Pulmonary Infections

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Whether you think that you can, or that you
can't., you are usually right! Henry Ford
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Normal Lung
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Normal Lung
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Normal Lung Tissue
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Chronic Obstructive Pulomary Diseases(COPD)

• Dr. Venkatesh M. Shashidhar
• Associate Professor of Pathology
• Fiji School of Medicine

Commitment to Excellence
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Obstructive Airway Disease

• Localised Mechanical
• Tumours, Trauma, Foreign body collapse
• Diffuse Distal airway diseases.
• COPD chronic
• COPD Definition
• Progressive irreversible airway obstruction with
  destruction of parenchyma.
• Chronic obstructive bronhitis
• Emphysema
• Mucous plugging.

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COPD Introduction.

• Chronic Slow progress (FEV1lt80, FEV1/CV lt70)
• Stable over several months. (chronic)
• 15 of smokers likely to develop COPD.
• Etiology smoking, pollution. Low birth wt.
• Smoke ?irritation ? mucosal hyperplasia ? excess
  mucous ? obstruction, inflammation.
• Metaplasia, lack of defense / clearance mech.
• Obstruction, lack of elastic recoil, collapse.

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Pathology of Smoking

• Irrefutable evidence - smoking ? disease
• gt4000 chemicals, 43 carcinogens.
• Range of non-neoplastic and neoplastic dis.
• Chronic bronchitis, emphysema common.
• Ca bladder, Pancreas, cervix, larynx.
• Gastritis, PUD, IHD, HPTN, atherosclerosis risk
  factor.
• Arteriosclerosis Bergers

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Smoking - Pathology

• Alveolar marcrophage
• CD8 Lymphocytes
• Neutrophils
• Proteases
• Bronchitis.
• Alveolar destruction.

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Pathogenesis Smoke - Lung Dis.
Irritation Inflammation Mucous - Infections
Carcinoma
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Chronic Bronchitis

• Productive Cough gt3 months in 2 years.
• Smoking / pollution - major cause.
• Acute Chronic inflammation of mucosa
• Lack of cilia - retention of secretions
• Increased mucous glands viscid mucous.
• Frequent secondary infections
• inflammation? retention? infection? obstruction
  cycle.

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COPD
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COPD
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Chronic Bronchitis
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smokers lung Normal Lung
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Emphysema

• Alveolar wall destruction, Dyspnoea, RHF.
• Pink Puffers normal ABG pattern.
• Types
• Centrilobular smoking
• Panlobular congenital - ?1 antitrypsin
  deficiency
• Paraseptal irregular subpleural, scarring
• Other
• Interstitial emphysema Air leak.
• Senile Emphysema

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smokers lung Emphysema
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smokers lung Pigmentation
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Emphysema
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Emphysema
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Centrilobular Emphysema
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Emphysema Ruptured alveloli.
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Centrilobular Emphysema
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Centrilobular Emphysema (smoking)
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Pan lobular bullous emphysema
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Local Bullous Emphysema
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Bronchitis Emphysema

• Blue Bloater
• Mild dyspnoea, late
• Infections common
• Cor-pulmonale
• Increased resistance
• Prominent BV, large heart.

• Pink Puffer
• Dyspnoea severe, early
• Occassional
• Rare, late
• Mild increase
• Hyperinflation small heart.

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Complications of COPD

• Cor Pulmonale
• syncope, hypoxia, pedal edema, passive hepatic
  congestion, and death.
• Acute Exacerbations.
• End-stage lung disease.
• Polycythemia hypoxia.
• Pneumothorax, Infections, Bronchectasis.

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Bronchiectasis

• Permanent dilatation of bronchi.
• Cough, copious purulent sputum.
• Lower lobes common
• Complications
• Pneumonia, empyema, septicemia, meningitis.
• Types
• Cylindrical, Saccular, Fusiform (no significance)

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Pathogenesis - Bronchiectasis

• COPD/Obstruction/Infection.
• Excess Mucous secretion
• Retention of secretion
• Secondary infection
• Destruction of bronchial wall
• Irregular, fixed inflamed dilated bronchus filled
  with pus.

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Bronchiectasis
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Bronchiectasis
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Bronchiectasis
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Bronchiectasis - Adhesions
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Saccular Bronchiectasis
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Summary - COPD

• Progressive, irreversible, obstruction,
  destruction.
• 3 etiology
• Smoking, pollution, Alpha1 AT Deficiency.
• 3 symptoms
• Cough, Dyspnoea, Hypoxemia
• 3 Diseases
• Chronic Bronchitis, Emphysema, Asthma

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COPD summary

• 3 Complications
• Exacerbations, Cor-pulmonale, End stage lung
  disease.
• 3 Investigations
• Spirometry (FEV1/VC), PaO2, PCO2.
• 3 grades
• Mild 69-80 FEV1 cough, exertional dysp.
• Mod 40-60 FEV1 - Wheeze, cough, sputum.
• Sev - lt 40 FEV1 - Right Heart Failure.

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"Troubles are often the tools by which God
fashions us for better things." - Henry Ward
Beecher