Date post: | 13-Dec-2015 |
Category: |
Documents |
Upload: | douglas-randell-mccoy |
View: | 215 times |
Download: | 0 times |
Chronic Obstructive Lung Diseases(COPD)
Lecture
Qassim University, Faculty of MedicineYear II , 201 DENM
Pathology DepartmentPresented by Dr. Ola Omran
Obstructive diseases
• Decreased expiratory flow rate• Loss of elastic recoil as in emphysema• Anatomic airway narrowing as in asthma
COPD
1. Emphysema 2. Chronic Bronchitis 3. Bronchial Asthma
EMPHYSEMA• Abnormal permanent enlargement of the air spaces
distal to the terminal bronchioles, accompanied by destruction of their walls without obvious fibrosis.
• Overinflation : enlargement of air spaces without destruction
Four major types (1) Centriacinar (2) Panacinar (3) Distal acinar (4) Irregular
Ruptured alveloli
Alveoli are larger and fewer
• Thinning and destruction of alveolar walls
• With advanced disease, adjacent alveoli create large airspaces
• Terminal and respiratory bronchioles may be deformed.
• With the loss of elastic tissue alveoli tend to collapse during expiration
• The number of alveolar capillaries is diminished
MorphologyMP: EMPHYSEMA
Cigarette smoking and emphysema
Chronic bronchitis
Prolonged lymphocytic inflammation of bronchial tree with hypertrophic mucosal glands that leads to productive coughChronic bronchitis as a clinical definition, requires all of: 1. Persistent cough and sputum production 2. Present for at least 3 months 3. Present for at least 2 consecutive years
6
Bronchitis Emphysema
Mild dyspnea, late.Mild dyspnea, late.
Infections commonInfections common
Prominent BV Prominent BV
Large heart.Large heart.
• Severe dyspneaSevere dyspnea, , earlyearly..
• Infections occasionalInfections occasional
• Hyperinflation Hyperinflation
• Small heart.Small heart.
Emphysema is morphologic feature & restricted to the acinusChronic bronchitis is clinical feature & involve large and small airways
Complications
1. Secondary pulmonary hypertension 2. Pulmonary failure with respiratory acidosis,
hypoxia, and coma. 3. hypoxia-> Polycythemia4. Right-sided heart failure (cor pulmonale).5. Infections, Bronchectasis.6. Bulla-Pneumothorax, collapse
3. Bronchial Asthma
Chronic inflammatory disorder of the airways that causes recurrent episodes of wheezing, breathlessness, chest tightness, & cough, particularly at night and/or early in the morning
1- Hypertrophy of submucosal mucous glands
2- Accumulation of mucus in the bronchial lumen
3- Intense chronic inflammation (eosinophils, macrophages)
4- Thickened basement membrane5- Hypertrophy and hyperplasia of
smooth muscle cells.
MP: Bronchial Asthma
Extrinsic : Association with atopy (allergies) mediated by type 1 hypersensitivity, and asthmatic attacks are precipitated by contact with inhaled allergens. This form occurs most often in childhood
Intrinsic : Asthmatic attacks are precipitated by respiratory infections, exposure to cold, exercise, stress, inhaled irritants, and drugs such as aspirin. Adults are most often affected
Bronchial Asthma
• AllergyAllergy• Inflammation of BronchiInflammation of Bronchi• ObstructionObstruction• Mucous PlugsMucous PlugsEpidemiology/pathology
AsthmaNormal
Barnes PJ
Mechanism of Asthma
Occupational Asthma • asthma is stimulated by:
– fumes (plastics) – organic and chemical
dusts (wood, cotton, platinum)
– gases (toluene)
• Develop after repeated exposure to the inciting antigen(s).
Drug-Induced Asthma
• Pharmacologic agents provoke asthma, aspirin
• Mechanism remains unknown
• The bronchial lumen filled with mucus
Submucosa widened by 1. smooth muscle
hypertrophy, 2. edema, 3. inflammation (mainly
eosinophils)
• Hypertrophy of submucosal mucous glands
CHRONIC ASTHMA
Charcot-Leyden crystals Eosinophilic needle-shaped crystalline structures. Represents breakdown products of eosinophils
CHRONIC ASTHMA Sputum smear
CURSCHMANN'S SPIRAL, Spiral shaped mucous plug+shedded epithielium.