clinical med resp

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)

they're all congenital abnormalilites

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

• 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

1/6 of all deaths

• any infection in the lung
• details of the pathological changes depend on the agent and the host's response

peribronchiolar and within the alveolar walls, which are widened by edema

alveolar spaces are generally free of sgnificant cellular exudate

a persistant nonproductive cough,

also seen: rare chest pain and dyspnea

inflammation and solidification of pulmonary parenchyma

• 1 - bronchopneumonia = patchy inflammatory consolidation
• 2 = lobar pneumonia - extensive inflam consol in a lobe, usually due to strept pneumonia

• 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,

they're weak, so the tissue damage they cause is mostlly due to the hypersensitivity reaction against the fungi proteins

• 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

• 1 - obstructive - increased resistance to airflow due to obstruction
• 2 - restrictive - reduced expansion of lung parenchyma and decreased total lung capacity

• asthma
• emphysema
• chronic bronchitis
• bronchiectasis

(and there's also tumors and inhaling shit)

OLD

I (extrinsic

there's also intrinsic, and he writes "nonimune: viurs infections, cold, stress..."

• episodic reversible bronchoconstriction
• increased responsiveness (inflammation) of trachobronchial tree to various stimuli

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

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

RLD!

affects the abiliity of chest wall to act as bellows (kypho-skoliosis, neuromuscular disorders)

• acute - adult respiratory distress syndrome
• chronic - pheumoconiosis, sarcoidosis,

there's also intersitial lung diseases, but he gives no ex.

• inspiratory obstruction by walls of pharynx (chest moves, but no airflow)
• when inspiratory efforts succeed finally, you'll get a loud snore

(happens in US in 2/1000 babies)

prolonged apnea, followed by cardiac arrhythmia, and the kid's too small and weak to wake himself

acute onset of dyspnea, hypoxemia, cyanosis

• 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

• a - squamous cell carcinoma
• b - adenocarcinoma
• c - bronchoalveolar
• d - small cell carcinoma

• centrilobular - in upper lobes due to neutrophil elastases
• panacinar - in lower lobes
• localized