Pulmonary 4: Pulmonary Pathology I

Atelectasis

Collapse of lung

Resorption

Compression

Contraction

Three patterns of atelectasis

Resorption

Due to obstruction in airway

Compression

Due to fluid, blood, or air accumulation in pleural cavity

Resorption and compression

What types of atelectasis are potentially reversible?

Contraction

Due to scarring causing contraction of parenchyma

Contraction

What is the only irreversible pattern of atelectasis?

Pulmonary edema

Results from increased fluid in alveolar wall, usually from left heart failure

"Heart Failure Cells"

Macrophages within alveolar spaces that have phagocytosed Hb

Increased work and right heart failure (cor pulmonale)

What does pulmonary hypertension result in?

50,000-100,000

May be virtually instantaneous

How many deaths per year are attributed to pulmonary emboli?

Venous stasis

Pulmonary emboli are typically seen with ______ ______.

False; rarely

T/F: Pulmonary emboli are normally due to other material.

Pulmonary vasculitis

Granulomatosis with polyangiitis (formerly Wegener granulomatosis)

Strawberry gingivitis

What is a key dental finding of pulmonary vasculitis?

LV failure

What is pulmonary edema most commonly caused by?

Right sided heart failure

Pulmonary hypertension is caused by...

Deep leg; 5% may cause sudden death, cor pulmonale, or shock

PEs most commonly develop from ____ ___ veins.

Granulomatosis with polyangiitis

What is associated with strawberry gingivitis?

Obstructive lung diseases

Emphysema

Bronchitis

Asthma

Bronchiectasis

Emphysema

Abnormal enlargement of airspaces distal to terminal bronchioles

Alveolar walls

There is destruction of what in emphysema?

True

T/F: Emphysema has absence of scarring.

Cigarettes

Emphysema is strongly associated with __________.

Centriacinar (centrilobular)

Panacinar (panlobular)

What are the main patterns of emphysema?

Centriacinar

Most common clinically significant pattern of emphysema

Centriacinar emphysema

Most commonly associated with smoking, but NOT associated with alpha-1 antitrypsin deficiency

Panacinar emphysema

Associated with alpha-1 antitrypsin deficiency

Irregular

Most common emphysema pattern, though usually asymptomatic

Insufficient wound repair

Exposure to toxins induces chronic inflammation

What does emphysema result from?

Proteases and protease inhibitors

In emphysema, there is an imbalance between...

Chronic bronchitis

Clinical diagnosis based on persistent cough for at least 3 consecutive months in 2 consecutive years

Cigarette smoking

What is chronic bronchitis clearly linked to?

Hypersecretion of mucus

Chronic bronchitis airway obstruction is due to...

Asthma

Intermittent and reversible airway obstruction with chronic bronchial inflammation, bronchial smooth muscle hypertrophy, and increased mucus secretion

Charcot-Leyden

Asthma involves eosinophilic infiltrate with ________ ______ crystals.

Atopic asthma

Type I hypersensitivity response

Bronchiectasis

Dilation of bronchi and bronchioles

Necrotizing pneumonia

What is a key predisposing condition to bronchiectasis?

FVC reduced

Expiratory flow rate reduced proportionately

Normal FEV:FVC ratio

In restrictive pulmonary disease, what is reduced vs. normal?

Restrictive pulmonary diseases

Chest wall disorders with normal lungs (obesity, disease of pleura, NMJ)

Interstitial lung diseases

Fibrosing

Granulomatous

Categories of chronic interstitial lung disease (restrictive)

Pneumoconioses

Lung reaction to inhalation of organic or inorganic particles

Coal dust, silica, asbestos

Most common mineral duct pneumoconioses are due to...

Asbestos

Tobacco smoking worsens effects of all inhaled mineral ducts, especially ________.

Silicosis

Most prevalent chronic disease worldwide

Increases susceptibility to TB

Carcinogenesis

Complications of silicosis

Interstitial fibrosis

Lung carcinoma

Mesothelioma

Laryngeal carcinoma

Asbestos is linked to multiple diseases:

True

T/F: There is an increased cancer risk in family of someone exposed to asbestos.

Sarcoidosis

Idiopathic multisystem disorder with bilateral hilar lymphadenopathy

Noncaseating

Sarcoidosis has ____________ granulomas.

Reduced to 40%

Mortality of acute respiratory distress syndrome