Non-neoplastic lung disease

HideShow resource information
  • Created by: z
  • Created on: 17-03-16 15:17

Asthma

  • paroxysmal, reversible
  • intrinsic- adults, causes such as exercise, infcetion, stress
  • extrinsic- largley in children, due to external agent (pollen, chemicals etc)
    • dust mites, cockroach allergen, animal allergens, mold allergens, tobacco smoke
  • allergen complex w/ IgE on mast cells > degranulation > prod histamine and leukotriene
  • histology:
    • shedding of bronchial epithelial cells
    • thickening of BM
    • eosinophils + Charcot-Leyden crystals (needle-like, purple/red in trichrome stain)
    • incr bronchial gland mass w/ incr mucus > Curschmann's spirals (coiled mucus plugs)
    • incr smooth muscle
    • inflam: T cells, eosinophils, +/- neutrophils
  • status asthmaticus:
    • hyperinflation
    • petechial haemorrhages (1-2mm, purple/red)
    • mucoid plugging (get cast of airways) w/ secondary atelectasis
1 of 14

COPD- chronic bronchitis

  • chronic bronchitis
    • clincial Dx: 'persistent cough w/ sputum prod for at least 3 months over 2 consecutive yrs'
    • recurrent infections
    • blue bloater
    • causes: smoking, pollution
    • pathological changes in lg airways:
      • increased mass of bronchial mucus glands (Reid index >0.4)
      • incr in no. of goblet cells
      • incr in smooth m.
      • chronic inflam cell infiltrate of lamina propria
2 of 14

COPD- emphysema

  • morphological Dx
    • permanent enlgmnt of air spaces distal to terminal bronchiole, accom by dstruction of their walls w/o obvious fibrosis
  • pink puffer
  • loss of alveolar walls and dilation of air spaces
  • morphological types:
    • centrilobular: 75% of cases- caused by smoking/pollution, most severe in upper lobes
    • panacinar/panlobular- assoc. w/ alpha anti-trypsin def
    • paraseptal/distal acinar- unclear cause, assoc. w/ spont pneumothorax
    • irregular- assoc. w/ scarring, clinically not significant
  • compensatory emphysema: response to loss of lung (e.g. pneumectomy)
  • senile emphysema: age related
  • obstructive: e.g. tumour
  • bullous: assoc. w/ bullae often w/ backgrd of centrilobular emphysema > rupture > pneumoT
  • interstitial: air in CT of lung/pleura/mediastinum
3 of 14

COPD- complications

  • cor pulmonale
  • resp failure
  • polycythaemia
  • lung ca
  • pneumothorax
4 of 14

Interstitial pulmonary fibrosis

  • 'progressive interstitial scarring leading to resp incapacity and effacement of lung architecture, in extreme cases get honeycomb structure'
    • honeycomb: cysts of mm-cm on background of dense fibrous scarring
      • causes: antecendent lung diseases:
        • idiopathic interstitial pneumonia
        • DAD
        • inorganic dust exposure (asbestos)
        • interstitial granulomatous disease EAA/hypersens pneum, sarcoidosis, berylliosis
        • histiocystosis X
  • interstitial fibrosing alveolitis;
    • idiopathic/cryptogenic
    • secondary
      • CT disease
      • dust/smoke inhalation
      • asbestos
      • EAA, sarcoidosis
      • shock lung, radiation, drugs
5 of 14

Interstitial pulmonary fibrosis

  • ·         Acute interstitial pneumonia (AIP)
  • ·          Usual IP
  • ·         Desquamate IP
  •          Non-specific IP
  • ·         GIP, LIP
6 of 14

AIP & UIP

  • AIP
    • Well individuals > URTI signs > progressive rapid resp failure 
    • High mortality
    • Histology:
      • Signs of diffuse alveolar damage
      • Necrosis of alveolar linig cells w/ exudate
      • Hyaline membranes  
  • UIP
    • Insidious onset od dyspnea
    • Survival 4/5yrs
    • Seen w/ CFA, also assoc. w/ collagen-vascular diseases esp RA, scleroderma
    • Histology:
      • Fibroblastic foci
      • Honeycomb change
7 of 14

DIP & NIP

  • DIP
    • Uncommon, think middle age smoker
    • Dyspnea, cough
    • Responds to steroid R, goodish prognosis
    • Pathology:
      • Incr macropahges in interstitial spaces
      • Uniform interstitial fibrosis
  • NIP
    • Dyspnea and cough in middle aged adults
    • Underlying CT D in some pts
    • Steroid responsive
    • Microscopy:
      • Uniform inflammatory and fibrosing process
8 of 14

EAA

  • Extrinsic Allergic alveolitis/hypersensitivity pneumonia
    • Wide range of antigen tho smt none found
    • Clinical presentation:
      • Acute: sudden onsent dyspnea, fever, chills; symtpoms subside w/ cessation of exposure, re-appear on re-exposure
      • Chronic: prolonged exposure to small amt of antigen; insidious onset dyspnea, dry cough, fatigues; reticulonodular infiltrates on CXR; progress to irreversible damage if persistent exposure
    • Radiologically:
      • Lower lobe ‘ground glass’ and fine nodular densities
    • Histology:
      • Variable lymphoplasmacellular infiltrate
      • Small non-necrotidsiing loose grnaulomas
      • Foamy macrophages
      • BOOP pattern in 50%
9 of 14

Pneumoconiosis

  • non-neoplastic reaction to inhalation of mineral dusts
  • reactin of lung to dust dep on:
    • propteries- fibrogenic vs inert
    • size of particles
    • length of exposure
    • susceptibilty of individual
  • fibrogenic dusts:
    • silica
    • asbestos
    • hard metals - cobalt, tungsten
10 of 14

Silicosis

  • most prevalent Occ D worldwide
  • airnorne silica prod by: sandblasting, rock drilling, foundry work, quarrying, tunneling
  • silicosis:
    • collagenous nodules in lungs and mediastinal lymph nodes
    • irreversilble low mort but pos resp incapacity
11 of 14

Asbestos

  • amphiboles
    • crocidolite and amosite (blue and brown asbestos)
    • more pathogenic as impact airways more
  • serpentines
    • chrysolite (white asbestos)
    • cleared effcetively, thus less pathogenic
  • asbestos chest disease
    • pleura pathology
      • benign pathology
        • pleural plaques: asymptomatic, composed of hydrolinised collagen
        • benign pleural thickening
        • pleural effusion
        • asbestosis/interstitial fibrosis
12 of 14

Asbestos- malignant disease

  • mesothelioma
    • 90% assoc w/ abestos exposure (decades prev)
  • bronchogenic carcinoma
    • assoc w/ accompanying asbestosis 
    • all forms of ca but esp adenocarcinoma
  • laryngeal ca
  • ?colon ca
  • RR of ca w/ asbestos + smoking exposure = 55
13 of 14

Pulmonary HTN

  • 'mean pulm art pr >25mmHg at rest or > 30 mmHg during exercise'
  • primary:
    • rare
    • F>M
    • young adults only
    • v poor prognosis- transplant pos 
  • secondary
    • L>R cardiac shunts
    • venous back pr (mitral stenosis)
    • hypoaxaemic lung disease (COPD)
    • drugs
    • vascular obstruction (repeated PTE)
  • morphology
    • muscularisation of arterioles
    • medial thickening of m. arteriesl
    • intimal thickening
14 of 14

Comments

No comments have yet been made

Similar Medicine resources:

See all Medicine resources »See all Respiratory resources »