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69 Cards in this Set
- Front
- Back
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ARDS/DAD pathogenesis
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-macs secrete TNF, IL1, IL8
-activated neutros secrete oxidants, proteases, PAF, LTs -causes tissue, damage, edema, surfactant inactivation, hyaline membrane OR -macs secrete TGF-B, PDGF -fibroblast proliferation -collagen synthesis |
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gross DAD morphology
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hepatization
-early = dark red -late = gray |
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DAD microscopic
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exudative phase
proliferative phase fibrotic phase -hyaline membrane |
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early clinical features of DAD/ARDS
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early: dyspnea and tachypnea
middle: cyanosis, hypoxemia, respiratory failure late: respiratory acidosis |
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atelectasis
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loss of lung volume due to inadequate airway expansion
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types of atelectasis
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-resorption (due to obstruction)
-compression (due to accumulation of fluid or air in pleural space) -microatelectasis (due to loss of surfactant) -contraction atelectasis (local or generalized fibrosis) |
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mechanisms of pulmonary congestion and edema
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-hemodynamic (hydrodynamic)
-microvascular injury |
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gross morphology of pulmonary congestion
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heavy lungs with wet cut surface
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microscopic morphology of pulmonary congestion
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-engorged capillaries
-alveolar eosins -alveolar microhemorrhages -siderophages (heart failure cells) |
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types of edema in pulmonary congestion
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-hemodynamic edema
-edema due to microvascular injury -edema of undetermined origin |
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type of edema?
hydrostatic pressure increase |
hemodynamic
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type of edema?
left HF |
hemodynamic
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type of edema?
volume overload |
hemodynamic
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type of edema?
pulmonary v obstruction |
hemodynamic
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type of edema?
dec oncotic pressure |
hemodynamic
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type of edema?
hypoalbuminemia |
hemodynamic
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type of edema?
nephrotic syndrome |
hemodynamic
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type of edema?
liver dz |
hemodynamic
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type of edema?
protein-losing enteropathies |
hemodynamic
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type of edema?
lymphatic obstruction |
hemodynamic
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type of edema?
infections |
microvascular injury
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type of edema?
inhaled gases |
microvascular injury
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type of edema?
liquid aspiration |
microvascular injury
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type of edema?
drugs and chemicals |
microvascular injury
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type of edema?
shock/trauma |
microvascular injury
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type of edema?
radiation |
microvascular injury
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type of edema?
transfusion related |
undetermined
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type of edema?
high altitude |
undetermined
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type of edema?
neurogenic (CNS) |
undetermined
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sequlea of PE
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-inc pulm artery pressure
-ischemia of downstream parenchyma -dec O2 due to V/Q mismatch, R->L shunt if PFO |
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morphology of pulmonary edema
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-initially in interstitium and goes into airspace
-hermosiderin in Macs -engorged capillaries |
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morphology of PE
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-serpentine blood clot impacted in pulmonary arterial tree
-intraalveolar hemorrhage (from ischemia) -infarct |
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pulmonary infarct morphology
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pink: little nuclei; WBCs in blood areas, karyolysis
hemorrhage wedge shaped |
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risk factors for PE
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-bed rest
-OC -polycythemia -multiple myeloma -fractures -hip operations, extension pelvic or ab operations -milk legs |
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pulmonary HTN: secondary
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-COPD
-autoimmune disorder -recurrent PE -heart dz with L->R shunt -OSA |
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pulmonary HTN genetics
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-BMPR2 mutation
-dec apoptosis, inc smooth m, inc construction, inc PHTN |
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PHTN pathogenesis
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mechanical force, shear, biochemical injury -> endothelial injury -> platelet adhesion and activation, pulmonary vasoconstriction, smooth m migration and replication
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morphology of PHTN
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-main elastic arteris (atheromas)
-med sized muscular arteries: intimal/medial hypertrophy -> wall thickening and stenosis -small arteries and arterioles: medial hypertrophy |
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clinical featuers of PHTN
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secondary: any age, sx reflect underlying dz, later, respiratory insufficiency and RHF/cor pulm
primary: 20-40 yo; fatigue, syncope, dysnpea, chest pain, resp insufficiency, cyanosis, death, RHF, CorPulm |
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goodpasture syndrome
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proliferative glomerulonephritis + necrotizing hemorrhaic intersitial pneum
-HLA subtypes -IgG autoantibody vs. basement membrane (collagen 4) -males |
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gross morphology of goodpastures
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heavy lungs with red-brown consolidation
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microscopic morphology of goodpastures
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-alveolar wall necrosis
-intraalveolar hemorrhage -septal fibrous thickening -septal lining cell hypertrophy -intraalveolar siderophages -immunofluorescence: linear IgG |
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clinical features of goodpastures
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-presentation = respiratory sx (hemoptysis)
-rapidly progressive renal failure -> uremia and death -therapy = plasma exchange + immunosuppression |
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wegener granulomatosis
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systemic vasculitis (pulm and renal)
5th decade pathogenesis: probably hypersensitivity -c-ANCA |
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morphology of wegeners
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URT: mucosal granulomata, ulcers rimmed by ganulmoata and vasculitis
lung: necrotizing granulomata, necrotizing/granulomatous vasculitis kidney: necrotizing/crescentic glomerulonephritis |
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clinical triad of wegeners
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acute necrotizing granulomata of URT
focal necrotizing or granulomatous inflamm in small and medium vessels renal dz (focal, necrotizing) |
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idiopathic pulmonary hemosiderosis clincial features
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-children and young adults
-productive cough -hemoptysis -anemia -dec weight |
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gross morphology of idiopathic pulmonary hemosiderosis
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-heavy lungs with red-brown consolidation
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micro morphology of idiopathic pulmonary hemosiderosis
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-degeneration/shedding/hyperplasia of alveolar epithelium
-capillary congestion -intersitial fibrosis -alveolar hemorrhage -intraalaveolar siderophages |
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drug:
cytotoxic drugs/bleomycin pulmonary dz: |
pneumonitis and fibrosis
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drug:
cytotoxic drugs/methotrexate pulmonary dz: |
hypersensitivity pneumonitis
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drug:
amiodarone pulmonary dz: |
pneumonitis and fibrosis
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drug:
nitrofurantoin pulmonary dz: |
hypersensitivity pneumonitis
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drug:
aspirin pulmonary dz: |
bronchospasm
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drug:
B-antagonist pulmonary dz: |
bronchospasm
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morphology of radiation-induced lung dz
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DAD + hyperplasia of type II cells + severe atypia (acute)
interstitial fibrosis (chronic) |
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transplantation patholgy:
dec immunosuppresion |
dec infection, inc rejection
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transplantation patholgy:
inc immunosuppression |
inc infection, dec rejection
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acute rejection morphology
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perivascular lymphocytic infiltrate
-lymphocytic bronchitis/bronchiolitis -hemorrhage/DAD <3 mo |
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chronic rejection morphology
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6-12 mo
bronchiolitis obliterans -fibrous plugs in bronchioles |
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pleural effusion types
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inflammatory
empyema hemorrhagic pleuritis hydrothorax hemothorax chylothorax pneumothorax |
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causes of inflammatory pleural effusion
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inflamm lung dz
RA SLE uremia pleural mets |
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causes of empyema
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seeding from intrapulmonary bac/fung
organization/adhesions |
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causes of hemorrhagic pleuritis
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-hemorrhagic diathesis
-rickettsial dz -mets to pleural space |
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cause of hydrothorax
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-CHF
-edema -Meig syndrome: ovarian fibroma, ascites, pleural effusion |
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causes of hemothorax
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-aortic aneurysm
-vascular trauma |
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causes of chylothorax
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usually left sided
-thoracic duct obstruction -thoracic duct trauma |
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pneumothorax cvause
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air or gas in pleural space secondary to
-lung abscess -intersitial empyema -asthma -TB -trauma |
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pneumo complications
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-hydropneumo
-infection -pyopneumo -death |
