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Anatomic Pathology > Atelectasis, ARDS, Pulmonary edema > Flashcards

Atelectasis, ARDS, Pulmonary edema Flashcards

1
Q

In relation to Neonates, what is Atelectasis ?

A

Neonatal Atelectasis an incomplete explanation of the lungs

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2
Q

Acquired Atelectasis is defined as?

A

A collapse of previously inflated lungs, resulting in areas of relatively airless pulmonary parenchyma.

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3
Q

Acquired atelectasis occurs commonly in ?

A

Adults

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4
Q

List the different types of acquired atelectasis ?

A
  • Resorption or obstruction Atelectasis
  • Compression Atelectasis
  • Contraction Atelectasis
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5
Q

In 6 steps, what’s occurs in resorption atelectasis?

A
  • This occurs from complete obstruction of an airway
  • Overtime, Air (oxygen) trapped in dependent alveoli (distal alveoli) is resorbed.
  • resorption occurs without impairment of blood flow through the affected alveoli walls
  • Because the lung volume is diminished, the mediastinum shifts TOWARDS the atelectatic lungs
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6
Q

Causes of resorption atelectasis

A
  1. Excessive secretions (Mucus plugs)
  2. Exudates within smaller bronchi. This is seen in conditions like?
    - Bronchial Asthma
    - Chronic Bronchitis
    - Bronchiectasis
    - Postoperative states
    - Foreign body aspiration
    - Bronchial neoplasms (intrabrochiaL-tumors)
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7
Q

Compression atelectasis ?

A

This results from the accumulation of a significant volume of
- Fluid( exudate, Transudafe)
- Air (Pneumothorax, Tension pneumothorax)
- Blood
- Tumor
Accumulate in the pleural cavity

Mediastinum shifts away from the affected lung

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8
Q

Contraction atelectasis ?

A
  • This occurs when focal or generalized pulmonary or pleural fibrosis prevent full lung expansion
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9
Q

Atelectasis is a reversible disorder except in?

A

Contraction Atelectasis

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10
Q

Significant atelectasis complications?

A
  • Leads to reduced oxygenation
  • Predisposes to infection
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11
Q

Pulmonary edema Definition?

A

Pulmonary Edema is defined as an abnormal increase in the interstitial fluid within lung parenchyma

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12
Q

Etiology of pulmonary Edema can be classified into?

A
  • hemodynamic disorders
  • Microvascular injury
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13
Q

Hemodynamic pulmonary edema is further classified into?

A

1) increased hydrostatic pressure - increased pulmonary Venous pressure
2) Decreased oncotic pressure
3) lymphatic obstruction (rare)

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14
Q

Causes of increased hydrostatic pressure includes?

A
  • Left sided heart failure
  • volume overload
  • pulmonary vein obstruction
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15
Q

Causes of decreased oncotic pressure ?

A
  • Hypoalbuminemia
  • nephrotic syndrome
  • liver diease
  • protein losing Enteropathies (PLE)
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16
Q

Classification of edema due to microvascular injury (alveolar injury)

A

Primary injury to the vascular endothelium
- infection; pneumonia, septicemia
- inhaled gases; oxygen, smoke
- liquid aspiration; gastric contents, near drowning
- Radiation
- Lung trauma
Indirect injury
- systemic inflammatory response syndrome (Sepsis, extensive trauma, burns, pancreatitis)
- Blood transfusion related
- Drugs and chemicals; chemotherapeutic agents (bleomycin), amphotericin B, heroine, cocaine, Paraquat, kerosine

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17
Q

What can cause Edema of undetermined origin?

A
  • Neurogenic edema- CNS trauma
  • High altitude
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18
Q

The commonest hemodynamic cause of pulmonary edema is ?

A

Increased hydrostatic pressure (as seen in left-sided heart failure )

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19
Q

Gross description of pulmonary edema

A

Clinically there’s pulmonary congestion and edema is evident by
- wet lungs
- Heavy lungs

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20
Q

What’s dependent edema ?

A

Edema accumulates initially in the basal regions of the lower lobes because hydrostatic pressure is greatest in these sites.

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21
Q

Histological features of pulmonary edema?

A
  1. Engorgement of the alveolar capillaries
  2. The presence of finely granular pale pink precipitate in the intra-alveolar space
  3. Presence of alveolar microhemorrhages
  4. Presence of hemosiderin-laiden macrophages (heart failure cells)
22
Q

Histological features of long standing pulmonary congestion ?

A

As seen in mitral stenosis
1) Abundant hemosiderin-Laiden macrophages
2) fibrosis and thickening of the alveoli walls
3) soggy lungs become firm with brown induration

23
Q

Edema in microvascular injury occurs as a result of?

A

1) Primary injury to vascular endothelium
2) Damage to alveolar epithelial cells
- Results in fluids and protein leakage into the interstitial space and then into the alveoli

24
Q

Injury-related alveolar edema is an important feature of which condition ?

A

Acute respiratory distress syndrome (ARDS)

25
Q

What’s the underlying pathology in Acute lung injury and ARDS

A

Pulmonary inflammation with epithelial and endothelial cell injury

26
Q

Definition of Acute Lung injury ?

A

Characterized by an abrupt onset of significant hypoxemia and diffuse pulmonary infiltrates in the absence of cardiac failure

Bilateral pulmonary edema (non-Cardiogenic pulmonary edema)

27
Q

ARDS is defined as?

A

This is a manifestation of severe Acute lung injury.

28
Q

Histological manifestation of ALI and ADRS?

A

Diffuse alveolar Damage

29
Q

Acute interstitial pneumonia is defined as ?

A

Acute lung injury occurring in the absence of any trigger, or any etiology

30
Q

Etiology of ALI?

A

Complication from direct lung injuries or systemic disorder

1) Infections;
2) Physical injury
3) inhaled irritants
4) chemical injury
5) hematological conditions
6) uremia
7) pancreatitis
8) hypersensitivity reactions (organic solvents and drugs)

31
Q

Examples of infections cause ALI?

A
  • sepsis
  • Diffuse pulmonary infection
  • viral infection
  • mycoplasma
  • Pneumocystis pneumonia
  • Miliary tuberculosis
  • Gastric aspiration
32
Q

Examples of physical injury causing ALI?

A
  • Head injuries
  • Pulmonary contusions
  • Near drowning
  • Fractures with fat embolism
  • Burns
  • Ionizing radiation
33
Q

Examples of inhaled irritants causing ALI?

A
  • Oxygen toxicity
  • Smoke
  • Irritant gases and chemicals
34
Q

Examples of chemical injury causing ALI?

A
  • Heroin or methadone overdose
  • Acetyl salicylic acid
  • Barbiturate overdose
  • Paraquat
35
Q

examples of Hematological conditions that can cause secretion

A
  • Multiple transfusions
  • Disseminated intravascular coagulation
36
Q

In the pathogenesis of ARDS, what’s is the root cause (pathogenesis )

A

An imbalance between pro-inflammatory and anti-inflammatory conditions

37
Q

Following an acute lung injury? What happens in ADRS?

A
  • Macrophages activate and increase synthesis of IL8, IL1 and TNF
    IL8 - is a potent neutrophil chemotactic.
38
Q

Functions of IL8 and TNF ?

A
  • IL8 causes activation of neutrophils
  • TNF aids activated neutrophils to bind their ligands on activated endothelial cells by up-regulating the expression of adhesion molecules
39
Q

Stiff neutrophils that are trapped in lung capillary bed secret what?

A

Inflammatory substances like
- protease
- Oxidants
- platelet activating factors
- leukotrienes

40
Q

Loss of surfactant causes ?

A

Endothelial and epithelial injury leads to loss of surfactant and inability of the alveoli unit to expand

41
Q

Dysregulation of coagulation system in ARDS ?

A

Yes,
- the protein C and anticoagulant levels are decreased in plasma and Bronchoalveloar lavage fluid
- Tissue factor levels are increased

42
Q

Clinical features of ARDS?

A
  • Increasing Cyanosis
  • Increasing Hypoxemia
  • Profound Dyspenea
  • Profound tachypnea
  • Respiratory acidosis
  • Respiratory failure
43
Q

Gross description of ALI in acute phase?

A

Lungs may be
- Heavy
- Red
- Boggy
- Firm

44
Q

Histological features of ARDS/ ALI?

A
  • interstitial and intra-alveolar edema
  • congestion
  • fibrin deposition
  • Diffuse alveolar damage
  • alveolar walls become lined with waxy hyaline membranes
45
Q

Chronic histological features of ARDS/ALI

A
  • Proliferation of type 2 pneumocytes
  • Granulation tissue seen in the alveolar spaces
  • Fibrotic thickening of the alveolar septa and walls due to interstitial cells proliferation and collagen deposit
46
Q

Summarized pathogens is of ALI, ARDS

A
  • Endothelial activation
  • Adhesion and extravasation of neutrophils.
  • Accumulation of intra-alveolar fluid and formation of hyaline membranes
  • Resolution of injury

Damage to endothelial and alveolar epithelial cells and secondary inflammation are the key initiating events and the basis of lung damage.

47
Q

Radiological findings in ARDS?

A

Diffuse bilateral Lung infiltrate

48
Q

Treatment of ARDS

A
  • Treat the underlying cause - sepsi etc
  • Mechanical ventilation
  • Supportive care
49
Q

Investigations to be carried out for this patient?

A

Sepsis work up
FBC
E/U/Cr

50
Q

Complications of ARDS?

A
  • Bronchopneumonia
  • Sepsis
  • Multi organ failure
  • Diffuse alveolar damage

Anatomic Pathology (12 decks)

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