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Flashcards in Histo: Respiratory Disease Deck (97)
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List some examples of airway diseases.

  • Asthma
  • COPD-chronic bronchitis
  • Bronchiectasis
  • Infections


List some examples of Parenchymal disease.

  • Pulmonary oedema and diffuse alveolar damage (includes Acute respiratory distress syndrome and HMD)
  • Infections
  • COPD-Emphysema
  • Granulomatous diseases
  • Fibrosing interstitial lung disease and occupational lung disease


What is lung agenesis or hypoplasia?

  • Low weight underdeveloped lungs
  • Impaired fetal respiratory movements (movement is important in lung development)


List some examples of congenital lung disease.

  • Lung agenesis or hypoplasia
  • Tracheal & bronchial stenosis
  • Congenital cysts


Define asthma.

A condition in which breathing is periodically rendered difficult by widespread narrowing of the airways that changes in severity over short periods of time.

NOTE: Prevalence increased in recent decades


What is the typical presentation of asthma?

  • Presents with wheezing, acute SOB
  • In a severe attack patients develop status asthmaticus


List some causes and associations of Asthma.

  • Allergens and atopy (house dust mites)
  • Pollution
  • Drugs - NSAIDs
  • Occupational - inhaled gases/fumes
  • Diet
  • Physical exertion - "cold"
  • Intrinsic
  • Underlying genetic factors


Describe the pathogenesis of asthma.

  1. Sensitisation to allergen
  2. Immediate phase:
    • Mast cells degranulate on contact with antigen
    • Mediators released cause vascular permeability, eosinophil and mast cell recruitment and bronchospasm
  3. Late phase:
    • Tissue damage
    • Increased mucus production
    • Mucus hypertrophy


What are the macroscopic features of asthma?

  • Mucus plug
  • Overinflated lung


List the histological feeatures of asthma.

  • Hyperaemia
  • Eosinophilic inflammation and goblet cell hyperplasia - mucus
  • Hypertrophic constricted muscle
  • Mucus plugging and inflammation


Define COPD.

  • Chronic cough productive of sputum
  • Most days for at least 3 months over at least 2 consecutive years


Describe the pathophysiology of COPD.

Chronic injury to airways elicits local inflammation and reactive changes which predispose to further damage.


What are some common causes of COPD?

  • Smoking
  • Air pollution
  • Occupational exposures


List some histological features of COPD.

  • Dilatation of airways
  • Hypertrophy mucous glands - Reid Index
  • Goblet cell hyperplasia


What are some complications of chronic bronchitis?

  • Repeated infections (most common cause of hospital admission and death)
  • Chronic hypoxia and reduced exercise tolerance
  • Chronic hypoxia results in pulmonary hypertension and right sided heart failure (cor pulmonale)
  • Increased risk of lung cancer independent of smoking


Define Bronchiectasis.

Permanent abnormal dilatation of bronchi


What are common causes of bronchiectasis?

  • Congenital
  • Inflammatory
    • Post-infectious (especially children or cystic fibrosis)
    • Ciliary dyskinease 1° (Kartagener's) and 2°
    • Obstruction (extrinsic/intrinsic/middle lob syn.)
    • Post-inflammatory (aspiration)
    • Secondary to bronchiolar disease (OB) and interstitial fibrosis (CFA, sarcoidosis)
    • Systemic disease (connective tissue disorders)
    • Asthma


List some complications of bronchiectasis.

  • Recurrent infections
  • Haemoptysis
  • Pulmonary hypertension and right sided HF
  • Amyloidosis


Describe the inheritance pattern of Cystic Fibrosis.

  • Autosomal recessive (approx 1/20 of population are heterozygous carriers)
  • Affects 1 in 2,500 live births


Mutation in which gene causes Cystic Fibrosis?

  • Chr 7q3 = CFTR gene (Cystic Fibrosis Transmembrane Conductance Regulator) = ion transporter protein
  • Abnormality leads to defective ion transport and therefore excessive resorption of water from secretions of exocrine glands
  • Results in abnormally thick mucus secretion - affects all organ systems


How does CF affect various organs?

  • Lung: airway obstruction, respiratory failure, recurrent infection
  • GI tract: meconium ileus, malabsorption
  • Pancreas: pancreatitis, secondary malabsorption
  • Liver: cirrhosis
  • Male reproductive system: infertility


What is the management of cystic fibrosis?

  • Improved treatment (physio, antibiotics, enzyme supplements, parenteral nutrition) has led to survival often into fourth decade
  • Lung transplantation offers longer survival


What are the main consequences of CF?

  • Over 90% of patients have lung involvement: patter of bronchiectasis
  • Recurrent infections (S. aureus, H. influenzae, P. aeruginosa, B. cepacia)
  • Other complications:
    • Haemoptysis
    • Pneumothorax
    • Chronic respiratory failure and cor pulmonale
    • Allergic bronchopulmonary aspergillosis (ABPA)
    • Lung collapse
    • Small airway disease


Define pulmonay oedema.

Accumulation of fluid in alveolar spaces as consequence of 'leaky capillaries' or 'backpressure' from failing left ventricle.


What are the main causes of pulmonary oedema?

  • Left heart failure
  • Alveolar injury
  • Neurogenic
  • High altitude


Describe the pathology of pulmonary oedema.

  • Heavy watery lungs, intra-alveolar fluid on histology
  • Poor gas exchange therefore hypoxia and respiratory failure


List some causes of acute respiratory distress syndrome in adults.

  • Infection
  • Aspiration
  • Trauma
  • Inhaled irritant gases
  • Shock
  • DIC


What causes hyaline membrane disease in newborns?

Lack of surfactant (mainly in premature babies)


On a cellular level, what insult results in ARDS?

  • Acute damage to the endothelium and/or alveolar epithelium
  • The basic pathology is the same regardless of cause: diffuse alveolar damage


Describe the appearance of the lungs on post-mortem examination in a patient who died from ARDS.

  • Plum-coloured
  • Heavy
  • Airless