Respiratory dis. presentation1 for gen path copy (2)

GENERAL PATHOLOGY

RESPIRATORY DISEASE

Prof. dr. Bacani

By

Kazemi Mohammad Sadegh

Dmd2ee

2013

Major Determinants of Disease

• Diseases of one lung compartment tend to

affect the others

• The lungs are open to the environment,

exposing them to infectious agents,

allergens, irritants, & carcinogens

• Most lung disease is caused by inhalation of

material; the most common exception is

autoimmune lung disease

• Lost pulmonary membrane is not

recoverable

• Smoking is a major cause of lung

disease

• The heart & lungs are a functional unit;

lung disease usually affects the heart; &

heart disease usually affects the lungs

Chronic Obstructive PulmonaryDiseases (COPD)

• Chronic bronchitis

• Emphysema

• Bronchiectasis

• Asthma

Chronic Bronchitis

• Chronic bronchitis is defined clinically. It ispresent in any patient who has persistent cough with sputum production for at least 3 months in at least 2 consecutive years, in the absence of any other identifiable cause.(1) Progress to chronic obstructive airwaydisease (2) Lead to cor-pulmonale and heart failure(3) Cause atypical metaplasia and dysplasia ofthe respiratory epithelium

Pathogenesis

• Tobacco smoke– 90% of patients are smokers.• Grain, cotton, and silica dust• Air pollution

• Infection– Bacterial and viral infections are important intriggering acute exacerbation of the disease.• Others

Chronic bronchitis. The lumen of the bronchus is above. Note the marked thickening of the mucousgland layer (approximately twice normal) and squamous metaplasia of lung epithelium. (From the teaching collection of the Department of Pathology, University of Texas, Southwestern Medical School,Dallas, Texas.)

Clinical Course

• Prominent cough

• Production of sputum

• Hypercapnia, hypoxemia, and cyanosis

• Pulmonary hypertension and cardiac failure

• Recurrent infections and respiratory failure

Emphysema

• Definition

– Emphysema is a condition of the lungcharacterized by abnormal permanentenlargement of the airspaces distal to theterminal bronchiole, accompanied bydestruction of their walls and without obvious fibrosis.

Pathogenesis

• The genesis of emphysema is notcompletely understood.• A consequence of two critical imbalances– The protease-antiprotease imbalance– Oxidant-antioxidant imbalance

Pathogenesis of emphysema. The protease-antiprotease imbalance andoxidant-antioxidant imbalance are additive in their effects and contribute to tissue damage. α1-antitrypsin (α1-AT) deficiency can be either congenital or "functional" as a result of oxidative inactivation.

Types of Emphysema

• According to its anatomic distribution withinthe lobule• Four major types– Centriacinar– Panacinar– Paraseptal– Irregular• Only the first two cause clinically significantairflow obstruction.

A, Centriacinar emphysema. Central areas show marked emphysematous damage (E), surrounded by relatively spared alveolar spaces.B, Panacinar emphysema involving the entire pulmonary architecture.

Microscopically at high magnification, the loss of alveolar walls with emphysema is demonstrated. Remaining airspaces are dilated.

Clinical Course

• Dyspnea is usually the first symptom• Steadily progressive• Cough and wheezing• Weight loss• Pulmonary function tests– The ratio of FEV1 to FVC is reduced

Complications

• Cor pulmonale

• Pneumothorax

• Respiratory failure

Anatomic distribution of pure chronic bronchitis and pure emphysema. Inchronic bronchitis the small-airway disease (chronic bronchiolitis) results inairflow obstruction, while the large-airway disease is primarily responsible forthe mucus hypersecretion.

Bronchiectasis

• The permanent dilation of bronchi andbronchioles caused by destruction of themuscle and elastic supporting tissue.

Pathogenesis

• Obstruction• Chronic persistent infection– Damage to bronchial walls, leading toweakening and dilation.– Obstructive secretions, inflammationthroughout the wall

Morphology

• Affects the lower lobes bilaterally• The airways dilated• Histologically– Intense acute and chronic inflammatory exudate within the walls of the bronchi and bronchioles– The desquamation of lining epithelium cause extensive areas of ulceration– Fibrosis of the bronchial and bronchiolar walls and peribronchiolar fibrosis

This is the microscopic appearance of bronchiectasis. Bronchiectasis is not a specific disease, but a consequence of another disease process that destroys airways.

Clinical Course

• Severe, persistent cough with expectorationof mucopurulent– Fetid, sputum.– The sputum may contain flecks of blood• Hypoxemia, hypercapnia, pulmonaryhypertension, and (rarely) cor pulmonale.

Complications

• Lung abscess

• Pyemia--metastatic abscesses

• Pulmonary fibrosis

• Cor pulmonale

Asthma

Pathophysiology Asthma trigger

- Inflammation & edema of the mucous membranes.

- Accumulation of tenacious secretions from mucous glands.

- Spasm of the smooth muscle of the bronchi & bronchioles decreases the caliber of the bronchioles.

Symptoms of

asthma

• Coughing

• Wheezing, a whistling

sound

• Shortness of breath

• Chest tightness

• Sneezing & runny

nose

• Itchy and inflamed

eyes

Asthma

Therapeutic

management

- Allergic control

to prevent

attacks.

Drug therapy:B- adrenergic,

Theophyllin, &

corticosteroids

preparations + chest

physiotherapy (only

in between attacks).

ClinicalTerm

AnatomicSite

MajorPathologicChanges

Etiology Signs/Symptoms

Chronicbronchitis

Bronchus Mucous glandhyperplasia,hypersecretion

Tobaccosmoke, airpollutants

Cough,sputumproduction

Bronchiectasis Bronchus Airway dilationand scarring

Persistent orsevereinfections

Cough,purulentsputum, fever

Emphysema Acinus Airspaceenlargement;walldestruction

Tobacco smoke

Dyspnea

Asthma Bronchus Smoothmusclehyperplasia,excess mucus,inflammation

Immunologicor undefinedcauses

Episodicwheezing,cough,dyspnea

Lower Respiratory Tract Infections:

Bronchiolitis (RSV Infection)

• 2-12 month• Caused by syncytial virus• Transmitted by oral droplet• Predisposing factors (asthma, smoking)• Causes necrosis and inflammation of small bronchi and

bronchioles

• Signs– Wheezing and dyspnea– Rapid, shallow respirations– Cough– Rales– Chest retractions– Fever

• Treatment– Supportive and symptomatic

Pulmonary Infections

• Pneumonia can result whenever these defensemechanisms are impaired or whenever theresistance of the host in general is lowered.

• Most deadly infectious disease in the U.S.• 6th leading cause of death

Pneumonia• Etiological classification

– Bacterial pneumonia– Viral pneumonia– Fungal pneumonia• Anatomical classification

– Lobar pneumonia– Lobular pneumonia– Interstitial pneumonia

Pulmonary Infections or Pneumonia

• Pneumonia can be very broadly defined as any infection in the lung. It may present as acute, fulminant clinical disease or as chronic disease with a more protracted course.

Pathogenesis

• Streptococcus Pneumoniae– The most common cause of acute pneumonia.– Examination of Gram-stained sputum is an important step in the diagnosis of acute pneumonia.– Pneumococcal pneumonias respond readily to penicillintreatment, but there are increasing numbers of penicillinresistantstrains of pneumococci.

• Haemophilus Influenzae– A major cause of life-threatening acute lower respiratory tractinfections and meningitis in young children.• Moraxella Catarrhalis

Lung cancer

• Lung cancer is currently the most

frequently diagnosed major cancer in the

world and the most common cause of

cancer mortality worldwide.

• Cancer of the lung occurs most often

between ages 40 and 70 years, with a

peak incidence in the fifties or sixties.

• The 5-year rate for all stages combined is

only 15%.

Etio

logy

&

path

ogen

esis

• Cigarette smoking

– Passive smoking increases the risk of

developing lung cancer to approximately twice

that of nonsmokers.

• Industrial Hazards

• Air Pollution

• Molecular Genetics

Classificatio

n• Squamous cell carcinoma (25% to 40%)

• Adenocarcinoma (25% to 40%)

• Small cell carcinoma (20% to 25%)

• Large cell carcinoma (10% to 15%)

Lung

Can

cer

Signs

and

Sym

ptom

s

• Insidious onset• Normally metastized

before diagnosis• 4 possible categories of

signs of lung cancer–Direct effects of tumor–Systemic effects of

cancer–Paraneoplastic

syndromes–Metastizes at other

sites

Lung Can

cer

Diagnost

ic Te

sts

• Chest X-rays• Bronchoscopy• Pulmonary function tests

Lung Cancer

Treatment

• Surgery on localized lesions

• Chemotherapy and radiation

• Poor prognosis unless tumor in early stages of development

What is tuberculosis (TB)?

► Tuberculosis (TB) is a disease caused by bacteria called Mycobacterium tuberculosis.► The TB bacteria can affect any part of the body, but usually affects the lungs.► If not treated properly, a person who has TB infection can develop TB disease.► If a person develops TB disease and does not get appropriate medical treatment he/she can die.

• Mycobacterium tuberculosis• Chronic granulomatous inflammation with

caseous necros

What are the symptoms of TB?

►Symptoms of TB disease include:feelings of sickness or weakness,weight loss, fever, and night sweats.►When TB disease affects the lungs, additional symptoms may include: a bad cough that lasts longer than 2 weeks, shortness of breath, pain in the chest and coughing up blood.

Remember…

► TB infection occurs when a person has breathed in the TB germ, but the person is not sick.► TB disease can develop in a person with TB infection if they do not get medical treatment.► A person with TB disease is sick and may have several symptoms of the disease.► If left untreated, persons with TB disease can die from TB.

How is TB treated?

► TB disease can usually be curedby taking several medicines for 6-12 months.► It is very important that people who have TB disease take the medication exactly as prescribed.► If you stop taking the medication too soon, you can become sick again.► Also, if you do not take the medication correctly, the germs may become resistant to those medications and become more difficult to treat.

LARYNGITIS

An inflammation of the larynx.

It causes hoarse voice or the complete loss of the voice because of irritation to the vocal folds.

ETIOLO

GY

Colds or flu. This is the most common cause

What are the symptoms?The main symptom of laryngitis is hoarseness. Your voice may sound raspy, be deeper than normal, or break now and then. You may lose your voice completely. Other symptoms may include a dry or sore throat, coughing, and trouble swallowing.

How is it treated?With most cases of laryngitis, home treatment is all that you need. Try to rest your voice, add moisture to the air in your home with a humidifier or vaporizer, and drink plenty of fluids. Don't smoke, and stay away from other people’s smoke.Chronic laryngitis may need more treatment. If you keep getting laryngitis because of a problem with the way you talk or sing, you may need speech training. This can help you change habits that can cause laryngitis. It can also help your larynx heal.You may need surgery if your vocal cords have been damaged, such as by sores or polyps.

Bronchitis•Bronchitis is an inflammation of the main air passages to the lungs

•Most prevalent in winter

•Generally part of an acute URI

•It may develop after a common cold or other viral infection of the nasopharynx, throat, or bronchi

•Often with secondary bacterial infection

Signs &

symptoms

1.Malaise

2.Chilliness

3.Slight fever

4.Back and muscle pain

5.Sore throat

6.Onset of a distressing cough usually signals onset of bronchitis

7.Cough starts off dry and later produces mucous.

Treatment 1.The patient should rest until fever subsides

2.Drink plenty of fluids.

3.Fever reducer.

TonsillitisWhat is tonsillitis?• Tonsillitis is a viral or bacterial infection in

the throat that causes inflammation of the tonsils. Tonsils are small glands (lymphoid tissue) in the pharyngeal cavity.

• In the first six months of life tonsils provide a useful defense against infections. Tonsillitis is one of the most common ailments in pre-school children, but it can also occur at any age.

Tonsillitis

• Palatine tonsils

(Visible during oral examination)

What causes

tonsillitis?

Tonsillitis is caused by a variety of

contagious viral and bacterial

infections. It is spread by close

contact with other individuals and

occurs more during winter

periods. The most common

bacterium causing tonsillitis is

streptococcus.

ETIOLOGY

Tonsillitis caused by bacteria

Antibiotics are prescribed for tonsillitis caused by strep bacteria. A strep infection will usually go away on its own, but antibiotic treatment is needed because untreated strep throat can cause serious complications

TREATMENT Surgery

Surgical removal of the tonsils (tonsillectomy) is still a common procedure, particularly for children