Card Set Information
Disease states that promote pulmonary embolism in situ?
hypertension, pulmonary atherosclerosis, heart failure
Number one cause for patients dying in the hospital?
Secondary hypercoagulable causes for pulmonary embolism?
oral contraceptives, recent surgery, obesity, cancer, pregnancy
Two main pathological consequences of PE
respiratory compromise, non perfused but ventilated portion of the lung.
cardiac compromise, increased pulmonary resistance
What is cor pulmanale?
Failure of the right heart due to pulmonary hypertension
Will a small pulmonary embolism cause an infarct?
not usually in an individual with normal heart function
How to distinguish from a pulmonary infarct or hemorrhage
An infarct will cause damage to the lung parenchyma
PE lesion has a wedge shape with apex pointing to hilum.
PE that is infected, leads to more intense neutrophile exudation and more intense inflammatory response
Some convert to abscesses.
ECG shows a rhythm but there is no pulse.
Clinical symptoms after surviving a PE
chest pain, fever, dyspnea, shock, increased serum lactic dehydrogenase
Testing for PE
Prophylactic treatment to prevent PE
early ambulation, elastic stockings, anti coagulation
Non thombotic forms of PE
air, fat, amniotic fluid, sickle cells, foreign bodies during IV drug use
What pressure is pulmonary hypertension?
In obstructive pulmonary disease pulmonary hypertension is caused by?
alveolar hypoxia causes vasoconstriction of its bronchioles
4 causes of pulmonary hypertension?
1. COPD, vasoconstriction due to hypoxia
2. left heard failure of mitral stenosus
4. Autoimmune, sclerosis, attach of collagen leading to inflammation
P hypertension with no known cause
idiopathic primary p hypertenstion
Cause of primary pulmonary hypertension?
mutation in the BMOR2 signaling pathway
What is BMPR2
cell surface protein of the TGF-beta family
binds TGF, BMP, activin, inhibin
in vascular smooth muscle BMPR2 causes inhibition of proliferation and favors apoptosis
Two hit model where a person with BMP2 mutation needs additional genetic or environmental insult to develop the disease
Loss of _ promotes vascular constriction and plt adhesion
Environmental and drugs that have proven to cause pul htn
crotalaria spectabilis, bush tea
aminorex, appetite suppressant
fenfluramine and phentermine, anti obesity drugs
plexogenic pulmonary arteriopathy?
tuft of capillaries that form producing a network that spans the lumens of dilated thin walled vessels.
coughing up blood?
Hardening of tissues?
Causes of vascular lessons in pul htn
medial muscular hypertrophy
organized thrombi, recanulization
Good pastures syndrom?
autoimmune disease of circulating antibodies targeted to collagen IV
Initiate an inflammatory destruction of the basement membrane in the lungs and kidney glomeruli
Causes rapid progressive glomerulonephritis and necrotizing hemorrhagic interstitial pneumonitis
may be unmasked by some environmental insult
Deposits of immunoglobins on the BM
Treat with plasma replacement and immunosuppresive therapy
Illness accompanying kidney failure?
Idiopathic pulmonary hemosiderosis
Intermittent diffuse alveolar hemorrhage
Presents with cough, hemoptysis, anemia, weight loss
longs have areas of consolidation
What is the key feature to idiopathic pulmonary hemosiderosis?
There is hemorrhage into the alveolar space and hemosiderosis in the alveolar space and free macrophages in the alveoli
abnormal accumulation of hemociderin
hemociderosis, iron overload disorder.
autoimmune, upper respritory tract and lungs
Diagnostic features are capillarities and scattered poorly formed granulomas
Infection of the lung parenchyma?
Most common infection?
Factors that affect resistance to infection?
Ways the respritory clearing mechanism can be interfered with, 5?
Loss of cough reflex; anesthesia, coma, drugs, chest pain
Injury to ciliary apparatus; smoking, genetic, corrosive gases
Loss of alveolar macrophages; smoking, drinking, anoxia, oxygen intoxication
pulmonary congestion or edema
accumulation of secretions; CF
One type of pneumonia can predispose you to another
Infection originating in the hospital
7 pneumonia syndromes
1. community acquired
2. community acquired atypical
6. necrotizing and lung abcess
7. pneumonia in the immune compromised host
Bacterial invasion of the lung causes the alveoli to be?
filled with an inflammatory exudate, thus causing consolidation of the tissue.
Film produced my bacteria in the lungs to protect itself
Streptococcus pneumoniae, pneumococcus
Most common community acquired
Diagnosis with gram positive filled macrophages
responds to PCN
20% of the population have this as normal flora, can then check for blood culture
pleomorphis, gram negative
major cause of life threatening lower repritroy infections and meningitis in children
community acquired acute pneumiae
colonizes the pharynx
two forms incapsulated and un-incapsulated, the encapsulated secretes haemocin that kills the un-cap
can produce otitis media, sinusitis, and bronchopneumonia
secretes a factor that disorganizes ciliary beating and a protease that that degrades IgA
can cause acute pink eye in children
Most common bacterial cause of acute COPD
community acquired, one of the top causes of otitis media in children
community and nosocomial
secondary bacterial pneumonia following a viral infection
lung abscess and empyema
most frequent cause of gram negative pneumonia
Thick and gelatinous sputum
commonly affects malnourished and debilitated people, alcoholics
most common cause of nosocomial pneumonia but also community acquired with cystic fibrosis patients
lives in artificial aquatic environments, water cooling tower, portable water supplies
predisposed by chronic organ disease
diagnose by culture, antigens in the urine
Community acquired pneumonia morphology
bronchial, patchy consolidation
four stages; congestion, red hepatization, grey hepatization, resolution
red stages is blood filled exudate and when when blood is digested just fibrin exudate is left behind
complication of pneumonia
tissue distraction with necrosis and abcsess formation
spread of infection to the pleural cavity known as empyema
organization of the exudate
bacterial dissemination to the heart valves, brain kindness spleen and joints
Clinical course of community acquired pneumonia
abrupt onset of fever, shaking chills, cough with mucopurulent sputum, hemptysis
radio-opaque appearance of lobe or broncials
collection of pus and infection in the pleural cavity
Community acquired atypical pneumonia
modorate amount of sputum , no physical findings of consolidation, small elevation of white cells, lack of exudate and afebrile
most common cause is mycoplasma pneumonia
viral causes are; influenza, synctial, adenovirus, rhinovirus, herpis simplex, cytomeglovirus)
most of the time identified as the common cold
attaches to upper respritory tract and causes inflammation
Atypical pneumonia morphology
trasidate edema in the alveoli
Patchy or lobar ares of congestion without consolidation
viral envolope contains hemagglutinin and neuraminidase
cleared by cytotoxic t cells
pandemics occur when there are mutation in the hemaggluinin and neuraminidase; can be with the animal forms
Severe acute respiratory syndrome (SARS)
Incubation period of 2-4 days
dry cough, malaise, myalgias, fever and chills
caused by a coronavirus, infects the lower respiratory tract and spreads throughout the body
pain in muscles
general feeling of illness
common in patients with severe underlying disease, immunosuppressed, prolonged antibiotic therapy, pt with IV catheters
Gram negative rods of enterobacteria and staphylococcus aureus
can aspire while unconscious or during repeated vomiting
typically recover more then one organism from culture, aerobes are more common
a local suppurative process within the lungs
common organisms are streptococci, staphylococcus auras and a host of gram negative
Introduction methods organisms of lung abscess
1. aspiration of infected material; in acute alcoholism, coma, anestesia, dental sepsis depressed cough reflex,
2. primary bacterial infection
3. septic emobolism
4. neoplasia, from a malignancy
5. miscellaneous; direct trauma, spread of infection,
6. no known cause, primary cryogenic lung abscesses
Morphology of abscesses
very in size
if due to inspiration, more common on right
scattered if due to infection
can lead to gangrene of the lung
CARDINAL CHANGE; suppurative destruction of the lung parenchyma within the central area of cavitation
must rule out carcinoma
usually a localized lesion in the immunocompetent patient
fungal ( histooplasmosis, blastomycosis, coodioidomycosis); granulomatous that resemble TB, thermally dimorphic,
thermally dimorphic fungi?
grow as hyphae and produce spores at environmental temps but grow as yeasts at body temp
Histoplasma capsulatum is acquired by inhalation of dust particles for soil contaminated by bird or bat droppings
ohio, mississippi river, and caribbean
intercellular parasite of macrophages
self limited primary pulmonary
expresses a heat shock protein that binds to macrophage B2-integrin
multiple in the phagasome and multiple in the macrophage before lysing it
T cells recognize the fungal cell wall antigens and secrete interferon which activates the macrophage to kill the yeast
Histoplasma induces macrophages to secrete TNF to recrouit more macrophages
Disseminates in the immunecompromised patient
seen in apices of the lungs
central and southeast US, canada, middle east, and africa
can come through the skin
abrupt illness with productive cough, headache, chest pain, fever, and pain
suppurative granulomas in which macrophages can not digest, the prolonged precense of yeast cells keeps recruiting neutrophils
skin can be involved and may be mis diagnosed as squamous cell cancer
almost 100% infection rate if inhaled
southwest and far west US
positive skin test reaction
when ingested by the macrophage the fusion of the phagosome and lysosome is blocked to resist killing
Pneumonia in the immunocompomised host
infected by opportunistic bacteria
in AIDs patients it is usually P. carinii
Bacteria; pseudomonas aeruginosa, mycobacterium, legionella pneumophilia, listeria monocytogenes
Viral; CMV and herpes
Fungi; pneumocysetes caranii canidida, aspergillus, phycomycetes, cryptococcus neoformes
Pulmonary disease in HIV patients
leading cause of disease in HIV patients
Kaosi sarcoma and non hogkins lymphoma, both non infectious agents
CD4 count; bacterial and tubrical infections with a count over 200, pneumocystis usually below 200, mycobacterium below 50.