clinical med resp
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under-development of lungs (one or both) due to impeded dev of thoracic cavity
partial or total absence of diaphragm---> herniation of abdominal contents into thoracic cavity
- peribronchial cysts, lined by bronchial epithelium
- may contain air or snot
- may ---> abscess formation or rupture into bronchi or pleural cavity
presence of lung tissue that's not connected to the bronchial system
can be extralobar or intralobar (outside or within visceral pleura)
what do hypoplasia, diaphragmal hernia, brochogenic cysts, and brochopulmonary sequestration have in common?
they're all congenital abnormalilites
atelectasis refers to...
incomplete expansion of alveoli
- results from lungs failing to ventilate at time of birth
- due to birth trauma, bronchial obstruction, immaturity
dead baby who never breathed won't float
secondary atelectasis may be due to...?
- deficiency of surfactant
- loss of neg intrapleural pressure
- obstruction of airways
- direct pressure on lungs w focal, segmental, or massive distribution
- permanent dilation of bronchi and bronchioles
- due to destruction of muscle and elastic supporting tissues, often resulting from chronic necrotizing infections or mechanical obstruction of bronchi
- symptoms: cough and spitting
- an OLD
pulmonary infections in the form of pneumonia are responsible for __ deaths in the US
1/6 of all deaths
pneumonia broad def
the specifics depend on..?
- any infection in the lung
- details of the pathological changes depend on the agent and the host's response
where are the lesions?
peribronchiolar and within the alveolar walls, which are widened by edema
viral pneumonia -- where don't you see much exudate?
alveolar spaces are generally free of sgnificant cellular exudate
viral pneumonia - hallmark symptom?
a persistant nonproductive cough,
also seen: rare chest pain and dyspnea
bacterial pneumonia refers to..?
inflammation and solidification of pulmonary parenchyma
2 classes of bacterial pneumonias
- 1 - bronchopneumonia = patchy inflammatory consolidation
- 2 = lobar pneumonia - extensive inflam consol in a lobe, usually due to strept pneumonia
pneumococcal pneumonia 4 stages of dev
- 1 - congestion - bacterial proliferation and inflam response and serous exudation into alveolar space
- 2 - red hepatization - outpouring of neutrophils and precipitated fibrin into alveolar space ---> look and feel of the liver
- 3 - grey hepatization - disintigration of neutrophis and erythrocytes w accumulation of fibrin
- 4 - resolution - digestion and reabsorption of exudate and restoration of pulm parenchyma to normal
- sooo... 1 - congestion = bacteria and body start to fight
- 2 - red hepatization = neutrophils & fibrin come along and we start looking liver-y
- 3 - gray hepatization = the fighters die, the fibrin stays
- 4 - resolution = eating up the casualties, getting back to normal,
fungi as antigens
they're weak, so the tissue damage they cause is mostlly due to the hypersensitivity reaction against the fungi proteins
more detailed def
- accumulation of pus in lung tissue
- localized suppuration and liquefaction necrosis of lung parenhcyma due to inhaling shmutz
- right side due to shallow angle of R bronchus
2 categories of diffuse pulmonary disease (think of Amy Hess)
- 1 - obstructive - increased resistance to airflow due to obstruction
- 2 - restrictive - reduced expansion of lung parenchyma and decreased total lung capacity
4 major OLDs
- chronic bronchitis
(and there's also tumors and inhaling shit)
when does a pulm pt have normal lung capacity but decreased expiratory flow rate?
asthma is what type of hypersensitivity reaction
there's also intrinsic, and he writes "nonimune: viurs infections, cold, stress..."
asthma is characterized by...?
results from ...?
- episodic reversible bronchoconstriction
- increased responsiveness (inflammation) of trachobronchial tree to various stimuli
in OLD which part of breathing is more affected
exp is more affected than insp
changes to bronchioles of upper lobe due to neutrophil elastases -- seen in smokers
- lower lobe
- in smokers w alfa-1-antitrypsin deficiency
what's going on w alveoli in emphysema
alveoli break and what's left merges, so now you have a few big alveoli instead of many small one ---> decreased surface area and gas exchange
what do you have if there's reduced compliance, reduced capacity, normal flow rates?
the extrapulmonary disorder flavor of RLD
affects the abiliity of chest wall to act as bellows (kypho-skoliosis, neuromuscular disorders)
RLD -- an acute syndrom and 2 chronic
- acute - adult respiratory distress syndrome
- chronic - pheumoconiosis, sarcoidosis,
there's also intersitial lung diseases, but he gives no ex.
sleep apnea is due to...?
- inspiratory obstruction by walls of pharynx (chest moves, but no airflow)
- when inspiratory efforts succeed finally, you'll get a loud snore
hypothesis on cause of sudden infant death syndrome
(happens in US in 2/1000 babies)
prolonged apnea, followed by cardiac arrhythmia, and the kid's too small and weak to wake himself
adult respiratory distress syndrome is a life-threatening disorder char by:
acute onset of dyspnea, hypoxemia, cyanosis
etiology of ARDS
- factors that produce diffuse alveolar damage (DAD)
- injury of alveolar capillary endothelium
- this triggers inflam response and alveolar accumulation of fibrinous exudate & dyspnea
- 90% of primary malignant lung tumors
- leading cause of cancer deaths in US
- smoking, occupation (exposure to bad stuff)
- begins in hilar regions and then metastesizes
4 classes of bronchogenic carcinomas
- a - squamous cell carcinoma
- b - adenocarcinoma
- c - bronchoalveolar
- d - small cell carcinoma
three flavors of emphysema
- centrilobular - in upper lobes due to neutrophil elastases
- panacinar - in lower lobes
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