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2010-B3 Pathophysiology Lung Pneumonia: Pathology
2010-B3 Pathophysiology Lung Pneumonia: Pathology
2010-B3 Pathophysiology Lung Pneumonia: Pathology
Pneumonia
Pathology:
Alveolar
Bronchopneumonia
(Streptococcus pneumoniae,
p
influenza,
f
z ,
Haemophilus
Staphylococcus aureus)
Lobar (Streptococcus
pneumoniae)
Interstitial (Influenza virus,
Mycoplasma pneumoniae)
Pathogenesis
Inhalation of air droplets
Aspiration
p
of infected
secretions or objects
Hematogenous spread
1
Lungg abscess
Localized suppurative necrosis
Organisms commonly cultured:
Staphylococci
Streptococci
Gram-negative
Anaerobes
Frequent mixed infections
Pathogenesis:
Aspiration
Pneumonia
Septic emboli
T
Tumors
Direct infection
Pulmonary tuberculosis
Pulmonaryy tuberculosis
Secondary
Caused by Mycobacterium
tuberculosis.
Transmitted
T
itt d through
th
h iinhalation
h l ti
of infected droplets
Primary
Miliary
Granuloma
Opportunistic
pp
p
pneumonias
Chronic bronchitis
Definition
Persistent cough with sputum
production for:
at least 3 months,
in at least 2 consecutive years.
AIDS
Iatrogenic
Cancer patients
Transplant recipients
Aspergillus
Pathology
Inflammation of airways
Hyperplasia of
mucous producing cells
Squamous metaplasia
Injury to cilia
Cytomegalovirus
7
Pneumocystis carinii
Emphysema
Destructive enlargement of
airspaces distal to terminal
bronchioles
Two main
i types
Centriacinar
Destruction of central portion
with
ith sparing of distal airways
air a s
Upper lobes > lower
Cause: smoking
Panacinar
Unform injury
Lower lobes > upper
Cause: alpha-1-antitrypsin
deficiency
10
Bronchial Asthma
Bronchiectasis
Dilatation of bronchi
and bronchioles
secondary to chronic
inflammation
Associated conditions
Intrinsic (non-atopic)
Initiated by infections, drugs, pollutants, chemical
irritants
Obstruction
Ob
i
Cystic fibrosis
Immotile cilia syndromes
Necrotizing pneumonia
ATOPIC ASTHMA
Allergen
I E
IgE
Mucus
secretion
Mast cell
Muscle
contraction
Mucus
secretion
Muscle contraction
11
Release of inflammatory
mediators
Recruitment of leukocytes
Acute phase
12
Late-phase
Atelectasis
Emergency symptoms:
p
Bluish color to the lips
and face
Decreased level of
alertness
l
suchh as severe
drowsiness or confusion,
g an asthma attack
during
Extreme difficulty
breathing
Rapid pulse
Severe anxiety due to
shortness of breath
Sweating
13
14
Pulmonaryy edema
Oncotic pressure
Hydrostatic pressure
Normal
Oncotic pressure
Hydrostatic pressure
Causes:
- Heart
H t failure
f il
- Mitral stenosis
Etiology:
Hydrostatic pressure
Causes:
- Infections
p
- Aspiration
- Drugs
- Radiation
Oncotic pressure
Causes:
- Nephrotic
y
syndrome
- Liver diseases
Infections (viral)
Gas inhalation or liquid aspiration
Drugs, chemical, radiation
Hypotension, sepsis, trauma
Pathology:
Acute (exudative) stage
Proliferative or organizing stage
Microvascular injury
15
16
Pulmonary embolism
Most emboli arise in veins
from the legs
Large emboli (10%) are a
cause of sudden death
Small emboli (70%) may
be:
Clinically
y silent
Cause infarctions (in patients
with heart failure).
Cause hemoptysis
17
18
Hypersensitivity pneumonitis
Pulmonaryy hypertension
yp
Secondary (most
common):
)
Primary (idiopathic)
Chronic
obstructive
pulmonary
l
disease
Chronic
interstitial
pulmonary
di d
disorders
Chronic heart
failure
Recurrent
pulmonary
emboli
Farmers lung
Thermophilic actinomycetes in hay
Pigeon
breeder s
breeders
Air-condition lung
19
Th
Thermophilic
hili bacteria
b t i
20
Pneumoconioses
Disorders caused by inhalation
of inorganic elements,
primarily metals.
metals
Injury is determined by:
Progressive
fibrosing
g disorder
off off unknown
cause
Adults 30 to 50 y/o
Respiratory and
heart failure (cor
pulmonale)
l
l )~5y
Length of exposure
Physicochemical
Ph i h i l characteristics
h
t i ti
Host factors
Silicosis
Silicotic nodules
Asbestos
Asbestosis (pulmonary fibrosis)
Pleural disease (fibrous plaques,
plaques
mesothelioma).
21
Smoking-related diseases
22
35%
30%
25%
10%
35
operable
25 30
25-30
resected for c
23
8-12
survive for 5 y
24
(30% of those
res
Adenocarcinoma
Frequency: 35%
Smoking: X 25 (increased risk)
Males > females
S
Survival
i l (5 years):
) 15 - 20%
Arises in bronchial squamous metaplasia
Centrally located
25
May cavitate
Bronchioloalveolar carcinoma
26
Frequency: 25 %
Smoking: 95% of patients
M l >> females
Males
f
l
Survival (5 years): 1 - 5 %.
27
28
Mesothelioma
Mesothelioma:
Frequency: 10 %
Gross
G
Malignant tumor of
mesothelial cells
Highly malignant
neoplasm with short
survival
Most p
patients ((70%))
have an asbestos
exposure history
Peripheral lesion
Microscopic
Wastebasket group of tumors
that do not fit the criteria of a
squamous cell carcinoma,
carcinoma
adenocarcinoma, or small
cell carcinoma
A
Asbestos
b t exposure
also increases the risk
of pulmonary cancer
Smoking is not related
to mesothelioma
Prognosis
Similar to adenocarcinoma
Frequency: 30%
Smoking: X 3 (increased risk)
M l < females
Males
f
l
Survival (5 years): 15 - 20%
Peripheral
Frequency: 2 %
Smoking: yes
Males = females
Survival (5 years): 25 a 40 %
%.
Presentation:
Single or multiple tumor nodules
Miliary tumor
Pneumonic form
29
30