necrotizing pneumonia + lung abscess |
| typical (acute) community acquired pneumonia | causes 90% of lobar pneumonia and is mostly caused by S. pneumoniae |
| types of community acquired pneumonia (2) | typical (acute) and atypical |
| causative organisms (5) | bacteria (gram +/-), viruses, mycoplasma, fungi, and inorganic agents (inhaled dusts or gases) |
| aspiration pneumonia | occurs when gastric contents and oral bacteria are inhaled into the lungs due to abnormal gag/swallow reflexes |
| possible outcomes of pneumonia (6) | resolution, organisation, abscess formation, empyema, bacteremia, and death |
| symptoms of all pneumonia (6) | fever, chills, dyspnoea, cough with purulent sputum, crackles on auscultation, and consolidation in radiograph |
| what is used to diagnosis pneumonia (3) | sputum is tested (cultured and gram stained to show gram +/-, shape), xray shows symptoms, FBC test to count WBC |
| treatment for all pneumonia | antibiotics |
| difference between bronchial and vesicular (normal) breathing | vesicular is heard over whole lung where inhalation is longer than exhalation but bronchial is only over trachea where expiration is longer than inhalation |
| describe how TB is a localised lesion | TB acts in a small area and body makes granulomas (granulomatous inflammation) to block it with/without involvement of lymphomatous |
| bacteria causing TB | mycobacterium tuberculosis |
| symptoms of TB (6) | gradual onset of anorexia, weight loss, fever (low grade + remitting), night sweats, chest pain, and prolonged coughing with sputum production |
| diagnosis of TB | sputum analysis and chest x ray |
| sputum analysis of TB shows (3) | slender rods (aerobes), a lot of complex lipids (identified by acid fast stains), and cultures (to check drug susceptibility) |
| pathogenesis of TB in first 3 weeks | macrophages engulf inhaled mycobacteria but TB manipulates endosomes (pH and maturation) so phagosome cannot fuse with lysosomes to kill TB so TB survives multiplies inside macrophages |
| Ghon focus in TB | subpleural caseous granuloma (body's attempt to block off bacteria) |
| Ghon complex in TB | ghon focus + lymph node |
| primary TB (exogenous) | ghon focus + ghon complex formed as a fibrous encapsulation to block off infection making TB latent (dormant) but TB survives well leading to hypersensitivity of host (tissue damage) with patients having little/no symptoms |
| secondary TB (reactivated) | occurs if patient is weak/ immunocompromised where TB is reactivated meaning caseating tubercle enlarges and erodes into bronchial wall/ vessels leading to live microbes in sputum |
| re-exposure of TB spreads through which vessel (systemic dissemination) | pulmonary vein |
| cavitation | caseating tubercle (lesion) erodes into lung vasculature |
| obstructive diseases of airway + gas exchange (5) | asthma, chronic bronchitis, emphysema, bronchiectasis, and cystic fibrosis |
| restrictive diseases of airway + gas exchange (4) | ARDS, pulmonary fibroses, pneumoconioses (asbestosis/ silicosis), and granulomatous disease (sarcoidosis) |
| pulmonary infections (2) | pneumonia and TB |
| upper airway diseases (2) | nasopharyngeal carcinoma and laryngeal tumours |
| vascular diseases (4) | pulmonary hypertension, pulmonary embolism, haemorrhage, and infarction |
| neoplasm (abnormal cell growth) disease | lung cancer |
| pleural disease (3) | pleurisy, pneumothorax, and cancer |
| atelectasis | collapse of one or more lobes of lung |
| organisation | exudate is converted into fibromyxoid masses by macrophages and fibroblasts |
| what can cause reflexes protecting airways to fail leading to aspiration pneumonia | stroke, unconsciousness, repeated vomiting, and underlying disease (MS) |
| what happens in aspiration pneumonia | often necrotising leading to death but survivors form abscess |
| abscess | full of pus |
| pathogenesis of TB after 3 weeks | cell mediated response occurs where macrophages drain into lymph nodes and present antigens to T cells. T cells become TH1 which release INF-Y and these activate macrophages |
| granulomas | cluster of immune cells |
| secondary TB in bronchial wall causes | tuberculous bronchopneumonia (in lower lobes and rapidly progresses into whole lung - galloping consumption) |
| secondary TB in vessel causes | miliary or isolated organ TB |
| what causes miliary TB in lungs | TB spread back towards lungs via pulmonary artery via lymphatic drainage into right side of heart |
| effect of miliary TB in organs | grow and merge (coalesce) and destroy large areas of affected organs eg liver/kidney |
| isolated organ (metastatic) TB | few TB bacteria invade bloodstream and reach specific organ (eg brain,/ kidney) where the body either contains them or they remain latent for years |
| dysphagia | problem swallowing |
Created by:
kablooey
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