ICL 3.6: Pathology of Pulmonary Vascular Diseases Flashcards Preview

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Flashcards in ICL 3.6: Pathology of Pulmonary Vascular Diseases Deck (68)
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1

eosinophilia in the context of pulmonary diseases

1. asthma

2. sarcoidosis

3. Churg-Strauss

2

hypertrophy of smooth muscles

asthma

bronchi are constricted

3

blue bloated

chronic bronchitis

cyanosis around the mouth and nails

4

spontaneous pneumothorax

paraseptal emphysema

usually in young males who develop sudden sharp chest pain

5

cirrosis and emphysema in young patient

alpha-one antitrypsin deficiency with PZZ phenotype

panacinar emphysema

6

insulation industry

asbestos

can cause pulmonary fibrosis, cancer, pleural plugs, mesothelioma etc.

7

sand balsting

silicosis

8

egg shell calcification in the mediastinum

silicosis

9

pleural plug

asbestos

10

Caplan syndrome

RA and any pneumoconosis

11

serositis

associated with SLE

inflammation of a serous membrane

12

alveolitis

****it's the pathogenesis of restrictive lung disease

13

smoking

1. chronic bronchitis

2. emphysema

14

constipation and hypercalcemia

sarcoidosis

15

paniculitis in the legs/inflammation of subcutaneous fat

erythema nodosum

sarcoidosis

16

infertility

Kartageners

17

65 year old male smoker with a known history of hypertension and hyperlipidemia presents to the ER with severe shortness of breath and productive cough with frothy sputum PE reveals bilateral basal crackles in the lungs.

Tests: His BNP is 500

diagnosis?
pathogenesis?

pulmonary edema due to CHF!!

frothy sputum = water + air together = water and air in the alveoli!

crackles = alveoli

risk factors = HTN, hyperlipidemia, smoker

18

what are some of the things that can cause pulmonary edema?

1. increased hydrostatic pressure

2. decreased oncotic pressure

3. lymphatic obstruction

4. microvascular injury

5. undetermined origin

19

what can cause pulmonary edema due to increased hydrostatic pressure?

1. increased pulmonary venous pressure like in CHF*

2. volume overload

3. pulmonary vein obstruction

20

what can cause pulmonary edema due to decreased oncotic pressure?

1. hypoalbuminemia

2. nephrotic syndome*

3. liver disease

4. protein losing enteropathies

21

what can cause pulmonary edema due to microvascular injury?

1. infections: pneumonia, septicemia*

2. inhaled gases: oxygen, smoke

3. liquid aspiration: gastric contents, near-drowning

4. drugs and chemicals: chemotherapeutic agents (bleomycin), other medications (amphotericin B), heroin, kerosene, paraquat

5. shock, trauma*

6. transfusion related (TRALI)*

22

why are we worried about pulmonary edema due to microvascular injury?

this is what causes ARDS!!!

there is leakage of fibrin from the capillaries due to the damage which cements the walls of the alveoli so that they can't diffuse gas and they become really hypoxic and giving oxygen doesn't even help

23

what can cause pulmonary edema due to undetermined origin?

1. high altitude

2. neurogenic (CNS trauma)

24

what are the gross changes seen in pulmonary edema?

1. heavy, wet lungs and frothy blood tinged fluid

2. fluid accumulates in the lower lobes where hydrostatic pressure is greater

changes lead to impaired function (interstitial edema) and predisposes one to infections (intra-alveolar edema)

25

what are the microscopic changes seen in pulmonary edema?

1. intra-alveolar granular pink (eosinophilic) precipitate

2. alveolar microhemorrhages and hemosiderin-laden macrophages (“heart-failure cells”) present in chronic cases

with long-standing chronic passive congestion (e.g. mitral stenosis), lungs become visibly brown and firm due to numerous hemosiderin-laden macrophages and interstitial fibrosis which is termed “brown induration”***

26

This thirty-four year old white male collapsed suddenly while waiting for his baggage at the airport after arriving from a business trip to Tokyo on a non-stop, private charter flight. CPR was begun at the airport and continued until his arrival at the ER. At that time, he was found to have electromechanical dissociation and, in spite of all efforts, he could not be resuscitated.

His family history was positive for early death from heart disease, and he had been warned about his elevated cholesterol. He had sustained a recent fracture to his right tibia while skiing, and his right lower leg was in a walking cast.

diagnosis?

pulmonary embolism

was on the plane not moving for a super long time

electromechanical dissociation = pulsus paradoxicus associated with cardiac tamponade

recent fracture to tibia = immobilization

27

what is a pulmonary embolism?

blood clots that occlude the large pulmonary artieres

most common cause is DVTs in the legs

28

what are the predisposing factors for developing a PE?

Virchow's triad:
1. immobilization

2. hypercoagulable states

- factor V bleeder

- contraceptive pills (especially estrogen)

- SLE

3. endothelial injury

29

what are the consequences of having a PE?

depends on the size of the embolus

large emboli may occlude main pulmonary artery, major branches or lodge at the bifurcation --> if it's at the bifurcation it's called a saddle embolus and this is what kills people most often

if it's small the emboli may travel to more peripheral vessels and may or may not cause infarction

30

what are the outcomes of a PE?

1. most of the time they're clinically silent because they're so small so there is none! one (~60-80% are clinically silent)

2. hemorrhage (~10-15%): tissue viability sustained by collateral blood flow

3. transient chest pain and cough

4. only 10% develop infarction if they have inadequate collateral blood flow; often coexisting heart and lung disease is present

5. acute right heart failure, cardiovascular collapse and sudden death

6. pulmonary hypertension caused by multiple emboli over time; can cause chronic right heart straight and hypertrophy

7. secondary embolus (30% chance)