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Pulmonology > Lecture 13: Pathology of Airway Disease > Flashcards

Lecture 13: Pathology of Airway Disease Flashcards

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1
Q

Asthma: definition

A

Episodic condition of airflow obstruction characterized by REVERSIBLE airway narrowing

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2
Q

Three types asthma

A

Extrinsic (Type 1 hypersensitivity); intrinsic (nonimmune: aspirin/cold/exercise); status asthmaticus (unremitting due to previously sensitized antigens)

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3
Q

Which asthma can be deadly?

A

Status asthmaticus

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4
Q

Asthma: gross (3)

A

Overdistended lungs, small areas of atelectasis, thick mucus plugs in proximal bronchi

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5
Q

Asthma: microscopic (6)

A

Mucus plugging, EOSINOPHILIC inflammation, increased mucosal goblet cells, THICKENED BASEMENT MEMBRANE, bronchial SM hypertrophy, airway wall edema

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6
Q

Do you see enlarged submucosal glands in asthma?

A

Somewhat

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7
Q

When you think asthma, what should you think is filling the airways?

A

MUCUS

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8
Q

COPD: diagnosis

A

History (chronic bronchitis), physical exam, gross pathology, PFTs + DLCO, ABG

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9
Q

DLCO is ________ in COPD and ________ in chronic bronchitis

A

Reduced; normal

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10
Q

Emphysema: definition

A

Permanent enlargement of the airspace distal to the terminal bronchiole due to destruction

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11
Q

Three kinds of emphysema

A

Centriacinar (smoking, 95%), panacinar, paraseptal

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12
Q

Which kinds of emphysema cause clinically significant airflow obstruction?

A

Centriacinar and panacinar

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13
Q

Centriacinar: define

A

Central/proximal parts of acini are affected, whereas distal alveoli are spared that typically involves upper lobes (smoke floats upward)

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14
Q

Centriacinar is often associated with…why?

A

Chronic bronchitis; smokers/coal miners

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15
Q

Panacinar: define

A

Acini are uniformly enlarged associated with alpha-1 antitrypsin deficiency

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16
Q

Paraspetal: define

A

Proximal portion of acinus is normal, but distal is involved (adjacent to pleura), can result in spontaneous pneumothorax

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17
Q

Alpha-1 antritrypsin deficiency: what does AAT do and where is it from?

A

AAT of liver provides 90% of elastase inhibition in plasma

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18
Q

Alpha-1 antritrypsin deficiency: normal allele and bad allele

A

“M” vs “Z”

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19
Q

Alpha-1 antritrypsin deficiency: presentation

A

Young emphysema and cirrhosis

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20
Q

How does AAT work?

A

Inhibits proteases (elastase) secreted by neutrophils –> if AAT is not there, you end up with too much elastase, which destroys lung tissue

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21
Q

How does smoking work?

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A

You end with a functional AAT deficiency because free radicals, etc, inactivate antiproteases (like AAT) –> increase in neutrophil elastase –> tissue damage

22
Q

How much lung is lost before you get symptoms?

23
Q

Bullos emphysema: define

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A

Any form of emphysema that forms very large air spaces (>2 cm) right under the pleura

24
Q

What can bullos emphysema cause?

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A

Pneumothorax and hemorrhage

25
Is chronic bronchitis more common in smokers? Pathology?
Yes (4-10x), tobacco interferes with ciliary action --> directly damages airway epithelium, inhibits WBC ability to clear bacteria, infections maintain the bronchitis
26
Chronic bronchitis: gross
Boggy mucosa with excessive mucinous secretions and pus (if infection)
27
Chronic bronchitis: histologically (early and late)
Early: hypersecretion of mucus in large airways w/ hypertrophy of submucosal glands; later: increase in goblet cells in small airways cause excessive mucus production and airway obstruction
28
At what stage in chronic bronchitis do you see an increased Reid index? What is the Reid index?
Later stages; ratio of thickness of mucus gland layer to wall b/t epithelium and cartilage
29
Does chronic bronchitis have eosinophil infiltrate?
Nope: more neutrophil and lymphocyte
30
Normal Reid index
0.4
31
Bronchiectasis: definition
IRREVERSIBLE dilatation of proximal bronchi due to destruction of bronchial wall
32
Two types of bronchiectasis
Localized (obstructive process) or diffuse (non-obstructive)
33
Bronchiectasis is not a disease itself, but a...
Pulmonary manifestation of some other disorder
34
Obstructive cause of localized bronchiectasis
Tumor, foreign body, inspissated mucus
35
Congenital cause of diffuse bronchiectasis
CF, immunodeficiency states, immotile cilia: Kartegeners syndrome
36
Infectious causes of bronchiectasis
Severe necrotizing pneumonia (staph, TB)
37
Pathogenesis of bronchiectasis: 3 main points
1. Impaired clearance --> 2. Inflammation --> 3. PMNs and their cell products
38
Bronchiectasis: gross
Dilated, tortuous airways extending to pleura with mucus
39
Why is bronchiectasis obstructive?
Collapse of dilated airways on expiration
40
Why can bronchiectasis cause hemorrhage?
Airways pairs with pulmonary artery, can be eroded into
41
Bronchiolitis: definition
Inflammatory response to injury of small airways +/- fibrosis in a diffuse or nodular fashion
42
What is a small airway and epithelium
Internal diameter of less than 2 mm devoid of cartilage; simple columnar cells +/- cilia with little connective tissue, resting on SM cells
43
Function of small airways
Don't contribute much but can harm lung function if damaged
44
Etiology of small airway disease
Primary: constrictive bronchiolitis; secondary: lots of other airway disease
45
Histological appearance of small airway disease
One restricted airway (for example, fibrotic) with nearby dilated airway and adjacent airspaces filled with foamy macrophages
46
Form of bronchiolitis that is more problematic. Two types?
Fibrotic; constrictive and intralumenal
47
Describe constrictive bronchiolitis
Primary disease of small airways; subepithelial collagen deposition (increased CT b/t epithelium and SM layers)
48
What do you see constrictive bronchiolitis with (main association)?
Chronic transplant rejection (abnormal healing response)
49
Late in the stage of constrictive bronchiolitis, what can you see histologically?
Airway lumen completely filled with scar due to OUTSIDE --> INSIDE CONSTRICTION
50
Describe intraluminal bronchiolitis (obliterans)
Organization of luminal inflammatory exudates; polypoid plugs of fibroblastic tissue; FILLING COMES FROM INSIDE --> OUTSIDE
51
What is intraluminal bronchiolitis associated with? What is it rarely?
Alveolar organizing pneumonia; rarely an isolated disease

Pulmonology (21 decks)

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