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Organ Pathology-Disorders of lung airiness PowerPoint Presentation

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Slide 1-

Organ Pathology Respiratory System - I Jaroslava Dušková Inst. Pathol. ,1st Med. Faculty, Charles Univ. Prague Disorders of lung airiness
Slide 2-

Lung Function oxygenation carbon dioxide excretion normal aeration of the lung tissue - conditio sine qua non
Slide 3-

Disorders of Lung Airiness - atelectasis / collaps + emphysema coexistent in many pathology conditions !
Slide 4-

Atelectasis / Collaps Def.: (cz) : A: inadequate expansion C: secondary loss of airiness (irrespective of age) (eng): A: inadequate expansion A: loss of lung volume
Slide 5-

Atelectasis in Children Inadequate expansion: immature lung tissue – insufficient surfactant (S) production Clinical manifestation - RDS Regulation of (S) synthesis: corticoids, thyroxine insuline
Slide 6-

The main events and outcomes in ARDS
Slide 7-

Atelectasis (collaps) in Adults - causes obstruction compression microatelectases contraction chest wall restriction flail chest
Slide 8-

Atelectasis (collaps) in Adults – causes I obstruction – mucopurulent plug (infection, mucoviscidosis), bronchomalacia – bronchiectasis, chronic bronchitis, astma foreign body, neoplasm (pores of Kohn) compression – fluid, air, neoplasms in the pleural cavity microatelectases – loss of surfactant contraction – loss of lung elasticity mostly following fibrosis
Slide 9-

Atelectasis (collaps) in Adults – causes II chest wall restriction (obesity, scoliosis) flail chest (several broken ribs)
Slide 10-

Mucoviscidosis cystic fibrosis, fibrocystic disease autosomal recessive 7th chromosome 2-5% heterozygotic carriers in the caucasian population abnormal viscosity of mucin disturbance of the membrane associated protein that serves as a calcium channel increased concentration of chloride in sweat decreased water content in excocrine secrets
Slide 11-

Mucoviscidosis cystic fibrosis, fibrocystic disease Complications: meconium ileus steatorrhea pancreatic fibrosis & cysts bronchitis, bronchopneumonia, bronchiectasia sterility
Slide 12-

Bronchiectasis Def.: persistent abnormal dilation of the bronchus. Types: cylindrical saccular
Slide 13-

Chronic Obstructive Airways Disease COAD limitation to airflow in the lungs due to: airways resistence increased – narrowing loss of elastic recoil Diseases of COAD type: chronic bronchitis asthma emphysema
Slide 14-

Chronic obstructive pulmonary disease (COPD) Def.: chronic productive cough lasting at least three months during two subsequent years Causes: SMOKING, air pollution
Slide 15-

Chronic Bronchitis Morphology: hyperplasia of mucin producing goblet cells (1GC :7CC 1GC:1CC) epithelial hyperplasia (& dysplasia!) inflammatory infiltrate
Slide 16-

Asthma Def.: a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role, in particular, mast cells, eosinophils, T lymphocytes, macrophages, neutrophils, and epithelial cells.
Slide 17-

Asthma Clinical manifestation: recurrent episodes of wheezing breathlessness chest tightness, coughing at night or in the early morning Prologed attack – status asthmaticus
Slide 18-

Intrinsic abnormal β-adrenergic reaction IgE normal causes: coolness effort infection aspirin… Extrinsic type I hypersensitivity IgE causes: dust pollen animal fur drugs foodsuff…. Asthma - types
Slide 19-

Asthma Morphology: bronchial lumina blocked by viscose mucus and exudate with eosinophils oedema and infiltration of the mucose thickening of the muscle layer and basement membrane Sputum: Charcot-Leyden crystals derived from eosinophils Curshman spirals – glycoproteins Creola bodies
Slide 20-

Start in childhood, evidence of atopy Allergens - household dust, organic dusts, pollens – grasses and trees, animal fur, food products, drugs Reagin – mediated type I hypersensitivity reaction Serum IgE increased, Skin tests against antigens positive Mast cell degranulation – histamin, bradykinin Smooth muscle contraction, hyperemia, edema, eosinophils, mucus retention Leukotrines, prostaglandins – brochoconstriction vasodilatation, incr. permeability. Extrinsic allergic astma
Slide 21-

Start in adult life, no evidence of atopy Hyperactivity of airways is response to nonspecific stimuli e.. Aspirin, cold, exercise….. Constriction of bronchial wall IgE levels normal, skin test normal Associated with nasal polypi and bronchitis Pathogenesis – abnormal β-adrenergic response Intrinsic nonallergic astma
Slide 22-

Emphysema Def.: Increased airiness of the lung tissue Abnormal permanent enlargement of gas exchange airways (?
Slide 23-

Emphysema Types: non destructive (overinflation) destructive centriacinar (smoking, chronic bronchitis…) panacinar (α1- antitrypsin deficiency)
Slide 24-

Smoking & Emphysema numbers of neutrophils & macrophages in smokers elastase activity macrophage elastase not blocked by α1- antitrypsin oxygen free radicals in smoke inhibit α1- antitrypsin
Slide 25-

barrel chest, hypertrophy of intercostal muscles dyspnea, prolonged expiration productive cough (if infected) Emphysema - clinical symptoms
Slide 26-

pneumothorax polycytemia cor pulmonale Emphysema - complications
Slide 27-

Macroscopy cushion- like light pink voluminous pericardium overlapping bullae Emphysema - morphology
Slide 28-

Microscopy alveolar distension centriacinar panacinar thinning and destruction of alveolar septa reduction of capillary bed Emphysema - morphology
Slide 29-

Def.: Entrance of air into the connective tissue of the lung, mediastinum and soft tissue Interstitial emphysema
Slide 30-

Pathogenesis: spontaneously increased intraalveolar pressue (cough, violent vomiting) iatrogenous - in patiens on respirator traumatic - lung trauma – fractured ribs Interstitial emphysema
Slide 31-

Symptoms swelling of the neck and head crackling crepitation Interstitial emphysema