Lecture 58 - Pathology of Obstructive Disease

Question 1

what are the obstructive pulmonary diseases ?

Answer 1

COPD:
Chronic bronchitis
Emphysema

Asthma

Bronchiectasis

Question 2

where do the following occur anatomically ?

• chronic bronchitis
• Emphysema -
• Asthma

Answer 2

CB - bronchus, bronchioles

Emphysema – acinus

Asthma – bronchus, bronchioles

Question 3

what is emphysema?

what are the different pathological types?

Answer 3

Abnormal enlargement of the air spaces distal to the bronchiole (acinus)

Destruction of the airspace walls, and their elastic recoil

“think of trying to inflate plastic bag, rather than balloons”

Centriacinar
Panacinar
Paraseptal

Question 4

Centriacinar emphysema –

what is it associated with?
where is it worse

what does it look like under the microscope

Answer 4

Associated with smoking
More severe in the upper lobes

Looks like cysts but there is no scar or fibroustissue; no discrete lining

Question 5

Panacinar emphysema

• what is it associated with?
• where is it worse?

Answer 5

Associated with 1-antitrypsin deficiency

most severe at lung bases, lower lobes

Question 6

Paraseptal emphysema

• what is seen patholgocially
• what complication can arise

Answer 6

blebs and bullae
which can cause spontaenous pneumothorax

pneumothorax

Question 7

what is the pathophysiology of Emphysema?

Answer 7

Abnormal balance of proteolysis -ant proteolysis

Question 8

what cells secrete elastases, how are they kept in check?

Answer 8

Elastases – secreted by macrophages, mast cells, neutrophils and even bacteria in response to inflammation (such as foreign particles of smoking). Usually kept in check by Elastase inhibitors so they will do their job but not damage the lung

Question 9

how does smoking lead to an imbalance of proteases and antiproteases

Answer 9

Smoking – can activate macrophage that relase IL-8 and other neutrophil chemotactic factors

Neutrophils and macropages secrete elastases

Cigarette ROS can inhibit anti-proteolytic activity

Question 10

how does alpha 1 anti-trypsin lead to emphysema ?

what other organ is damaged?

Answer 10

Autosomal recessive d/o
Defect in the folding of the alpha 1 anti-trypsin enzyme which is produced in the liver

therefore deficienct

leads to pan acinar emphysemia

cirrhosis

Question 11

what is the pathophysiology of chronic bronchitis?

Answer 11

Smoking/smog

leads to increased goblet cells and increased mucous gland production

Question 12

complications of chronic bronchitis ?

Answer 12

Cor pulmonale

Pulm HTN

Question 13

Presenation of Chronic bronchtis vs emphysema

Answer 13

Chronic Bronchitis – the blue bloater. Productive cough;
Dyspnea
Common infections

Emphysema - the pink puffer
cough with minimal sputum
prused lips
worse dyspnea

Question 14

Bronchiole Asthma

what is it?

causes?

Answer 14

Chronic relapsing inflammatory disease with hyperreactive airways
Episodic reversible bronchoconstriction

Causes – Atopy (IgE mediated)

non atopic (virus, irritants, cold, aspirin, exercise)

Question 15

pathologic changes in an asthma attack?

Answer 15

Broncho - constriction

Mucous production

smooth muscle

Question 16

what is the role of mast cells?

what is the role of eosinophils

Answer 16

Eosinophils (IL-5, IgE) –

Question 17

gross morphological findings of patients who’ve died of asthma attacks ?

Answer 17

mucus plugs

hyperinflated lungs

Question 18

Mircoscopic findings of patients who’ve died of asthma attacks?

what are the two eponym findings?

Answer 18

Microscopic: Bronchial inflammation, layer of eosinophils, prominent smooth muscle cells, mucous gland hyperplasia, thick basement membrane

		Curschmann's Spiral -- whorls of shed epithelium 

		Charcot Leyden Crystals --- eosinophil derived crystals

Question 19

Bronchiectasis –
what is it?
what causes it?

Answer 19

Inflammatory destruction of bronchial wall; loss of airway tone leading to trapping

Cystic fibrosis 
TB 
Kartagener syndrome (cilia dont' work) 
Post obstructive infections and inflammation 
allergic bronchopulmonary aspergillosis