Diseases of the Respiratory System Pathology Department of S iChuan University Su Xueying
Dec 22, 2015
Major aetiological factors in respiratory disease
• Emvironmental Smoking Lung cancer Chronic bronchitis and emphysema Susceptibility to infection Air pollution Chronic bronchitis Susceptibility to infection Infection Influenza Pneumonia Tuberculosis Occupation Lung cancer Mesothelioma
• Genetic Cystic fibrosis Some asthma
OUTLINE
1.Pulmonary Infections Bacteria Pneumonias Atypical Pneumonias Tuberculosis 2.Chronic Obstractive Lung Diseases (COPD) Emphysema Chronic Bronchitis 3.Bronchiectasis 4.Cor Pulmonale 5.Lung tumors
OUTLINE
1.Pulmonary Infections Bacteria Pneumonias Atypical Pneumonias Tuberculosis 2.Chronic Obstractive Lung Diseases (COPD) Emphysema Chronic Bronchitis 3.Bronchiectasis 4.Cor Pulmonale 5.Lung tumors
• Definition
Bacteria pneumonia is due to bacteria infection affecting distal airways, especially alveoli, with formation of an inflammatory exudate.
often follows a viral upper respiratory tract infection
• Streptococcus pneumoniae
(pneumococcus)• Staphylococcus• Haemophilus influenzae• Klebsiella pneumoniae• Moraxella catarrhalis
Lobar pneumonia
• Affects a large part, or the entirety of a lobe, frequently unilateral
• Affects otherwise healthy adults between 20 and 50 years of age, males more than females
• 90% due to Streptococcus pneumoniae
Symptoms• High fever• Chills• Chest pain• Mucopurulent cough• with/without hemoptysis
(rusty sputum)• Dyspnea
Bronchopneumonia(Lobular pneumonia)
• Patchy consolidation• Centred on bronchioles or br
onchi• Usually in infancy or old age• Usually secondary to pre-exis
ting disease• Fever, cough
Outcomesof Pneumonia
• Complete recovery
• Complications developed
Abscess formation
Empyema
Bacteremic dissemination
• Organization
• Diagnosis & Therapy
Physical examination
X-ray
Blood culture
Penicillin or other sensitive antibiotic
treatment
• Diagnosis & Therapy
Physical examination
X-ray
Blood culture
Penicillin or other sensitive antibiotic
treatment
OUTLINE
1.Pulmonary Infections Bacteria Pneumonias Atypical Pneumonias Tuberculosis 2.Chronic Obstractive Lung Diseases (COPD) Emphysema Chronic Bronchitis 3.Bronchiectasis 4.Cor Pulmonale 5.Lung tumors
Total Recovery Death
Mainland 1807 1165 79
Guangdong 1304 1110 46
Beijing 339 33 18
Shanxi 108 8 4
Neimeng 25 8 3
Guangxi 12 0 3
Hunan 6 5 1
SiChuan 5 3 1
Fujiang 3 0 0
Shanghai 2 0 0
Henan 2 0 0
Ningxia 1 0 0
Atypical pneumonia
• The concept was set forth in 1938
• The clinical course is unlike the “typical” bacteria pneumonia
• Microscopic characteristic
the inflammatory reaction is largely
confined within the walls of the alveoli,
the septa are widened and edematous
with mononuclear cells infiltration---
interstitial pneumonia
• Clinical course
Cough, fever, headache, malaise
Sputum is modest
No bacteria be isolated
Leukocytosis is modest
Physical findings of consolidation is
varied
OUTLINE
1.Pulmonary Infections Bacteria Pneumonias Atypical Pneumonias Tuberculosis 2.Chronic Obstractive Lung Diseases (COPD) Chronic Bronchitis Emphysema 3.Bronchiectasis 4.Cor Pulmonale 5.Lung tumors
Tuberculosis
• Tuberculosis (TB) is a communicable chronic granulomatous disease caused by Mycobacterium tuberculosis (tubercle bacillus).
• It usually involves the lungs but may affect any organ or tissue in the body.
• Typically, the centers of tubercular granulomas undergo caseous necrosis.
Epidemiology
• Tuberculosis remains a leading cause of death among medically and economically deprived persons throughout the world.
poverty
crowding
elderly person
chronic debilitating illness, including
AIDS
Epidemiology(western world)
• Deaths from tuberculosis peaked in 1800s, Steadily declined untill 1984, then increased beause of human immunodeficiency virus (HIV) infected
• 25,000 new cases in USA annually currently
Epidemiology(Asia)
• The incidence of TB in India is the highest in the world, china is the second
• It is estimated that there is near 400,000,000 persons have once been infected tubercle bacilli in china
• Slender rod shape• Gram +• Acid fast +• High content of complex li
pids• Obligate aerobe • M.hominis and M.bovis( or
opharyngeal and intestinal TB)
Pathogenesis
• Development of a targeted T cell-mediated immunity (>3weeks) that confers resistance to the organism and results in development of tissue hypersensitivity leading to caseous necrosis and granuloma formation
Primary tuberculosis
• Previously unexposed, unsensitized person, most frequently in children
• Almost in the lungs• Typically in the distal airspaces of the lower par
t of the upper lobe or the upper part of the lower lobe, usually closed to the pleura
Primary tuberculosis
• Ghon complex (primary complex)
parenchymal lesion
lymphatitis
lymph node involvement
Clinical course
• 95% cases development of cell-mediated immunity controls the infection and increases resistance
• The Gohn complex undergoes fibrosis and calcification
• The scaring foci may harbor viable bacilli for years
• A few immunocompromised patients develop progressive primary TB
Secondary Tuberculosis
• It arises in a previously sensitized host• reactivation of dormant primary lesions or exogenous reinfection • Less than 5% patients
Secondary Pulmonary tuberculosis
• It is classically localized to the apex of upper lobes
• Cavitation occurs readly• The patient raises sputum c
ontaining bacilli
Miliary Tuberculosis
• Systemic miliary tuberculosis
liver, spleen, bone marrow, kidney,
fallopian tubes
• Pulmonary miliary tuberculosis
Extrapulmonary tuberculosis
• Intestinal tuberculosis Secondary to the swallowing of coughed-up
infective material
Drinking of contaminated milk is the reason of primary lesion
lymphadenitis
• Most frequent form• Cervical region• Unifocal in HIV(-) pati
ents• Multifocal in HIV(+) p
atients
Clinical course
• Asymptomatic
• Systemic symptoms
malaise
anorexia
weight loss
fever (low, remittent)
night sweats
Clinical course
• localizing pulmonary symptoms
Cough
Mucoid, purulent sputum
Hemoptysis
Pleural pain
Dyspnea• localizing extrapulmonary symptoms
• Diagnosis & Therapy
• History
• Physical and x-ray findings of consolidation
• Tubercle bacilli must be identified
• Multiple drugs treatment
OUTLINE
1.Pulmonary Infections Bacteria Pneumonias Atypical Pneumonias Tuberculosis 2.Chronic Obstractive Lung Diseases (COPD) Chronic Bronchitis Emphysema 3.Bronchiectasis 4.Cor Pulmonale 5.Lung tumors
Chronic Obstractive Lung Diseases(COPD)
• 10% US adults involved• The 4th leading cause of death in USA• Persisting and irreversible airway
obstruction
OUTLINE
1.Pulmonary Infections Bacteria Pneumonias Atypical Pneumonias Tuberculosis 2.Chronic Obstractive Lung Diseases (COPD) Emphysema Chronic Bronchitis 3.Bronchiectasis 4.Cor Pulmonale 5.Lung tumors
• Definition
Emphysema is characterized by permnent
Enlargement of the air spaces distal to the terminal bronchioles accompanied by destruction of their walls
Emphysema vs overinflationWith destruction without destruction
Complicated reasons compensatory
obstructive
Emphysema vs chronic bronchitis
Morphologic feature clinical feature
Restricted to acinus large and small
airway
The two deaseas usually coexist
Types of Emphysema
• Centriacinar
• Panacinar
• Distal acinar
(according to the distribution of lesions in the lobule and acinus)
Distal acinar Emphysema
• It is more striking adjacent to the pleura, septa, scaring , at the margins of the lobules
• Be more severe in the upper half of the lungs
• With the destruction of alveolar walls and loss of elastic tissue , Small airways tend to collapse during expiration-----an important cause of chronic airflow obstruction
pathogenesis
• Protease-antiprotease imbalance
• Oxidant-antioxidant imbalance
These two imbalances are almost always coexist
Clinical course
• Dyspnea• cough, purulent sputum (with bronchiti
s) • barrel-chest• Secondary pulmonary hypertension d
evelops gradually
OUTLINE
1.Pulmonary Infections Bacteria Pneumonias Atypical Pneumonias Tuberculosis 2.Chronic Obstractive Lung Diseases (COPD) Emphysema Chronic Bronchitis 3.Bronchiectasis 4.Cor Pulmonale 5.Lung tumors
Chronic Bronchitis
• Definition (made on clinical ground)
persistent productive cough for at least
3 consecutive months in at least 2
consecutive years
It is often developed in middle age to
old men with cigarette smoking
• Grossly, the mucosal of the trachea, bronchus, bronchiole is hyperemic, covered by a layer of mucinous or mucopurulent secretion
Clinical course• Cough with mucus or mucopurulent sputum• With/without ventilatiory dysfunction, hypoxemia, hypercapnia (COPD developed) • Secondary pulmonary hypertension develop
s gradually
OUTLINE
1.Pulmonary Infections Bacteria Pneumonias Atypical Pneumonias Tuberculosis 2.Chronic Obstractive Lung Diseases (COPD) Emphysema Chronic Bronchitis 3.Bronchiectasis 4.Cor Pulmonale 5.Lung tumors
• Definition Bronchiectasis is the permanent dilation of br
onchi and bronchioles caused by destruction of the muscle and elastic supporting tissue.
It is not a primary disease but rather is secondary to persisting infection or obstruction caused by variety of conditions
Conditions that predispose to bronchiecctasis
• Bronchial obstruction• Bacteria pneumonia• Congenital conditions
pathogenesis
• Obstruction Chronic infection
Tissue damage secretion accumulation
irreversible dilation
Dilated bronchus in which the mucosa and wall is not clearly seen because of the necrotizing inflammation
Clinical Course• severe, persistent cough with copious amou
nt of mucopurulent ,fetid sputum• Hemoptysis• symptoms are episodic and are precipitated
by upper respiratory tract infection• Secondary pulmonary hypertension develop
s gradually
OUTLINE
1.Pulmonary Infections Bacteria Pneumonias Atypical Pneumonias Tuberculosis 2.Chronic Obstractive Lung Diseases (COPD) Chronic Bronchitis Emphysema 3.Bronchiectasis 4.Cor Pulmonale 5.Lung tumors
Cor pulmonale
• Definition
It also called pulmonary heart disease, is used to describe disease of the right-side cardiac chambers caused by pulmonary hypertension resulting from pulmonary parenchymal or pulmonary vascular disease
Disorders that predispose to cor pulmonale
Diseases of the lungs Chronic obstructive lung disease Diffuse pulmonary interstitial fibrosis Extensive, persistent atelectasis Cystic fibrosis Diseases of pulmonary vessels Pulmonary embolism Primary pulmonary vascular sclerosis Extensive pulmonary arteritis Drug-, toxin-, or radiation-induced vascular sclerosis Disorders affecting chest movement Disorders inducing pulmonary arteriolar constriction
Heart changes
• right ventricular, and often right artrial hypertrophy.
• It may be dilated when ventricular failure develops.
• Conic of pulmonary artery bulges
• The point of the heart become blunt and round
• Thickness of the right ventricle exceeds the left ventricle
Pulmonary changes
• Primary lung diseases (such as chronic bronchitis, emphysema)
• with blood vessel changes-----pulmonary hypertension.
OUTLINE
1.Pulmonary Infections Bacteria Pneumonias Atypical Pneumonias Tuberculosis 2.Chronic Obstractive Lung Diseases (COPD) Chronic Bronchitis Emphysema 3.Bronchiectasis 4.Cor Pulmonale 5.Lung tumors
Lung tumors
• Bronchogenic carcinoma:95%• Miscellaneous group:5%
bronchial carcinoid tumor
fibrosarcoma
lymphoma
hamartoma
Bronchogenic carcinoma
• No.1 cause of cancer-related deaths in industrialized countries.
• Cigarette smoking is a important cause• The peak incidence occurs between ages 55
and 65 years.• The male to female ratio is 2:1• The prognosis of lung cancer is dismal
Histologic classification of Bronchogenic carcinoma
• Non-small cell lung carcinoma 1.squamous cell carcinoma(25%-30%) 2.adenocarcinoma,including bronchioloalveolar ca(30%-35%) 3.large cell carcinoma(10%-15%)
• Small cell carcinoma(20%-25%)• Combined pattens(5%-10%)
Clinical course
• Silent, insidious lesion• Chronic cough and expectoration• Hoarseness, chest pain, pleural or pericardial
effusion• Symptoms emanating from metastatic spread
to the brain, liver,or bone• NSCLCs have a better prognosis than SCLCs