patho lec 3.pptx ..hfndisksbdukdndhdkdnchdkmd
- 1. PULMONARY PATHOPHYSIOLOGY OF PULMONARY SYSTEM Dr Sohail Khan DPT( AUIC) MS-NPT(FUMC)
- 3. OBSTRUCTIVE AND RESTRICTIVE PULMONARY DISEASES Diffuse pulmonary diseases are divided into: 1. Obstructive disease: characterized by limitation of airflow owing to partial or complete obstruction at any level from trachea to respiratory bronchioles. Pulmonary function test: limitation of maximal airflow rate during forced expiration (FEVI). 2. Restrictive disease: characterized by reduced expansion of lung parenchyma with decreased total lung capacity while the expiratory flow rate is near normal. Occur in: 1. Chest wall disorder. 2. Acute or chronic, interstitial and infiltrative diseases, e.g. ARDS and pneumoconiosis.
- 4. CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
- 5. EMPHYSEMA Is characterized by permanent enlargement of the airspaces distal to the terminal bronchioles accompanied by destruction of their walls, without obvious fibrosis. Over inflation. Types of emphysema: 1. Centriacinar (20x) 2. Panacinar 3. Distal acinar 4. Irregular
- 6. EMPHYSEMA: • Centriacinar: Smoking • Panacinar: deficiency of α1 AT • Paraseptal • Irregular: scar Types • Cough and wheezing. Respiratory acidosis • Weight loss. • Pulmonary function tests reveal reduced FEV1. Clinical features • Pneumothorax • Death from emphysema is related to: • Pulmonary failure with respiratory acidosis, hypoxia and coma. • Right-sided heart failure ( Cor pulmnale) Complications Dilated air spaces beyond respiratory arteriols
- 7. CHRONIC BRONCHITIS · Mucosa of the lower respiratory passages becomes severely inflamed · Mucus production increases · Pooled mucus impairs ventilation and gas exchange · Risk of lung infection increases · Pneumonia is common · Hypoxia and cyanosis occur early
- 8. CHRONIC BRONCHITIS: • 1. Simple chronic bronchitis. • 2. Chronic mucopurulent bronchitis. • 3. Chronic asthmatic bronchitis. • 4. Chronic obstructive bronchitis. forms: • Enlargement of the mucus glands, increased number of goblet cells, loss of ciliated epithelial cells, squamous metaplasia, dysplastic changes and bronchogenic carcinoma. • Inflammation, fibrosis and resultant narrowing of bronchioles. • Coexistent emphysema Morphology • Prominent cough and the production of sputum. • COPD with hypercapnia, hypoxemia and cyanosis. • Cardiac failure Clinical features Persistent productive cough for at least 3 consecutive months in at least 2 consecutive years, smoking related
- 9. EMPHYSEMA AND CHRONIC BRONCHITIS Predominant Bronchitis Predominant Emphysema Appearance Age Dyspnea Cough Infection Respiratory Insufficiency Cor pulmonale Airway resistance Elastic recoil Chest radiography “Blue bloaters” 40-45 Mild, late Early, copious sputum Common Repeated Common Increased Normal Prominent vessels, large heart “Pink Puffers” 50-75 Severe, early Late, scanty sputum Occasional Terminal Rare, terminal Normal or slightly increased Low Hyperinflation, small heart
- 10. Chronic Obstructive Pulmonary Disease Emphysema Bronchiectas is Chronic Bronchitis Asthma A group of conditions characterized by limitation of airflow Emphysema and chronic bronchitis often co-exist. Chronic Obstructive Pulmonary Disease
- 11. LUNG CANCER · Accounts for 1/3 of all cancer deaths in the United States · Increased incidence associated with smoking · Three common types ·Squamous cell carcinoma ·Adenocarcinoma ·Small cell carcinoma
- 12. ASTHMA · Chronic inflamed hypersensitive bronchiole passages · Response to irritants with dyspnea, coughing, and wheezing
- 13. ASTHMA Bronchial asthma Chronic relapsing inflammatory disorder characterized by hyperactive airways leading to episodic, reversible bronchoconstriction owing to increased responsiveness of the tracheobronchial tree to various stimuli. It has been divided into two basic types: 1. Extrinsic asthma. 2. Intrinsic asthma.
- 14. EXTRINSIC ASTHMA Initiated by type 1 hypersensivity reaction induced by exposure to extrinsic antigen. Subtypes include: a. atopic (allergic) asthma. b. occupational asthma. c. allergic bronchopulmonary aspergillosis. Develop early in life Intrinsic Asthma • Initiated by diverse, non-immune mechanisms, including ingestion of aspirin, pulmonary infections, cold, inhaled irritant, stress and exercise. • No personal or family history of allergic reaction. • Develop later in life CLASSIFICATION OF ASTHMA
- 15. ASTHMA: DYSPNEA AND WHEEZING • 1. Extrinsic asthma: Type 1 Hypersensitivity reaction, IgE, childhood, family Hx of allergy. • 2. Intrinsic asthma: associated e bronchial asthma, aspirin, exercise, cold induced. No Hx of allergy Types • Hypertrophy of bronchial smooth muscle & hyperplasia of goblet cells e eosinophils • Mucous plug e Curschmann spirals & Charcot- Leyden crystals. Morphology • Superimposed infection • Chronic bronchitis • Pulmonary emphysema • Status asthmaticus Complication
- 16. PATHOLOGY OF LUNG DISEASES Very important in clinical medicine Complication of air pollution Common symptoms: Dyspnea: difficulty with breathing Decrease compliance, fibrosis Increased airway resistance , ch. bronchitis Chest wall disease, obesity Fluid accumulation, left sided heart failure Cough Postnasal discharge, GERD, Br. Asthma, ch. Bronchitis, pneumonia, bronchiectasis, drug induced Hemoptysis Ch. Bronchitis, pneumonia, TB, bronchiectasis, aspergilloma
- 17. ATELECTASIS (COLLAPSE) Incomplete expansion of the lungs or collapse of previously inflated lung substance. Significant atelectasis reduce oxygenation and predispose to infection.
- 18. Atelectasis occurs : blocked airway (obstructive) or pressure from outside the lung (non-obstructive). General anesthesia is a common cause of atelectasis. It changes your regular pattern of breathing and affects the exchange of lung gases, which can cause the air sacs (alveoli) to deflate
- 19. TYPES OF ATELECTASIS 1. Resorption atelectasis. 2. Compression atelectasis. 3. Contraction atelectasis.
- 20. TYPES OF ATELECTASIS 1. Resorption atelectasis - Result from complete obstruction of an airway and absorption of entrapped air. Obstruction can be caused by: a. Mucous plug ( postoperatively or exudates within small bronchi seen in bronchial asthma and chronic bronchitis). b. Aspiration of foreign body. c. Neoplasm (Abnormal mass tissue) d. enlarged lymph node - The involvement of lung depend on the level of airway obstruction. - Lung volume is diminished and the mediastinum may shift toward the atelectatic lung.
- 21. 2. Compression atelectasis Results whenever the pleural cavity is partially or completely filled by fluid, blood, tumor or air, e.g. - patient with cardiac failure - patient with neoplastic effusion - patient with abnormal elevation of diaphragm in peritonitis or subdiaphragmatic abscess. Peritoneum: It is the serous membrane that lines the abdominal cavity & it serves to support the organs of the abdomen
- 22. 3. Contraction atelectasis. Local or generalized fibrotic changes in pleura or lung preventing full expansion of the lung.
- 23. BRONCHIECTASIS Chronic necrotizing infection of the bronchi and bronchioles leading to or associated with abnormal dilatation of these airways. Bronchial dilatation should be permanent.
- 24. BRONCHIECTASIS: • Infection • Obstruction • Congenital (Cystic fibrosis, Kartagener’s Syndrome) Causes • Sever persistent cough with sputum (mucopurulent sputum) sometime with blood. • Clubbing of fingers. Clinical features • If sever, obstructive pulmonary function develop. • Lung Abscess • Rare complications: metastatic brain abscess and amyloidosis. complications Chronic necrotizing infection of the bronchi and bronchioles leading to permenant dilatation of these airways