Emphysema Pathophysiology

Tobacco smoke, Air Pollution Inherited -1 Anti-trypsin Deficiency

Inflammation of the Airway Epithelium Inhibition of Endogenous AntiProteases

Infiltration of Inflammatory Cells & Release of Cytokines

(Neutrophils, Macrophages, Lymphocytes, Leukotrines, Interleukins)

Increased Protease Activity with Breakdown of Elastin in Connective Tissue of Lungs (Elastases, Cathepsins, etc.)

Irreversible Enlargement of the Air Spaces distal to the Terminal Bronchioles

Destruction of Alveolar Walls & Septa and Loss of Elastic Recoil of Bronchial Walls
(EMPHYSEMA)

Loss of Fibrous & Muscle Tissue A Portion of the Capillary Bed of an Alveolus has been eliminated.
Breakdown of Alveolar Elasticity Alveoli cannot support the Increased Air Volume in the Acinus
airways to keep them open

Change in
Dyspnea on Decreased Tactile Inability of the Alveoli to recoil
Airway Size
Exertion Fremitus on Palpation normally after expanding
Amount of air that can be
expired is diminished

Lungs become Chest X-Ray Crackles & Wheezing Bronchiolar Collapse on Expiration
less Compliant
Air Trapping
Barrel Chest, Hyperresonance
Pulmonary Function Test on Chest Percussion Increased Pulmonary
Inability of the Lungs to Vascular Resistance
Circulate Sufficient Air Overdistended Lungs Hyperinflation of the Alveoli
ECG

Airway Calibration Increased Total Lung Capacity Bullae (air spaces) will be formed Pulmonary Hypertension
is Decreased And Residual Volume adjacent to the Pleura (blebs)

Right Ventricular Hypertrophy

Ruptured Bullae and Blebs (Cor Pulmonale)
Part of Each Inspiration is Trapped Arterial Blood Gas

Spontaneous Pneumothorax

Hypoventilation Decreased Oxygenation Prolonged Hypoxia Electrocardiography Chest X-Ray

Chest X-Ray

Decreased Chest Expansion Tachypnea Clubbing of Fingers & Toes

LEGEND:
Black Text usual pathway
Square Dotted Line Clinical Manifestations
Gray Text Complications
Dash Dot Line with Diamond Arrow Laboratory & Diagnostic Tests