Respiratory Tutorial

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Respiratory Tutorial
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Pulmonary oedema

• Causes
• Haemodynamic
• Increased hydrostatic pressure
• (heart failure, mitral stenosis, volume overload)
• Decreased oncotic pressure
• Hypoalbuminaemia
• Lymphatic obstruction
• Microvascular injury
• Infections (sepsis/viral/Mycoplasma)
• Toxic injury (gases/aspirated liquids/drugs/chemot
  herapy)
• Trauma, shock, DIC, emboli, heat
• Uraemia, pancreatitis
• Extracorporeal circulation

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Pulmonary oedema

• Gross findings

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Pulmonary oedema

• Microscopic findings

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Pulmonary oedema

• Microscopic findings

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ARDS/Diffuse Alveolar Damage

• Damage to what?
• Diffuse alveolar capillary damage
• Presentation
• Oedema, resp failure, hypoxia resistent to O2
• Pathogenesis
• Endothelial damage
• Increased vasc permeability
• Fibrin exudation membrane formation
• Inflammatory cell infiltrate in alveolar septum
• Causes

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ARDS/Diffuse Alveolar Damage

• Gross findings

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ARDS/Diffuse Alveolar Damage

• Microscopic findings

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Pulmonary Emboli

• Types of emboli?
• Majority thromboemboli
• Majority from deep leg veins
• Risk factors
• Surgery, immobility, old age
• Hypercoagulability, pregnancy, OCP, malignancy,
  esp gynae malignancy
• Trauma, burns, fracture

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Saddle embolus sudden death
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Large embolus acute right heart failure
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Medium embolus pulmonary infarct
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Small embolus /- infarct depending on
circulatory status
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Pulmonary Emboli

• Consequences
• Embolus
• Resolution
• Organization
• Vascular sclerosis
• Pulm HTN
• Chronic cor pulmonale
• Infarct
• Organization

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Pulmonary Hypertension

• Causes
• Chronic lung disease (interstitial or COPD)
• Chronic left heart failure
• Recurrent pulmonary emboli
• Primary / idiopathic
• Pathogenesis
• Endothelial injury
• Vasoconstriction
• Medial hypertrophy
• Intimal fibrosis

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Pulmonary Hypertension

• Histology
• Large arteries Atheroma
• Medial and small arteries

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COPD

• Emphysema
• Abn. Enlargement of airways distal to terminal
  bronchioles with destruction of walls
• Bronchitis
• Persistent cough with sputum x 3/12 x 2 conseq
  years
• Asthma
• Chronic inflammatory disorder with
  hyper-responsiveness paroxysmal contraction of
  bronchial tree
• Bronchiectasis
• Chronic necrotizing infection of bronchi
  bronchioles with abn permanent dilatation of
  their walls

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What type? Pathogenesis?
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Emphysema

• Microscopic findings

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Bronchitis

• Pathogenesis
• Chronic irritation of airways
• Inflammation, congestion, edema
• Increased mucus secretion
• Mucous gland hypertrophy in bronchi
• Goblet cell metaplasia in bronchioles
• Secondary infection
• Morphology
• Inflamed bronchi with thickening of mucus layer
• Mucous plugs
• Fibrosis
• Squamous metaplasia
• Squamous dysplasia

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Asthma

• Types
• Extrinsic (atopic)
• Intrinsic (non-atopic)
• Pathogenesis
• Atopic
• Antigen binding to IgE on mast cell acute phase
• Cytokine release late phase
• Morphology
• Gross
• Overinflation with mucus plugging
• Micro
• Edema, inflammation, mucous gl and smooth m
  hypertrophy

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What type of COPD? Causes? Pathogenesis?
Obstruction Atelectasis Infection Necrosis of
bronchial walls Irreversible dilation
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What is this? Causes? Morphology? Consequences?

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What is this? Causes? Morphology? Consequences?

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What is this? Morphology? Consequences?
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Secondary TB Cavitating Miliary TB
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Adenocarcinoma Squamous cell carcinoma
Small cell carcinoma
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Adenocarcinoma Squamous cell carcinoma
Small cell carcinoma
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Bronchioloalveolar carcinoma
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Hamartoma
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Mesothelioma