Non-neoplastic lung disease
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- Created by: z
- Created on: 17-03-16 15:17
Asthma
- paroxysmal, reversible
- intrinsic- adults, causes such as exercise, infcetion, stress
- extrinsic- largley in children, due to external agent (pollen, chemicals etc)
- dust mites, cockroach allergen, animal allergens, mold allergens, tobacco smoke
- allergen complex w/ IgE on mast cells > degranulation > prod histamine and leukotriene
- histology:
- shedding of bronchial epithelial cells
- thickening of BM
- eosinophils + Charcot-Leyden crystals (needle-like, purple/red in trichrome stain)
- incr bronchial gland mass w/ incr mucus > Curschmann's spirals (coiled mucus plugs)
- incr smooth muscle
- inflam: T cells, eosinophils, +/- neutrophils
- status asthmaticus:
- hyperinflation
- petechial haemorrhages (1-2mm, purple/red)
- mucoid plugging (get cast of airways) w/ secondary atelectasis
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COPD- chronic bronchitis
- chronic bronchitis
- clincial Dx: 'persistent cough w/ sputum prod for at least 3 months over 2 consecutive yrs'
- recurrent infections
- blue bloater
- causes: smoking, pollution
- pathological changes in lg airways:
- increased mass of bronchial mucus glands (Reid index >0.4)
- incr in no. of goblet cells
- incr in smooth m.
- chronic inflam cell infiltrate of lamina propria
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COPD- emphysema
- morphological Dx
- permanent enlgmnt of air spaces distal to terminal bronchiole, accom by dstruction of their walls w/o obvious fibrosis
- pink puffer
- loss of alveolar walls and dilation of air spaces
- morphological types:
- centrilobular: 75% of cases- caused by smoking/pollution, most severe in upper lobes
- panacinar/panlobular- assoc. w/ alpha anti-trypsin def
- paraseptal/distal acinar- unclear cause, assoc. w/ spont pneumothorax
- irregular- assoc. w/ scarring, clinically not significant
- compensatory emphysema: response to loss of lung (e.g. pneumectomy)
- senile emphysema: age related
- obstructive: e.g. tumour
- bullous: assoc. w/ bullae often w/ backgrd of centrilobular emphysema > rupture > pneumoT
- interstitial: air in CT of lung/pleura/mediastinum
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COPD- complications
- cor pulmonale
- resp failure
- polycythaemia
- lung ca
- pneumothorax
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Interstitial pulmonary fibrosis
- 'progressive interstitial scarring leading to resp incapacity and effacement of lung architecture, in extreme cases get honeycomb structure'
- honeycomb: cysts of mm-cm on background of dense fibrous scarring
- causes: antecendent lung diseases:
- idiopathic interstitial pneumonia
- DAD
- inorganic dust exposure (asbestos)
- interstitial granulomatous disease EAA/hypersens pneum, sarcoidosis, berylliosis
- histiocystosis X
- causes: antecendent lung diseases:
- honeycomb: cysts of mm-cm on background of dense fibrous scarring
- interstitial fibrosing alveolitis;
- idiopathic/cryptogenic
- secondary
- CT disease
- dust/smoke inhalation
- asbestos
- EAA, sarcoidosis
- shock lung, radiation, drugs
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Interstitial pulmonary fibrosis
- · Acute interstitial pneumonia (AIP)
- · Usual IP
- · Desquamate IP
- Non-specific IP
- · GIP, LIP
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AIP & UIP
- AIP
- Well individuals > URTI signs > progressive rapid resp failure
- High mortality
- Histology:
- Signs of diffuse alveolar damage
- Necrosis of alveolar linig cells w/ exudate
- Hyaline membranes
- UIP
- Insidious onset od dyspnea
- Survival 4/5yrs
- Seen w/ CFA, also assoc. w/ collagen-vascular diseases esp RA, scleroderma
- Histology:
- Fibroblastic foci
- Honeycomb change
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DIP & NIP
- DIP
- Uncommon, think middle age smoker
- Dyspnea, cough
- Responds to steroid R, goodish prognosis
- Pathology:
- Incr macropahges in interstitial spaces
- Uniform interstitial fibrosis
- NIP
- Dyspnea and cough in middle aged adults
- Underlying CT D in some pts
- Steroid responsive
- Microscopy:
- Uniform inflammatory and fibrosing process
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EAA
- Extrinsic Allergic alveolitis/hypersensitivity pneumonia
- Wide range of antigen tho smt none found
- Clinical presentation:
- Acute: sudden onsent dyspnea, fever, chills; symtpoms subside w/ cessation of exposure, re-appear on re-exposure
- Chronic: prolonged exposure to small amt of antigen; insidious onset dyspnea, dry cough, fatigues; reticulonodular infiltrates on CXR; progress to irreversible damage if persistent exposure
- Radiologically:
- Lower lobe ‘ground glass’ and fine nodular densities
- Histology:
- Variable lymphoplasmacellular infiltrate
- Small non-necrotidsiing loose grnaulomas
- Foamy macrophages
- BOOP pattern in 50%
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Pneumoconiosis
- non-neoplastic reaction to inhalation of mineral dusts
- reactin of lung to dust dep on:
- propteries- fibrogenic vs inert
- size of particles
- length of exposure
- susceptibilty of individual
- fibrogenic dusts:
- silica
- asbestos
- hard metals - cobalt, tungsten
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Silicosis
- most prevalent Occ D worldwide
- airnorne silica prod by: sandblasting, rock drilling, foundry work, quarrying, tunneling
- silicosis:
- collagenous nodules in lungs and mediastinal lymph nodes
- irreversilble low mort but pos resp incapacity
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Asbestos
- amphiboles
- crocidolite and amosite (blue and brown asbestos)
- more pathogenic as impact airways more
- serpentines
- chrysolite (white asbestos)
- cleared effcetively, thus less pathogenic
- asbestos chest disease
- pleura pathology
- benign pathology
- pleural plaques: asymptomatic, composed of hydrolinised collagen
- benign pleural thickening
- pleural effusion
- asbestosis/interstitial fibrosis
- benign pathology
- pleura pathology
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Asbestos- malignant disease
- mesothelioma
- 90% assoc w/ abestos exposure (decades prev)
- bronchogenic carcinoma
- assoc w/ accompanying asbestosis
- all forms of ca but esp adenocarcinoma
- laryngeal ca
- ?colon ca
- RR of ca w/ asbestos + smoking exposure = 55
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Pulmonary HTN
- 'mean pulm art pr >25mmHg at rest or > 30 mmHg during exercise'
- primary:
- rare
- F>M
- young adults only
- v poor prognosis- transplant pos
- secondary
- L>R cardiac shunts
- venous back pr (mitral stenosis)
- hypoaxaemic lung disease (COPD)
- drugs
- vascular obstruction (repeated PTE)
- morphology
- muscularisation of arterioles
- medial thickening of m. arteriesl
- intimal thickening
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