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OBSTRUCTIVE LUNG DISEASE (COPD) - Coggle Diagram
OBSTRUCTIVE LUNG DISEASE (COPD)
Chronic Bronchitis
Chronic inflammation with cough for 3 months in 2 consecutive years
Aetiology & p.f.: Smoking – Infection – Allergy
Morphology
• Gross: Swollen – contain secretions
• Micro: Chrnic inflammation – gland proliferation- goblet cell metaplasia – sq. metaplasia
Emphysema
Permanent dilatation & destruction of air spaces distal to terminal bronchioles
Aetiology & pathogenesis:
Smoking: Excess inflammatory cells→secrete Elastase & IL-8→ damage of Elastin→more
inflammation
Genetic factors:
α1-AT deficiency associated with neonatal jaundice &hepatitis
True emphysema
Centri-acinar
-Dilated resp bronchiole Associated with smokers & coal miners
More in upper lobe
Pan-acinar
-Dilated both resp. bronchiole & alveoli associates with α1-AT deficiency more in lower lobe
Para septal
-dilated alveoli associated with lung scar or atelectasis
Peripheral, upper, bullae are common
Irregular
Irregular focal dilatation
Gross: Large (voluminous), pale, dry , with indentations and containing Bullae
Micro: Alveoli are Dilated & thin-walled→damaged (no fibrosis) Capillaries are compressed
Clinical picture and Complications:
Pulmonary hypertension→right sided H F (common cause of death)
Hypoxia→Cyanosis→Polycythemia and clubbing of fingers
Respiratory acidosis & coma (fatal)
Bullae → pneumothorax (fatal) or interstetial emphysema
Barrel-shaped chest
Bronchial asthma
Chronic inflammatory disease with Repeated(paroxysmal) reversible attacks of broncheospasm and increased mucous production
Types
Atopic (Extrinsic):
Age : -Children and young
P.F.: -Family history of allergy -Following exposure to Antigen
-elevated IgE
Non Atopic (Intrinsic):
Age : -Older
P.F.: -No Family history -following viral infection -Normal IgE levels
Aspirin induced Asthma: A type of non Atopic asthma, which is caused by aspirin
Gross:
-Bronchi: Thick wall→narrow -Mucous plug (curshman spirals) -Lung: Over inflated & Focal collapse
Micro:
Lumen: mucous whorls (curshman spirals) + eosinophils debri (Charcot- Leyden crystals)
Mucosa: thick B.M. & proliferated glands with goblet cell metaplasia
Wall: inflammatory cells (excess eosinophils and mast cells ) + inflammatory edema
Muscle: hypertrophy
C/P:
Cough with scanty tenacious mucous - Dyspnea (expiratory) - Wheezes
Bronchiactasis
Chronic suppuration characterized by Permanent dilatation & damage of medium sized bronchi
Aetiology & P.F.:
Infection Pyogenic (Suppurative pneumonia “septic bronchopneumonia”)
• Complete Obstruction:
o Tumor
o Foreignbody
o Congenital ▪ Cystic fibrosis "muco-vidcoidosis"
▪ Immotile cilia (Kartegner syndrome) → accumulated secretions
Site: Mostly lower lobe
Gross: Bronchi “mainly in the lower lobe “ are Dilated & thick (cylindrical, saccular, fusiform) contain pus , with ulcerated mucosa , lung fibrosis , Pleural fibrosis and adhesions
Micro:
Lumen: necrotic tissue + pus cells
Mucosa : ulceration – Hyperplasia – dysplasia – sq. metaplasia
wall: inflammatory cells + necrosis→fibrosis
Alveoli : Fibrosis with some emphysema
Complications:
Carcinoma(sq.cell carcinoma)
Right S H F (due to lung fibrosis)
Abscess→2ry amyloidosis
Spread→Direct: Abscess & empyema – Blood: Toxemia,
pyemia
Bronchiolitis (small airway disease):
same as bronchitis, but caused mainly by infection, and ends by fibrosis