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Obstructive and restrictive dz - Coggle Diagram
Obstructive and restrictive dz
Obstructive DZ
COPD
Limitation to air flow
Increase resistance due to partial or complete obstructive at any level
5 entities
Chronic bronchitis
Persist cough with
sputum at least 3 months,
in at least 2 consecutive years
Smoker ,urban 的人, 中年男人
Chronic irritation by inhaled substance such as sulphur dioxide ,nitrogen dioxide
Mediated by
local release of T cell cytokines
Microbiologic infection
often present but
has a secondary
role
Gross: Hyperaemia ,swollen airway
Covered by mucinous/mucopurulent secretion
Microscopic
Increase no. of goblet cell of small bronchi and bronchioles
Increase size of mucous gland and thickness of mucous gland layer
Clinical feature , hypercapnoea ,hypoxaemia
Severe case , cyanosis=blue bloaters
Complication
Pulmonary hypertension
Elevated mean arterial pressure more than 25mmHG
at rest by RIGHT HEART CATHETERIZATION
:explode:
5 Groups
Pulmonary arterial hypertension
PH due to lest heart dz
PH due to lung dz / hypoxemia
PH due chronic thromboembolism
PH with unclear multifactorial mechanism
Cardiac failure
Reccurent infection
Respiratory failure
Bronchiectasis
:lock:
PERMANENT dilation of bronchi and bronchioles
caused by
destruction of ms
and
supporting elastic tissue
, resulting from or ass with
chronic necrotizing infection
:<3:
Not
primary
dz
:warning:
Clinical presentation :Severe persistent cough with copious foul smelling (臭）
:taurus:
Predisposing conditions
Bronchial obstruction
Tumour, foreign body ,mucous impaction ,as well as complicated from atopic asthma and chronic bronchitis
Congenital / hereditary condition
Cystic fibrosis
Congenital bronchiectasis
Immune deficiency state
Immotile cilia, Kartagener's syndrome
Necrotizing pneumonia
Pathology
Macro
Usually affect the
lower
lobes bilaterally
:!!:
Dilated airway ,become cystic
Micro
Active and chronic inflammation
:confetti_ball:
Desquamation of epithelium
Extensive ulceration
Fibrosis and scarring
Complication
Haemorrhage
Lung abscess with secondary fungal ball
Cor pulmonale
septic emboli
Secondary amyloidosis
Asthma
Intermittent
:tada:
Reversible airway obstruction
:champagne:
Chronic bronchial inflammation with eosinophils
Bronchial smooth ms cell
hypertrophy and hyperactivity
increased
mucous secretion
ass with
atopy
(Increased susceptibility to generate IgE in response to external allergen)
Aetiology
:fire:
Genetic predisposition to
type 1 hypersensitivity (atopy
)
Acute and chronic airway inflammation
Bronchial hyper-responsiveness to variety of stimuli
TYPES
Atopic asthma
Most common
Begin in
childhood
,classic example of type 1 IgE mediated hypersensitivity reaction
Triggered by
Environmental allergen
Positive family history is common
Attacks often preceded by allergic rhinitis, urticaria ,eczema
Non-atopic asthma
Drug-induced asthma
Occupational asthma
Clinical presentation
Cough ,特别是在晚上和早上
dyspnea
Chest tightness
Wheezing
Hyperinflation of lung
Attacks relieved spontaneously or need bronchodilator therapy and corticosteroid
Pathology
Macroscopic
Hyperaemia, swollen mucous membrane
Mucopurulent secretion in bronchi and bronchioles
Microscopic
Hypertrophy and hyperplasia of mucous secreting glands
Squamous metaplasia / dysplasia of bronchial epithelium
Narrowing of lumen with inflammation
Complication
Status asthmaticus
Severe paroxysm (突然攻击） that does not respond to therapy and persist for days and even weeks
Disabling and lethal from hypercapnoea ,acidosis and severe hypoxia
Chronic bronchitis
Bronchiectasis
Pneumonia
Cor-pulmonale
Emphysema
:checkered_flag:
PERMANENT enlargement of
airspaces distal to the terminal bronchiole
accompanied by destruction of their wall without significant fibrosis
Imbalance btw activity of neutrophil elastase and anti-elastase in lung
:fast_forward:
ELASTASE causes destruction of alveolar walls
Digestion of human lung is inhibited by anti-elastase named alpha-1-antitrypsin
:!?:
Smoking causes reduction in anti-elastase activity
and
increase elastase production
from n
eutrophils and macrophages
:no_smoking:
Protease-antiprotease mechanism of emphysema
Smokers have
greater no. of neutrophil and macrophages
in alveoli. :forbidden:
Nicotine is
chemotactic
for neutrophil
Smoking stimulate
release of elastase from neutrophils.
Smoking enhances elastolytic proteases activity in macrophages
1 more item...
Macro
Panacinar - voluminous （大多数） lung
Overlapping heart
Centriacinar
Upper 2/3 of lung affected more severely
Micro
Destruction of alveolar wall
Fusion of alveoli
Bleb and bullae (Enlarged air spaces)
Loss of elastic tissue in surrounding alveolar septa
Traction of small airway reduced
Collapsed during expiration
:warning:
Clinical feature
Barrel chested
Dyspnea usually on effort ,at rest
Cough with sputum or wheezing
Weight loss
Pink puffer
generalized term for a person who is thin, breathing fast and is pink.
Complication
:check:
Right heart failure(cor pulmonale)
Pulmonary failure with respiratory acidosis, hypoxia and coma
Secondary pneumothorax
Bronchiolitis
:white_flower:
Goblet cell metaplasia ,mucous plugging ,inflammation and fibrosis.
If severe,
obliteration (抹杀） of lumen
Restrictive DZ
Chronic diffuse interstitial lung dz
Heterogenous group of disorder characterized by
bilateral ,often patchy
,usually chronic involvement of pulmonary connective tissue
Most peripheral and delicate interstitium in the alveolar wall
Hallmark features
:star:
Reduced
compliance
because lung is stiff
Increased effort of breathing
:panda_face:
Symptoms
:checkered_flag:
Dyspnoea
Tachypnea
End-inspiratory crackles
Eventual cyanosis
Without wheezing
or other evidence of airway obstruction
CXR :
bilateral diffuse infiltrative lesions-small nodules
,irregular lines, or
ground-glass shadow
Hence term infiltrative
Advanced result in
scarring and gross destruction
of lung
:waning_gibbous_moon:
End-stage/honey-comb lung
Major categories of
chronic interstitial lung dz
:candy:
Fibrosing
Pneumoconiosis
Non-neoplastic lung reaction to inhalation of mineral dusts encountered in workplace
include dz induced by
organic and inorganic particulates
and chemical fumes and vapors
Eg: coal worker pneumoconiosis ,silicosis, asbestosis
coal worker pneumoconiosis
Spectrum of lung finding
Asymptomatic anthracosis (accumulation of carbon)
Accumulate in
connective tissue along the lymphatic
or in organized lymphoid tissue along the
bronchi or lung hilus.
Simple 的话
little or no pulmonary dysfunction
复杂的话
Progressive massive fibrosis
Granulomatous
Sarcoidosis
Multisystem dz of
unknown cause,
characterized by
non-caseating (cheese) granulomas
in many tissue and organ
Clinical feature
:red_flag:
Bilateral hilar lymphadenopathy
, lung involvement (visible on CXR in 90% of cases), eye ,skin lesion
Cough, night sweat , haemoptysis ,fever ,weight loss
Pathology
Non-caseating granuloma
Aggregate of
tightly clustered epithelioid cells
, often with Langhans or foreign body - giant cell
少central necrosis
Schaumann bodies
Site of involvement
Lung ,lymph nodes ,spleen ,bone marrow and skin
:fountain_pen:
Eosinophilic
Smoking related
:smoking:
DIFFERENCE
Obstructive
Reduction in airflow
Shortness of breath
:warning:
Air remain inside the lung after full expiration
EXP:COPD ,asthma and bronchiectasis
:staff_of_aesculapius:
Restrictive
Reduction in lung volume
Difficulty in taking air inside lung
:warning:
DUE TO stiffness inside the lung tissue or chest wall cavity
EXP :Interstitial lung dz, scoliosis ,neuromuscular cause, marked obesity
:star_and_crescent: