Lecture 4 - PATHOLOGY Flashcards Preview

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Flashcards in Lecture 4 - PATHOLOGY Deck (33):
1

Where do you find normal mesothelium?

Lines the pleural cavity

2

What do mesothelial cells secrete?

Hylauronic acid - lubricates movement between visceral + parietal pleura

3

What are the 3 types of pleural pathology?

Inflammation

FIbrosis

Neoplasia

4

What are the causes of pleural inflammation?

Primary inflammatory diseases – causes pleura to thicken
o SLE (collagen vascular diseases)
o Rheumatoid arthritis (AI)

• Infections – secondary to pneumonia/ TB

o Viral primary coxsackle B infection (pleural pain)

• Pulmonary infarction – secondary to pulmonary arterial thromboembolus

• Emphysema – secondary to rupture bullae. Localised inflammation

• Neoplasms – primary or secondary pleural neoplasms inflammation of pleura

• Therapeutic pleurodesis (obliteration of pleural cavity by adding talc - causing parietal + visceral pleura to stick together)

• Iatrogenic radiotherapy to thorax/ immune reaction to drugs

5

If the patient has pleural inflammation, what are the symptoms and signs?

Symptoms
Pleuritic chest pain when inhaling

Signs - hear pleural rub.

6

What is Pleural fibrosis

What external substance do you breathe in that can cause pleural fibrosis?

• Scarring
• Secondary to pleural inflammation

Asbestos

7

What are the symptoms of pleural fibrosis?

Breathless, bc fibres prevent lung from expanding + contracting

8

How to treat pleural fibrosis?

Pleural decortication - removing fibrous tissue

9

What are the 2 types of pleural fibrosis plaques?

Parietal pleural plaque

Diffuse pleural plaque

10

What is parietal pleural plaque?

Type of pleural fibrosis

Dense cellular collagen

Caused by low level asbestos

11

What is Diffuse pleural plaque

Type of pleural fibrosis

Dense cellular collagen within the membrane, but not into the intelrobar fissure. Doesn't affect the mediastinum.

Caused by high level asbestos

Bilateral

12

What are the 4 types of fluid you can find in pleural cavities?

Serous fluid – plural effusion
Causes breathlessness – fluid in pleural cavity compresses lungs

Pus empyema - pyothorax
Secondary to pneumonia spreading to pleura pleural cavity

Blood - haemothorax
♣ Caused by trauma (fractured rib)
♣ Bleeds into pleural cavity

Bile - chylothorax
♣ Caused by trauma (thoracic duct damaged)

Gas - Air – pneumothorax

13

What is pleural effusion?

FLuid in pleural cavity?

14

How does transudate fluid get in to plural cavity?

o High vascular hydrostatic pressure - c

o Low cap oncotic pressure Hypoalbuminaemia, Hepatic cirrhosis, nephrotic syndrome

15

How does exudate fluid get into pleural cavity?

Abnormal blood vessels leak proteins

Caused by inflammation +/- infection (i.e. pneumonia damaging capillaries)

16

What are the 2 causes of high vascular hydrostatic pressure?

What are they caused by?

How does this affect the lung?

Caused by left ventricular failure --> PULMONARY OEDEMA

Kidney failure --> FLUID OVERLOAD

Can cause pleural effusion

17

How to diagnose effusion?

• Breathless – effusion compresses lungs

• No pleuritic pain

• Signs - dull percussion, decr breath sounds

• Investigations imaging (ultrasound/ CXR)

18

How to treat an effusion?

What to do if the effusions are recurrent?

• Remove fluid

• If recurrent effusions, consider temp/ permanent pleural drain

• Severe cases pleurodesis obliterate pleural cavity to prevent further effusion

• Treat underlying cause

o Local pleural fluid – look for malignant cells/ inflammation. Do a biopsy
o Systemic

19

What is a pneumothorax?

Air in pleural cavity

20

What are the 2 types of pneumothorax?

Open pneumothorax - caused by chest was perforation

Closed pneumothorax

21

What are the causes of a closed pneumothorax?

• Ruptured emphysematous bullae (air spaces in lung surrounding normal lung tissue)

• Inflamm lung disease asthma/a pneumonia, TB, CF

o Have cystic bullae on lung surface that can rupture

• Iatrogenic

• Trauma

• Cystic lung disease e.g. Langerhan’s cell histiocytosis,

o Cysts rupture

• Pleural endometriosis endometrium breakdown, causing leak to develop between underlying lung + cavity

22

Tension pneumothorax
What does it cause?

Pleural cavity perforates. Air into cavity.

Compresses mediastinal structure
Moves mediastinum.
Pushes trachea to opposite side.

23

Symptoms of tension pneumothorax

Signs of pneumothorax

Symptoms
o Breathless
o Pleurtiic chest pain

Signs
o Cyanosis
o Tachycardia
o Tracheal deviation
o Hyperresonant percussion (like a drum)
o Decr breath sounds because no air going in to lungs

24

Investigating pneumothorax

Treating a pneumothorax

Imaging - CT

Treating - needle inserted into intercostal space 2-5th mid-axillary line

Chest drain tube

Talc

25

What are the 2 types of pleural neoplasms

Primary - benign or malignant.
E.g. malignant mesothelioma

Secondary
Carcinoma, lymphoma, melanoma

26

What is malignant mesothelioma

Neoplasms of mesothelial cells that lines serous cavities

Can affect Pleura, peritoneum, pericardium, tunica vaginalis

Doesn't spread far

27

What causes it?

• Asbestos

• Thoracic irradiation

• BAP1 mutation (associated with BRCA 1)

• Old people

28

What does a early tumour cause?

Pleural effusion

Tumour to difficult to image, so take effusion cytology to i.d. malignant cells

29

What does a late stage tumour cause

How can it cause infection?

Pleural fibrosis

o Obstruction prevents normal clearance of lung
o Pus accumulates
o Infection develops
o Pneumonia

30

What are the 3 types of immunostain?

Cytokeratin 4
o Cytoplasmic stain forms little ring with pale centres

Wilms tumour antigen
o Nuclei stained
o Tumour in children

Calretinin
o Stains cytoplasm + nuclei

31

What pleural diseases caused by asbestos?

pleural effusion

parietal pleural fibrous plaques – low level asbestos exposure

diffuse pleural fibrosis – splits lung, high level exposure

malignant mesothelioma

32

What lung diseases caused by asbestos?

Asbestosis

Lung carcinoma

33

What skin diseases caused by asbestos?

Asbestos corns - benign hyperkeratotic wart-like skin lesion