GU Patho Pulmonary
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Cellls that secrete IgA into the lumen of the resp tract.
Cells that secrete anti-proteases & bacteriocidal agents as endogenous abx.
Cells that produce mucin, a bicarb-rich protein.
______ cells differentiate in to the surrounding epithelia as needed.
______ cells serve as detox cells and secrete a surfactant-like substance.
Bronchiolar cells contain _______ and ______ enzymes and may be used to digest the viscous mucus produced more proximately in the bronchial tree.
What do type I and type II pneumocytes do?
- Type I provide structural support
- Type II secrete surfactant
Surfactant ______ the surface tension in the alveoli.
Expansion in the lungs is partially facilitated by the _________ pressure of the pleural cavity.
Movement of gases is based on _______ within the lung.
An obstruction prevents air from reaching distal airways, therefore absorbing the air present, which is followed by alveolar collapse.
Most common cause of bronchus obstruction.
This form of atelectasis can also occur post and via aspiration of a foreign body, and tumors and enlarged lymph nodes (TB).
Also referred to as passive or relaxation atelectasis.
Accumulation of fluid, blood, or air in the pleural avity mechanically collapses the adjacent lung.
This commonly occurs with pleural effusions assoc w/ HF, pneumothorax, bedridden pts, and ascites.
Local or generalized fibrotic changes in the lung or pleura that hamper expansion and increase elastic recoil during expiration.
Extrinsic asthma is a Type ____ hypersensitivity response triggered by a foreign antigen and develops when?
Most common form of extrinsic asthma.
atopic, primarily IgE-mediated
Why do asthma attacks result in labored inspiration with progressive hyperinflation?
b/c of the air trapped in the bronchi filled with mucus & debris
The permanent enlargement of airspaces distal (overinflation) to terminal bronchioles accompanied by destruction of their walls.
Uniform enlargement from the respiratory bronchiole to the terminal alveoli.
Panacinar (panlobular) Emphysema
Lesions commonly found in upper lung and are assoc with the formation of cyst-like structures with progressive enlargement (bullae).
Distal acinar (paraseptal) Emphysema
Bullae (cyst-like structures formed in distal acinar emphysema) can result in ________.
A hallmark of emphysema.
Elastic tissue destruction
Smoking can complicate matters by increasing _______ and _________ accumulation in the alveoli, setting off the cascade of events starting with NFkB.
Smoking activates _______ activity, which is not inhibited by A1AT and digests it too.
What is A1AT?
- an enzyme that can be released by macrophages
- inhibits protease secreted by neutrophils
- genetic deficiency presisposes people to emphysema
What is one differentiation b/w chronic bronchitis and emphysema?
- Emphysema = damaged capillary bed
- Chronic bronchitis = NOT damaged
Blue bloater describes what? Why?
- someone with chronic bronchitis
- increased obstruction -> decreased ventilation & increased C.O. -> hypoxemia & polycythemia & increased CO2 retention ("blue")
- residual lung volume increases ("bloater")
Pink puffer describes what? Why?
- person w/ emphysema
- pink appearance d/t work of neck & chest muscles to take a breath
- hyperventilation compensation ("puffer")
Prolonged collapse of the lung can lead to infection and therefore subsequent ______.
How does alcohol increase the risk of aspiration with pneumonia?
depresses the cough and epiglottic reflexes
Patchy distribution of inflammation that getnerally involves more than one lobe, infection of the bronchi and bronchioles with extension into the adjacent alveoli.
Acute bacterial pneumonia
Type of pneumonia in which airspaces of part of all of a lobe are homogenously filled with an exudate that can be visualized on radiographs as consolidation.
Community-acquired acute pneumonias are generally _______ in nature and tend to follow a __________.
- viral upper respiratory tract infection
Abrupt onset, high fever, shaking, chills, pleuritic chest pain, productive mucopurulent cough, and sometimes hemoptysis.
Community-acquired acute pneumonia
________ are important for dx of acute pneumonia. Why?
- blood cultures
- sputum analysis can yield false positives b/c the bacteria are part of endogenous flora
The TB pathogen commonly causes ________ via ________.
What is the genetic predisposition that allows for proliferation of the mycobacteria (that causes TB) within the macrophage?
Natural resistance-associated macrophage protein (NRAMP1)
S/S of TB within first 3 weeks of exposure.
- Mostly asymptomatic
- might have mild flu-like symptoms
What follows TB infection?
T-cell mediated hypersensitivity and resistance
What accompanies T-cell mediated hypersensitivity after exposure to TB?
tissue destruction via rapid mobilization of defensive reaction and tissue necrosis
Primary TB often resembles what?
acute bacterial pneumonia
What often results with primary TB?
- lower and middle lobe consolidation
- hilar adenopathy
- pleural effusion
Where is secondary TB localized?
to the apex of one or both lobes
Four main s/s of TB.
- low grade fever
- night sweats
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