27/11/2013

CLASSIFICATION PATHOPHYSIOLOGY OF RESPIRATORY DISEASE

Dr Bridget Ellul According to anatomical site
Upper / lower respiratory tract

According to aetiology / pathogenesis

enetic !ardio"ascular #n$ections %ypersensiti"ity reactions &eoplasia
2

RESPIRATORY DISEASES: Classification according to Anatom

!""#r RT: Nos#$ lar n%$ &trac'#a(
Cong#nital Disord#rs &trac'#a( Inf#ctions &nos#$ lar n%( All#rgi#s &nasal "ol "s( T)mo)rs &lar n%$ naso"'ar n%(

RESPIRATORY DISEASES: Classification according to A#tiolog

AIR1AYS and L!NG Cong#nital Disord#rs H "o"lasia$ S#2)#stration /asc)lar Dis#as#s D/T $ ")lmonar #m,olism P)lmonar O#d#ma ARDS 0 Ad)lt R#s"irator Distr#ss S ndrom# Tra)ma Pn#)mot'ora% O,str)cti-# P)lmonar Dis#as#
COPD: C'ronic +ronc'itis . Em"' s#ma +ronc'ial Ast'ma

Lo*#r RT: +ronc'i$ l)ngs$ "l#)ra

Cong#nital Disord#rs
Inf#ctions '(ronchi) lung*
Pn#)monia$ T+ OPD: C'ronic +ronc'itis . Em"' s#ma '(ronchi and lung* +ronc'ial Ast'ma '(ronchi*

O,str)cti-# P)lmonar Dis#as#

R#stricti-# P)lmonar Dis#as#

Int#rstitial &infiltrati-#( l)ng dis#as#
Pn#)moconiosis H "#rs#nsiti-it Dr)gs$ to%ins$ radiation Idio"at'ic fi,rosis

R#stricti-# P)lmonar Dis#as# 'al"eoli*

Int#rstitial &infiltrati-#( l)ng dis#as#
Pn#)moconiosis H "#rs#nsiti-it Dr)gs$ to%ins$ radiation Idio"at'ic fi,rosis

T)mo)rs
+#nign 3alignant

/asc)lar Dis#as#s D/T $ ")lmonar #m,olism P)lmonar O#d#ma ARDS 0 Ad)lt R#s"irator Distr#ss S ndrom#

PLE!RA
T)mo)rs Pl#)ral #ff)sion
3 +

T)mo)rs '(ronchi) lung) pleura*

SY3PTO3S
-unny nose E.cess sputum production Dyspnoea !ough /hee0ing !hest pain
,

SY3PTO3S
R)nn nos#
Allergy !ommon cold &asal (loc2age

E%c#ss m)c)s
3mo2ing 4 clear #n$ection 4 yellow/green Asthma 4 yellow 'eosinophils* Bronchial carcinoma) 5B) pneumonia 4 (lood 6 haemoptysis
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SY3PTO3S
1'##4ing
Air$low limitation $rom any cause 4 not necessarily asthma

S m"toms
D s"no#a 'di$$iculty in (reathing* 7ulmonary disease !ardio"ascular disease 8eta(olic disease :thers

C'#st "ain
7leuritic 4 sharp) worse on (reathing -i( pain -etrosternal soreness 4 tracheitis !onstant dull chest wall pain 4 in"asion (y lung carcinoma !entral chest pain with radiation to nec2) arms 4 cardiac 3houlder pain 4 diaphragmatic pleura / 8#
7

Co)g'
Ca)s#s of c'ronic co)g' !:7D Asthma astro6oesophageal re$lu. 6 heart(urn 7ost6nasal drip 7ost chest in$ection 8edications
9

IN/ESTIGATION OF THE RESPIRATORY SYSTE3 ;ung <unction 5ests Blood as Analysis -adiology Histolog C tolog 8icro(iology :thers
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IN/ESTIGATION OF THE RESPIRATORY SYSTE3

HISTOLOGY CYTOLOGY

IN/ESTIGATION OF THE RESPIRATORY SYSTE3

+ronc'ial ,io"s at ,ronc'osco" L)ng ,io"s

trans(ronchial transthoracic open wedge Lo,#ctom 5 *'ol# l)ng Pl#)ral ,io"s 3#diastinal ,io"s L m"' nod# ,io"s $ n#c6

S")t)m
+ronc'ial as"irat#s 5 *as'ings 5 ,r)s'ings +ronc'oal-#olar la-ag# 0 +AL

Fin# n##dl# as"iration 7 FNA

trans,ronc'ial transt'oracic

L m"' nod#$ n#c6$ as"irat#

Pl#)ral fl)id
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/asc)lar Dis#as#s
Deep =ein 5hrom(osis
and pulmonary em(olism
/irc'o*8s triad:

P!L3ONARY E3+OL!S
?,@ arise $rom throm(i in large "eins) lower legs usually deep "eins o$ cal$ muscles) D=5) or pel"ic "eins em(oli tra"el to right side o$ heart and pulmonary trun2 and i$ total (loc2age cause death i$ small no symptoms till late pulmonary hypertension pulmonary in$arction i$ increase in "enous pressure in lungs

endothelial in>ury alterations in (lood $low hypercoagula(ility

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1+

R#s"irator Inf#ctions
Inflammations

R#s"irator Inf#ctions
more $reAuent than in$ections o$ any other organ largest num(er o$ wor2days lost in general population ma>ority in"ol"e only the upper respiratory tract and are caused (y "iruses 6 tri"ial or mild diseases

!""#r R#s"irator Tract Inf#ction /iral5,act#rial inf#ction Lo*#r R#s"irator Tract Inf#ction Pn#)monia 7 +act#rial Pn#)monia 7 /iral
P)lmonar T),#rc)losis

H "#rs#nsiti-it r#actions
1, 11

Im"air#d D#f#nc#s of R#s"irator Tract

cough re$le.
coma) anaesthesia) drugs 6 aspiration possi(le

T'# R#s"irator S st#m

#n$ection may (eB primary 6 "iral) (acterial) mycoplasmal) $ungal secondary (acterial 6 $ollowing a "iral in$ection secondary to irritants

$iltering $unction o$ nasopharyn. ciliary apparatus 6 action towards mouth

cigarette smo2e) hot gasses) corrosi"es) "iruses

secretion o$ #gA anti(odies phagocytic acti"ity (y al"eolar macrophages

alcohol) to(acco) smo2e) e.cess o.ygen

accumulation o$ secretions
cystic $i(rosis) (ronchial o(struction

al"eolar $luid 6 sur$actant) #gs) complement cell mediated immunity

chronic disease / cancer patients /treatment with chemotherapy immune diseases / %#= in$ection

"irulent in$ections

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!""#r R#s"irator Tract S#"sis

/iral common cold 0 commonest 6 di$$erent serotypes o$ rhino"irus Infl)#n4a 6 in$luen0a "irus +act#rial
healthy indi"iduals 6 uncommon in de"eloped countries

Lo*#r R#s"irator Tract S#"sis

Pn#)monia in$ection o$ al"eolar spaces host reaction 6 al"eolar e.udates polymorphs) $i(rin) oedema $luid resulting in consolidation

Str#"tococc)s in nose and throat

Ac)t# lar ngitis 5 #"iglottitis

Classification 3or"'olog
Bronchopneumonia) ;o(ar 7neumonia
many organisms present with either pattern C con$luent (ronchopneumonia / lo(ar radiologically

Ha#mo"'il)s infl)#n4a# t "# + or str#"tococc)s " og#n#s

swelling and mechanical ina(ility in (reathing irritation (y pollutants including smo2e and corrosi"es and no.ious gases
1?

A#tiolog Clinical S#tting

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+ronc'o"n#)monia
in$lammation starts in (ronchi 6 polymorphs) $i(rin spreads to ad>acent al"eoli patchy $oci coalesce consolidation
3treptococcus pneumoniae %aemophilus in$luen0ae 3taphylococcus pneumonia Dle(siella 7seudomonas aeruginosa !oli$orm (acteria

Lo,ar Pn#)monia
"irulent organism host "ulnera(ility ?06?,@ 3treptococcus
pneumoniae

in$lammation starts
in al"eoli

21

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Pn#)monia

Pn#)monia : Clinical S#tting

!ommunity AcAuired Acute 7neumonia
Str#"9 Pn#)monia#$ H9 infl)#n4a#$ 3ora%#lla catarr'alis$ Sta"'9 a)r#)s$ L#gion#lla$ :l#,si#lla$ Ps#)domonas

!ommunity AcAuired Atypical 7neumonia

m co"lasma$ c'lam dia$ co%i#lla$ -ir)s#s

&osocomial 7neumonia
Gram n#gati-# rods &:l#,si#lla$ E9 coli$ Ps#)domonas($ sta"' lococc)s a)r#)s &)s)all 3RSA(

Aspiration 7neumonia 7neumonia in #munocompromised %ost

C3/$ Pn#)moc stis carinii$ m co,act#ri)m a-i)m0 intrac#ll)lar#$ as"#rgillosis$ candidiasis$ ;)s)al< organisms 2+
<or in$o

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Com"lications
complete resolution i$ correct anti(iotic uncommon complications
pleural adhesions (eing the most common complications commoner with lo(ar pneumonia
(ut E10@ now die

/iral Pn#)monia
interstitial pneumonia misnomer as interstitial in$iltrate
histiocytes) lymphocytes

lung a(scess septicaemia uncommon i$ se"ere pneumonia is not treated death may occur

no al"eolar e.udate in$luen0a "irus / -3= / adeno"iruses / rhino"iruses

2,

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Pn#)monia 7 Ot'#r Organisms

Atypical Bacteria 4 atypical pneumonia
8ycoplasma !hlamydia ;egionella

P!L3ONARY T!+ERC!LOSIS
8yco(acterium tu(erculosis
droplet in$ection $rom acti"e 5B 7rimary 5u(erculosis in childhood 6 rare now primary lesion 6 hon $ocus (elow pleura) mid lung tu(ercles 6 epithelioid granulomas with caseation (acteria spread to hilar lymph nodes hon $ocus F nodes heal with $i(rosis / calci$ication 5B sur"i"es in $oci and (ecomes source o$ later in$ection cell mediated immunity to antigens o$ tu(ercle (acillus 6 positi"e tu(erculin s2in test 6 increased resistance to su(seAuent in$ection

<ungi

27

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P!L3ONARY T!+ERC!LOSIS
3econdary 5u(erculosis people pre"iously sensitised (y a primary lesion a new in$ection or (y reacti"ation o$ micro(e in chronic disease) steroid therapy) %#= ape. o$ the upper and lower lo(es $oci heal with $i(rosis and calci$ication haemoptysis with erosion o$ a "essel in the lung coughing up o$ caseous material 'ca"ities in the lung* pro"ides a source o$ in$ection to the other lung spread "ia lymph and (lood spreads tu(erculosis throughout the (ody 'military 5B*
2?

R#s"irator Dis#as#s
O,str)cti-# P)lmonar Dis#as# 0 Air*a s
COPD: C'ronic +ronc'itis . Em"' s#ma +ronc'ial Ast'ma

R#stricti-# P)lmonar Dis#as# 0 Al-#oli

Int#rstitial &infiltrati-#( l)ng dis#as#
Pn#)moconiosis H "#rs#nsiti-it Dr)gs$ to%ins$ radiation Idio"at'ic fi,rosis
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R#s"irator Dis#as#s
O,str)cti-# P)lmonar Dis#as# 7 Air*a s
airflo* limitation$ not f)ll r#-#rsi,l# "rogr#ssi-# in most a,normal inflammator r#s"ons# e.piratory $low rate <=! & or <E=1 <E=1 B <=! is low

CHRONIC +RONCHITIS
clinical term persistent cough with sputum production $or at least three months in at least two consecuti"e years middle6aged men especially smo2ers smo2e predisposes to in$ection (y inter$ering with ciliary action and causing direct damage to epithelium 1062,@ o$ ur(an population due to irritation (y inhaled pollutants
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R#stricti-# P)lmonar Dis#as# 7 Al-#oli

restriction o$ air $low due to reduced e.pansion o$ the lung parenchyma total lung capacity) "ital capacity) residual "olume) lung compliance <=! <E=1 & or <E=1 B <=! is & or high
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CHRONIC +RONCHITIS

Em"' s#ma
pathological term condition o$ the lung characterised (y a(normal permanent enlargement o$ the air spaces distal to the terminal (ronchiole) with destruction o$ their walls
elastases destroy elastin $ree radicals $rom smo2e

pathhsw,m,+Gucs$Gedu/o"er"iew/te.tGhtml

commoner in men) ,0690years associated with hea"y smo2ing

3+

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Em"' s#ma

proteases 'elastase* or antiproteases 'antielastase) alpha616 antitrypsin* elastin destruction in al"eolar walls

Em"' s#ma: Pat'og#n#sis

3,

de"elopment o$ emphysema in smo2ers there is lung in$ection with neutrophils and macrophages) which produce elastase lung damage stimulated neutrophils release o.ygen $ree radicals 6 cause damage
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Em"' s#ma 7rognosis with se"ere emphysema) cor pulmonale 'heart disease secondary to lung disease* and congesti"e heart $ailure de"elop death due to right heart $ailure and respiratory $ailure
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Ast'ma
increased responsi"eness o$ (ronchial tree to "arious stimuli) resulting in paro.ysmal constriction o$ the (ronchial airways triggered (y e.posure to an allergen (ronchospasm triggers se"ere dyspnoea and whee0ing (etween attac2s asymptomatic an unremitting attac2) status asthmaticus) may pro"e $atal
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Ast'ma
lungs are o"er distended (ronchi occluded (y thic2 mucous plugs eosinophils F oedema in (ronchial walls hypertrophy o$ (ronchial smooth muscle

Ast'ma
5ypes o$ Asthma 7recipitating <actors
3peci$ic allergens !hemicals Antigens'spores*

8echanism #mmune -eaction

5ype # '#gE* 5ype # 5ype # and 5ype ###

EH5-#&3#!
Atopic 'allergic* :ccupational Allergic aspergillosis

#&5-#&3#!
&onatopic 7harmacologic -espiratory 5ract #n$ection Aspirin Un2nownI hyper reacti"e airways prostaglandins leu2otrines

%yper reacti"e airways) which respond to non6speci$ic irritants 6 cold) e.ercise and stress
+0

3?

Ast'ma
Atopic or Allergic Asthma commonest type triggered (y en"ironmental antigens 6 dusts) pollen) $oods) house dust mite $amily history common 6 allergic rhinitis) urticaria or ec0ema genetic predisposition positi"e s2in tests classic 5ype # #gE hypersensiti"ity reaction

RESTRICTI/E P!L3ONARY DISEASE

Disorders o$ chest wall or pleural space
polio and 2yphoscoliosis

#nterstitial or in$iltrati"e diseases

J 1,0 di$$erent disease processes al"eolar wall and capillary endothelium damage results in $i(rosis 8ain !auses #diopathic $i(rosis 7neumoconiosis 6 inhalation o$ inorganic atmospheric
pollutants eGgG as(estos

%ypersensiti"ity 6 organic material is inhaled) eGgG pigeon

+1

$ancierKs lung due to protein $rom (ird droppings

+2

Drugs) to.ins) radiation

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St)d G)id# 5 O,=#cti-#s

1G 2G 3G +G ,G 1G 7G 9G ?G 10G 11G 12G

!lassi$y the common respiratory diseases ;ist the methods o$ in"estigation o$ the respiratory system Discuss the de$ence mechanisms o$ the respiratory system Discuss the importance o$ U-5 in$ections Discuss the pathogenesis and morphology o$ (ronchopneumonia and lo(ar pneumonia Di$$erentiate (etween "iral and (acterial pneumonia /rite a short note on pulmonary tu(erculosis Distinguish (etween o(structi"e and restricti"e lung diseases) in terms o$ lung $unction and morphological a(normalities De$ine chronic (ronchitis and emphysema Brie$ly discuss the pathogenesis o$ chronic (ronchitis and emphysema :utline the pathogenesis o$ asthma Descri(e the morphological changes that occur in asthma

+3