Respiratory (Response To Injury)

Front 1

__________ is a medical condition in which the lungs are not fully inflated. It may affect part or all of one lung. It is a condition where the alveoli are deflated, as distinct from pulmonary consolidation.

Back 1

Atelectasis

Front 2

Describe atelectasis and recognize the different types

Back 2

Atelectasis is collapse of lung tissue; usually reversible (as opposed to COPD which is usually not reversible); prone to infection

TYPES
1) resorption atelaectasis (due to airway obstruction)
2) compressive atelectasis (pleural cavity filled by air, fluid, blood, or tumor)
3) contraction atelectasis (local or generalized fibrotic changes that prevent complete expansion of the lung)

Front 3

provide examples of resorptive atelectasis

Back 3

-mucus plugs/exudates (ie. asthma, chronic bronchitis, bronchiectasis)
- aspiration of foreign body
- tumors

Front 4

in which of these types of atelectasis will mediastinum shift toward the atelectic lung as opposed to the normal lung?

a. resorptive (obstructive) aelectasis
b. compressive atelectasis
c. contraction atelectasis

Back 4

A. the other two will cause a shift toward normal lung

Front 5

tension pneumothorax, pleural effusions, pleural metastasis are examples of ________ atelectasis.

Back 5

compressive

Front 6

give an example of contraction atelectasis

Back 6

pulmonary fibrosis

Front 7

Diffuse alveolar damage (DAD) can lead to pulmonary edema by what mechanism?

a. hemodynamic
b. microvascular injury

Back 7

B. In DAD (which is the pathology of the clinical condition, ARDS), due to infection, sepsis, or trauma, damage is done to alveolar capillaries so that tight junctions within alveolar capillaries aren’t intact and will leak fluid and cells into interstitium and air space within alveoli.

Front 8

causes of diffuse alveolar damage (DAD) -- which, of course is the same thing as acute respiratory distress syndrome (ARDS)

Back 8

PSAT

Pneumonia (esp viral pulmonary infection)
Sepsis/DIC
Aspiration
Trauma

Front 9

Describe pulmonary edema and its causes

Back 9

pulmonary edema = filling of airspaces with fluid so that lungs become heavy and wet with foamy fluid in airways

TWO CAUSES:
1. hemodynamic ("cardiogenic" - due to back up of blood from left heart failure, for example, and causes increased hydrostatic pressure and alveolar capillary congestion)
2. microvascular injury (pulm edema due to direct injury to alveolar capillaries so that there is increased permeability and fluid leakage, like in ARDS/DAD)

Front 10

Describe alveolitis and tell me what kind of inflammatory cells are usually found

Back 10

ALVEOLITIS = acute injury to lung parenchyma (usually NEUTROPHIL infiltrate into interstitium and airspaces with edema and fibrin formation)

Front 11

__________ is a medical condition in which the lungs are not fully inflated. It may affect part or all of one lung. It is a condition where the alveoli are deflated, as distinct from pulmonary consolidation.

Back 11

Atelectasis

Front 12

Describe atelectasis and recognize the different types

Back 12

Atelectasis is collapse of lung tissue; usually reversible (as opposed to COPD which is usually not reversible); prone to infection

TYPES
1) resorption atelaectasis (due to airway obstruction)
2) compressive atelectasis (pleural cavity filled by air, fluid, blood, or tumor)
3) contraction atelectasis (local or generalized fibrotic changes that prevent complete expansion of the lung)

Front 13

provide examples of resorptive atelectasis

Back 13

-mucus plugs/exudates (ie. asthma, chronic bronchitis, bronchiectasis)
- aspiration of foreign body
- tumors

Front 14

in which of these types of atelectasis will mediastinum shift toward the atelectic lung as opposed to the normal lung?

a. resorptive (obstructive) aelectasis
b. compressive atelectasis
c. contraction atelectasis

Back 14

A. the other two will cause a shift toward normal lung

Front 15

tension pneumothorax, pleural effusions, pleural metastasis are examples of ________ atelectasis.

Back 15

compressive

Front 16

give an example of contraction atelectasis

Back 16

pulmonary fibrosis

Front 17

Diffuse alveolar damage (DAD) can lead to pulmonary edema by what mechanism?

a. hemodynamic
b. microvascular injury

Back 17

B. In DAD (which is the same thing as ARDS), due to infection, sepsis, or trauma, damage is done to alveolar capillaries so that tight junctions within alveolar capillaries aren’t intact and will leak fluid and cells into interstitium and air space within alveoli.

Front 18

causes of diffuse alveolar damage (DAD) -- which, of course is the same thing as acute respiratory distress syndrome (ARDS)

Back 18

PSAT

Pneumonia (esp viral pulmonary infection)
Sepsis/DIC
Aspiration
Trauma

Front 19

Describe pulmonary edema and its causes

Back 19

pulmonary edema = filling of airspaces with fluid so that lungs become heavy and wet with foamy fluid in airways

TWO CAUSES:
1. hemodynamic ("cardiogenic" - due to back up of blood from left heart failure, for example, and causes increased hydrostatic pressure and alveolar capillary congestion)
2. microvascular injury (pulm edema due to direct injury to alveolar capillaries so that there is increased permeability and fluid leakage, like in ARDS/DAD)

Front 20

Describe alveolitis and tell me what kind of inflammatory cells are usually found

Back 20

ALVEOLITIS = acute injury to lung parenchyma (usually NEUTROPHIL infiltrate into interstitium and airspaces with edema and fibrin formation)

Front 21

Describe the histopathology of different phases of alveolitis

Back 21

TWO PHASES: exudative and organizing phase

1) EXUDATIVE (EARLY) PHASE = characterized by inflammation/injury to alveolar endothelium and type 1 pneumocytes with inflammtion in interstitium and exudate in alveolar spaces

ORGANIZING (LATE) PHASE = scarring/fibrosis of granulation tissue in the interstitium (this is "healed" state)

Front 22

Describe the histopathology of the different phases of diffuse alveolar damage (remember DAD = ARDS)

Back 22

exudative phase = characterized by hyaline membrane that line airspace, edema, reactive type II pneumocytes, and interstitial inflammation

organizing phase = proliferation of reactive type II pneumocytes, fibroblasts lay down granulation tissue, lead to thickened alveolar septum and interstitial fibrosis

Front 23

what is BOOP?

Back 23

bronchiolitis obliterans organizing pneumonia = pattern of AIRWAY-CENTERED acute lung injury
- there's granulation tissue in the LUMEN of: bronchioles (BO) and adjacent alveoli (OP)

Front 24

Identify the causes of bronchiolitis obliterans-organizing pneumonia pattern

Back 24

#1 Idiopathic (COP - cryptogenic organizing pneumonia)

- infections (viral, mycoplasma)
- obstruction
- medications/radiation therapy
- bone marrow transplant

Front 25

Describe the pathologic features of bronchiolitis obliterans-organizing pneumonia

Back 25

intraluminal granulation tissue in membranous bronchioles, respiratory bronchioles, alveolar ducts, alveoli...leading to scarring around airways and fibrosis of intersitium

Front 26

Recognize histopathologic findings of rejection in the lung after transplantation

Back 26

grading scale (A1-A4) according amt of lymphocytic infiltration into the area

Front 27

what do you use to assess rejection in a lung transplantation?

Back 27

transbronchial biopsy

Front 28

DAD + Viral inclusions
= _____ pneumonia

DAD + Atypical fibroblasts/type II cells, Vacuolization of endothelium
= ______ pneumonitis

Back 28

viral

radiation

Front 29

Specific diagnostic clues
viral inclusions = ______pneumonia

food particles = ______ pneumonia

lymphoplasmacytic infiltrates + poorly formed granulomas = _______ pneumonitis

lymphoplasmacytic infiltrates + plasma cells dominant + rheumatoid nodules + follicular bronchiolitis or vasculitis = _______ lung

lymphoplasmacytic infiltrates + intraalveolar macrophage and eosinophil infiltrates = _________ pneumonia

Back 29

viral; aspiration; hypersensitivity; rheumatoid; eosinophilic

Front 30

what is obliterative bronchiolitis

Back 30

chronic rejection (fibrous obliteration of airway lumens)

Front 31

How does pulmonary edema differ from diffuse alveolar damage?

Back 31

DAD is a condition that can lead to pulmonary edema. pulm edema itself is when there is injury to alveolar capillaries such that there is increased permeability and fluid leakage

Front 32

How does organizing pneumonia differ from diffuse alveolar damage? How are they similar?

Back 32

organizing pneumonia and DAD are both conditions that specifically damage alveoli.

OP is granulation tissue that gets into the INTERSTITIUM and LUMEN of alveoli, whereas DAD is caused by infection or something else (sepsis, aspiration, or trauma) that leads to inflammation and granulation tissue formation in the INTERSTITIUM and ALVEOLAR SEPTAL WALL

Front 33

A 24 year old woman is burned in a house fire, suffers extensive fluid loss, and is hypotensive on arrival to the emergency department. She develops nosocomial infection and ARDS after prolonged intubation and ventilatory support. What do you expect her chest x-ray to show? What would a lung biopsy show? What are the potential multifactorial causes in this case?

Back 33

CXR = diffuse alveolar infiltrates ("white-out" or "snow storm")

lung biopsy would show widespread alveolitis in exudative phase (since it's acute) with lots of fibrinous exudate mixed with cell debris from necrotic pneumocytes (hyaline membranes), edema, reactive type II pneumocytes, interstitial inflammation

Front 34

Acute cellular rejection after lung transplant is characterized by what type of inflammatory cell reaction? What patterns may be seen on transbronchial biopsy?

Back 34

lymphocytes

transbronchial biopsy = would show lots of lymphocytic infiltrates in the perivasculature