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Flashcards in Lec 13 Deck (37):
1

What is definition of asthma?

episodic obstruction characterized by reversible airway narrowing

2

What is pathogenesis of asthma?

- development allergic phenotype in susceptibl individual characterized by TH2 lymphocyte IL 4/5/9/13 which orchestrate inflammatory response

3

What are major effects cells of asthma?

eosinophils

4

What is extrinsic asthma?

due to type 1 hypersensitivity
either atopic [allergic] or occupational

5

What is intrinsic asthma?

due to non-immune cause

aspirin ingestion, pneumonia, cold, stress, exercis

6

What is status asthmaticus?

unremitting attacks due to exposure to previously sensitized antigen

7

What do you see grossly in asthma?

- overdistended lungs
- thick mucus plugs in proximal bronchi

8

What do you on microscopy in asthma?

inflammation --> EOSINOPHILS
thickened basement membrane!!

also:
- mucus plugging
- increased goblet cells
- bronchial smooth muscle hypertrophy

9

How do you diagnose asthma?

PFTs including methacholine provocation + bronchodilator response

10

What is DLCO in emphysema? in pure chronic bronchitis?

emphysema = low DLCO
pure chronic bronchitis = normal

11

What is emphysema?

- permanent enlargement of airpsoaces distal to terminal bronchole and destruction of their walls

results in diminished expiratory drive and loss of tethering of small airways

12

What is centriacinar emphysema?

- central/proximal parts of acini affected; distal spared
- both emphysematous = normal airspaces exist within same acinus / lobule

usually upper lobe, heavy smokers

13

What is panacinar emphysema?

enlarges uniformly acini from level of respiratory bronchiole to terminal bronchiole

pan = entire acinus but not entire lung

14

What is paraseptal emphysema?

proximal portion of acinus is normal but distal involved

emphysema more striking adjacent to pleura

more severe in upper half of lungs

can cause spontaneous pneumothorax in young adult

15

What type of emphysema can cause spontaneous pneumothorax in young adult?

paraseptal

16

What are 2 subtypes of centriacinar emphysema?

- smoking related
- mineral dust [coal] associated

17

What is clinical of alpha 1 antitrypsin deficiency?

- early onset emphysema [< 45 yo]
- unexplained liver disease + possible cirrhosis

18

What is bullous emphysema?

any form that produces blebs/bulla = airspaces > 2cm

often subpleural near apex

can rupture --> pneumothorax, hemorrhage

19

What is chronic bronchitis?

hypersecretory process = non-specific pathologic changes

changes in mucus glands and too much mucus secretion in airways

have more infections, purulent sputum, hypercapnia, hypoxia than emphysema

20

How does tobacco lead to chronic bronchitis?

tobacco interferes with ciliary action
directly damages airway epitheilum and inhibits ability of WBCs to clear bacteria

21

What is microscopic morphology of early + later chronic bronchitis?

early: hyper-secretion of mucus in large airways; hypertrophy of submucosal glands

later: increase goblet cells in small airways; excess mucus production + airway obstruction; increased Reid index

22

What is definition of bronchiectasis?

pathologic irreversible dilatation of one or more proximal bronchi due to destruction of support structures of bronchial wall

can be localized but usually diffuse

23

What causes localized bronchiectasis/

obstruction due to tumor, foreign body, mucus

24

What causes diffuse bronchiectasis?

CF, immunodeficiency, kartageners
necrotizing pneumonia [staph or TB]

25

What is pathogenesis of bronchiectasis?

- inflammation
- PMNS/cell products overwhelm the bronchial wall
- impaired clearance mechs

26

What do you see on gross pathology in bronchiectasis?

- dilated tortuous easily collapsible airways often extending to visceral pleural surface

27

How does bronchiectasis cause obstruction?

- collapse of dilated airways with expiration = floppy
- poor air movement --> air just spins around not in and out
- excess secretions

28

What do you see in bronchiectasis on histology?

fibrosis, inflammation, loss of cartilage
increased vascularity

29

What is bronchiolitis?

inflammatory response to injury of small airways
can have inflammation/fibrosis in diffuse or nodular fashion

30

What kind of cells in small ariways?

simple columnar [ciliated and non-ciliated]
few neuroendocrine cells

31

What diseases can small airway disease be associated wtih?

- bronchiectsasis
- asthma
- COPD
- hypersensitivity pneumonitis

32

What do you see in small airway disease?

adjacent lung have have foamy macrophage accumulation + dilation of adajcent bornchioles

33

What things cause acute small airway disease?

infection, fume exposure, aspiration, wegener's

34

What thigns cause chronic small airway disease?

bronchiectasis, collagen vascular disease, IBD, aspiration

35

What is constrictive vs intralumenal bronchiolitis?

constrictive = in wall itself
intralumenal = within lumen

36

WHat is constrictive bronchiolitis?

subepithelial collagen deposits --> airway narrowing + constriction

secondary to chronic airway damage with abnormal healing response

see w/ chronic transplant rejection

37

WHat is bronchiolitis obliterans?

organization of luminal inflammatory exudates
polpoid plugs of fibroelastic tissue
rare as an isolated disease
more often associated with alveolar organizing pneumonia