1 / 68

Pathology of Respiratory System Disorders

Basic level for allied health students. Prepared specifically for Physician assistant course.

vmshashi
Download Presentation

Pathology of Respiratory System Disorders

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Pathology of Respiratory System Disorders MX1002-PAS-Wk7-RSThe only place wheresuccess comes beforework is in a dictionary…!Vidal Sassoon

  2. MX1002-PAS-Wk7-RSPathophysiologyRespiratory SystemDr. Venkatesh M. Shashidhar.Associate Professor & Head of Pathology MX1002-PAS-Wk7-RSPathophysiologyRespiratory SystemDr. Venkatesh M. Shashidhar.Associate Professor & Head of Pathology

  3. PAS-Respiratory PathophysiologyIntroduction to Resp. Sys:• 10,000L/day of air – filtered, moistened,warmed, O2/Co2. exchanged.!• Full capacity 6L. (500ml at rest)• Sinusitis, pharyngitis, laryngitis…* URI• Pneumonia: Inflammation of lung * LRI• Chronic: COPD, Fibrosis – Smoking.• Commonest internal Cancer.• Respiratory tract inflammations -commonest in medical practice.• Enormous morbidity & mortality.• Important medical learning. Doctors daily bread….! PAS-Respiratory PathophysiologyIntroduction to Resp. Sys:• 10,000L/day of air – filtered, moistened,warmed, O2/Co2. exchanged.!• Full capacity 6L. (500ml at rest)• Sinusitis, pharyngitis, laryngitis…* URI• Pneumonia: Inflammation of lung * LRI• Chronic: COPD, Fibrosis – Smoking.• Commonest internal Cancer.• Respiratory tract inflammations -commonest in medical practice.• Enormous morbidity & mortality.• Important medical learning. Doctors daily bread….!

  4. PAS-Respiratory PathophysiologyNormal Lung

  5. PAS-Respiratory PathophysiologyRespiration – Respiratory system:5 PAS-Respiratory PathophysiologyRespiration – Respiratory system:5

  6. PAS-Respiratory PathophysiologyRespiration – Respiratory system:6 PAS-Respiratory PathophysiologyRespiration – Respiratory system:6

  7. Normal Lung

  8. PAS-Respiratory PathophysiologyAlveolar Gas Exchange:8Co2O2 PAS-Respiratory PathophysiologyAlveolar Gas Exchange:8Co2O2

  9. PAS-Respiratory PathophysiologyLung Function testing:9Expiration0 ------- Volume ---------------6LInspiration PAS-Respiratory PathophysiologyLung Function testing:9Expiration0 ------- Volume ---------------6LInspiration

  10. . PAS-Respiratory PathophysiologyLung Function Testing:• Total Lung Capacity (TLC) 6L male/4.7L fem.• Tidal Volume (TV) – 500 / 390ml• Forced Vital Capacity (FVC) 4.8L / 3.7L• Forced Expiratory Volume in 1 Sec - FEV1• FEV1/FVC (FEV1%) - 75–80% normal.1. In Obstructive diseases (COPD) FEV1 low& FVC high. So FEV1/FVC is low (<80%).2. In Restrictive diseases (fibrosis) the FEV1and FVC are both low proportionally and theFEV1/FVC value normal or high. Volume (%FYC)

  11. . MX1002-PAS-Wk7-RSFirst step to make yourdreams come trueis to wake up!— Paul Valery

  12. . PAS-Respiratory PathophysiologyPneumonia: Infection of lung (LRT)• Inflammation of alveoli• Etiology: pathogens vs defence.• Types: Bacterial, viral, fungal, other.• Clinical: Lobar / Broncho pneumonia.• Symptoms: Fever, cough, dyspnoea.• Complications: Spread  septicemia,abscess, scarring.

  13. . PAS-Respiratory PathophysiologyPneumonia Types:Etiologic Types:• Infective– Viral– Bacterial– Fungal– Tuberculosis• Non Infective– Toxins– chemical– AspirationMorphologic types:• Lobar• Broncho• InterstitialDuration:• Acute• ChronicClinical:• Primary / secondary.

  14. . 1. Congestion 2.Red HepatisationNormal 4. Resolution 3. Grey HepatizationPathogenesis of Pneumonia

  15. . PAS-Respiratory PathophysiologyPneumonia:

  16. . PAS-Respiratory PathophysiologyLobar Pneumonia - Primaryin healthy people in community. Gram Positive Cocci, wholelobe unilateral. heals without scar. Rare complications.

  17. . PAS-Respiratory PathophysiologyBronchopneumonia - Secondaryin Sick patients, Gram Negative bacilli, bilateral,basal. More complications, heals by scarring.

  18. . PAS-Respiratory PathophysiologyBroncho-pneumonia – Lobar-pneumonia• Extremes of age.• Secondary, in sick.• Both genders.• Klebsiella, E.coli• Patchy, basal, bilateral.• Around Small Bronchi• Not limited by anatomicboundaries.• Usually bilateral.• Middle age – 20-50• Primary in a healthy adult.• males common.• 95% pneumococcus• Entire lobe consolidation• Diffuse• Limited by anatomicboundaries.• Usually unilateral

  19. . PAS-Respiratory PathophysiologyTuberculosis:• Mycobacterium tuberculosis (typical)• Primary & Secondary,• Chronic, Hypersensitivity to bacteria,• Caseating Granuloma + Fibrosis.• debilitating, weight loss.• Upperlobe, cavity + fibrosing.• Systemic spread, miliary spread.• Tuberculin Test – hypersensitivity.

  20. . MX1002-PAS-Wk7-RS“Whether you think that youcan or that you cant,you are right…!”– Henry Ford

  21. . MX1002-PAS-Wk7-RSChronic Lung disorders:Obstructive & Restrictive

  22. . PAS-Respiratory PathophysiologyRestrictive vs Obstructive• Interstitial fibrosis• Stiff hard lung• Increased tissue• Normal FEV1:FVC ratio• Normal PEFR.• Types:– Fibrosis,– Pneumoconiosis• Obstruction to air flow.• Soft lung• Loss of tissue.• Low FEV1:VC ratio• Low PEFR.• Types:–COPD–Asthma

  23. . PAS-Respiratory PathophysiologyRestrictive - Obstructive

  24. . PAS-Respiratory Pathophysiology• Irreversible, fibrotic pulmonarydisease due to the inhalationof large amounts of silica dustover time.• Road, civil & mining workers.• Toxic  Inflam  fibrosis.• dyspnea, fatigue, weight loss,fever, and pleuritic pain.• Multiple small, fibrotic Nodulesbilateral + emphysema.• Restrictive pattern of PFT.• TB association common.Silicosis: Restrictive COPDFine nodular shadows

  25. . PAS-Respiratory Pathophysiology• Beaded protein coveredneedle like microscopic .Asbestos bodies• Within alveoli & sputum.• Dyspnoea, dry cough• Diffuse fibrosis: Honey comblung  Pulmonary failure.• Mesothelioma – pleuralcancer.Asbestosis: Restrictive

  26. . MX1002-PAS-Wk7-RSPathology ofChronic ObstructivePulmonary Diseases (COPD)Dr. Venkatesh M. ShashidharAssociate Professor of Pathology

  27. . PAS-Respiratory PathophysiologyObstructive Airway Disease:• Localized: Foreign body, aspiration, tumor..• Diffuse – Distal airway diseases– Transient reversible spasm - Asthma– Chronic irreversible permanent – COPD.

  28. . PAS-Respiratory PathophysiologyAsthma Clinical Pathology:Chronic hypersensitivity inflammatorydisease of bronchi  excess mucousand spasmodic occlusion.Causes• Allergic: allergens, infection• non-allergic:neurogenic,psychogenicSigns and symptoms• dyspnea, wheezing, catching for air.• cough – viscous thick sputum• Tachycardia & chest pain

  29. . BronchialInflammationTRIGGERSAllergens, Exercise,Cold Air, SO2 ParticulatesAirwayHyperresponsivenessGenetic*INDUCERSAllergens,Chemical sensitisers,Air pollutants, Virus infectionsAirflow Limitation

  30. . PAS-Respiratory PathophysiologyChronic Obstr. Pulm Disease: COPD• Chronic, irreversible airway obstruction withdestruction of bronchi & alveoli.• Clinical: Chronic bronchitis, Emphysema orCOPD (combined).• Smoking / pollution – commonest cause• 15% smokers develop COPD.• Finally leads to lung failure or Cancer.

  31. . PAS-Respiratory PathophysiologySmoking – Pathogenesis• Increase in– Alveolar marcrophages– CD8 Lymphocytes– Neutrophils– Proteases.• Tissue irritation / destruction• Airway damage- Bronchitis• Alveoli damage- Emphysema.Emphysema Bronchitis

  32. . PAS-Respiratory PathophysiologySmoking effects: FEV 1 & Age

  33. . PAS-Respiratory PathophysiologyPathogenesis – Smoke - Lung Dis.CancerInflam COPDIrritation  Inflammation  Mucous  Infections  destr. COPD  Cancer

  34. . PAS-Respiratory PathophysiologyNormal - COPD

  35. . PAS-Respiratory PathophysiologyCombined  COPD (common)

  36. . PAS-Respiratory PathophysiologyLung Normal & in Smokers:

  37. . PAS-Respiratory PathophysiologySmokers lung – COPD Bronchitis

  38. . PAS-Respiratory PathophysiologyEmphysema

  39. . PAS-Respiratory PathophysiologyEmphysema:Pink Puffer:• Lean/weight loss• Forward stooping• Barrel chest• Flat diaphragm• Hyperlucent Lung

  40. . PAS-Respiratory PathophysiologyComplications of COPD:1. Cor Pulmonale – Heart failure.2. Acute Exacerbations.3. Recurrent pneumonia.4. End-stage lung disease.5. Polycythemia – hypoxia.6. Bronchiectasis.7. Lung Cancer.

  41. . PAS-Respiratory PathophysiologyBronchiectasis:• Permanent dilatation ofbronchi with pus.• Cough, copious purulentsputum (pus).• Lower lobes common• Complications -Pneumonia, septicemia,meningitis.• Management – surgicalresection.

  42. . MX1002-PAS-Wk7-RS“Get me well so I can get ontelevision and tell people tostop smoking…!”-- Nat King Cole

  43. . “Troubles are often the tools by whichnature fashions us for better things”- Henry Ward Beecher

  44. . Life’s battles don’t go always to the stronger orfaster man, sooner or later, The man who wins isthe man who thinks he can….!

  45. . MX1002-PAS-Wk7-RSPathology ofLung tumors(Lung Cancer)Dr. Venkatesh M. ShashidharA/Prof. & Head of PathologySchool of Medicine45

  46. . PAS-Respiratory PathophysiologyLung Cancer Intro:• Most common & fatal cancer (internalmalignancy)• Kills more people than colorectal,breast, and prostate cancers combined.• Significant increase in incidence..(developing countries*)• Now Increasing in females > breastcancer.• 90% of lung cancers are related tosmoking..! (passive smoking in 5%)• Mutagen sensitive genotype : P-450enzyme• Poor prognosis ~ 5% 5y survival *46

  47. . PAS-Respiratory PathophysiologyLung Cancer Incidence:47

  48. . PAS-Respiratory PathophysiologyLung Cancer & Smoking:• Proportional to duration, amount & quality of smoking &deep inhaling.• 90% are smokers and 10% are non smokers• 20 fold risk if >40cigarettes per day• >100 fold combined with Asbestos, coal, radon, etc.• Atypical cells in sputum in 96.7% of smokers - 0.9% in nonsmokers.• Smoke has several irritants & carcinogens.– Initiators – Benzo[o]pyrenes– Promoters – Phenol derivatives– Radioactive substances – Polonium, C14, K4048

  49. . PAS-Respiratory PathophysiologyLung tumors Classification:• Benign tumours – rare (Adenoma, Hamartoma)• Malignant (common):– Bronchogenic Carcinoma: (95%)– Bronchial Carcinoid Tumor (5%)– Other Tumors (<1%)– Metastasis (common)• Tumors of Pleura– Mesothelioma – asbestosis *49

  50. . PAS-Respiratory PathophysiologyTypes of Bronchogenic Ca.:• Bronchogenic Carcinoma (95%)– Small cell ca. SCC – 15-20% (oat cell carcinoma)– Non Small cell NSCC– 80%• Squamous cell carcinoma – 20-30%• Adeno carcinoma – 30-40%• Large cell anaplastic carcinoma• Clinical / prognostic classification:SCC - small cell CaEarly spreadSurgery not possible.Responds to chemo50Non-SCCLate spread – localizedStaging & SurgeryDoes not respond to chemo.

More Related