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Lung
Robbins & Cotran pg. 706-720
68
Pathology
Graduate
12/15/2010

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Term
What are the usual source of pulmonary emboli?
Definition
thrombi in deep veins of leg
Term
Examples of primary hyper-coagulbale states
Definition
factor V Leiden
Prothrombin mutations
Antiphospholipid syndrome
Term
Examples of secondary hyper-coagulable states
Definition
obesity
recent surgery
cancer
oral contraceptive use
pregnancy
Term
2 main pathophysiologic consequences of emboli:
Definition
RESPIRATORY COMPROMISE - from non-perfused by ventilated segments
HEMODYNAMIC COMPROMISE - increased resistance to pulmonary blood flow
Term
Acute cor pulmonale
Definition
Acute failure of the right side of the heart
Term
Infarcts are:
Definition
-only caused by about 10% of emboli
-occur when circulation is already inadequate (heart/lung disease)
-usually in lower lobes
Term
How to distinguish a post-mortem clot causing pulmonary embolism
Definition
Lines of Zahn - antemortum clots (alternating bands)
Term
unresolved small emboli can lead to
Definition
pulmonary hypertension
pulmonary vascular sclerosis
chronic cor pulmonale
Term
patients with a pulmonary embolism have a ___% chance of developing a second embolism
Definition
30%
Term
pulmonary circulation is ____ resistance compared to systemic circulation
Definition
LOW RESISTANCE
Term
When does pulmonary hypertension occur?
Definition
when pulmonary pressure reaches 1/4 of systemic levels
Term
Structural cardiopulmonary conditions that assoc with Pulmonary Hypertension
Definition
-increase in pulmonary blood flow and/or pressure
-pulmonary vascular resistance
-left heart resistance to blood flow
Term
Pulmonary Hypertension in Chronic Obstructive or Interstitial Lung disease
Definition
hypoxia & destruction of lung parenchyma --> fewer alveolar capilaries
**increased pulmonary arterial resistance
**elevated pressure
Term
Pulmonary Hypertension inCongenital or Acquired Heart Disease
Definition
-Incease in left atrial pressure --> increase in pulmonary venous pressure
**increase in pulmonary artery pressure
Term
Pulmonary Hypertension in Recurrent Thromboemboli
Definition
obstruction of pulmonary vascular bed
**increase in pulmonary vascular resistance
Term
Pulmonary Hypertension in Connective Tissue disease
Definition
-inflammation, intimal firbsosi, medial hypertrophy and PH
Term
Pulmonary Hypertension in Obstructive Sleep Apnea
Definition
impt in development of PH & Cor Pulmonale
Term
Familial PH is caused by mutations in
Definition
Bone Morphogenetic Protein Receptor Type 2 (BMPR2) signaling pathway
Term
Role of BMPR2 in familial hypertension
Definition
-NORMALLY: Vascular Smooth Muscle Cells BMPR2 signaling = inhibition of proliferation & favors apoptosis
-INACTIVE: increase smooth muscle survival & proliferaiton
Term
What occurs in secondary Pulmonary Hypertension
Definition
-Decreased prostacylcin & decreased NO
*Unchecked platelet adhesion & activation
-Increased release endothelin
*All above ++ Pulmonary Vasoconstriction
Term
Common pathologic features of PH
Definition
-medial hypertrophy of muscular & elastic arteries
-atheromas of pulmonary artery & its major branches
-right ventricular hypertrophy
Term
Plexiform Lesion
Definition
Occurs in: idiopathic/familial PH; unrpaired congenital disease (left-to-right shunts; PH assoc with drugs, HIV
-tuft of capillary formations produce a network that spans in the lumens of dilated thin-walled, small arteries
Term
Idiopathic PH is most common in:
Definition
women age 20-40 & occasionally in young children
Term
Examples of pulmonary hemorrhage syndrome
Definition
-Good-pasture syndrome
-Idiopathic pulmonary hemosiderosis
-Vasculitis-associated hemorrhage
Term
Good-Pasture is produces autoantibodies against:
Definition
alpha3 chain of Collagen IV
attacks basement membrane in kidneys & lungs
Term
Morphological changes from Good-Pastures in:
Lung
Kidney
Definition
LUNG - focal necrosis of alveolar walls; hemosiderin-laden macrophages in alveoli; hypertrophy of Type II Pneumocytes; deposition of antibodies in basement membrane
KIDNEY:focal proliferative glomerulonephritis
Term
Effect of plasmapheresis
Definition
remove circulating anti-basement membrane Ab's & chemical mediators of immunological injury
Term
Features of Idiopathic Pulmonary Hemosiderosis
Definition
-intermittend, diffuse alveolar hemorrhage
-most cases in young children
-unknown etiology: but responds to long-term immune suppression (may have a autoimmune factor)
Term
Features of Wegener Granulomatosis
Definition
-autoimmune disease of upper resp tract and/or lungs
-Hemoptysis common presenting symptom
-Need transbronchial lung biopsy = capillaritis & scattered, poorly formed granulomas = diagnostic features
Term
Interference of pulmonary defense mechanisms include:
Definition
-loss / suppression of cough reflex
-injury to mucociliary apparatus
-accumulation of secretions
-interference with phagocytic/bacterial action
-pulmonary congestion / edema
Term
Defects in innate & humoral immunity leads to increased incidence of what type of infections?
Definition
pyogenic (pus-forming) bacteria
Term
Defects in cell-mediated immunity result in an increase in what type of infections?
Definition
Intracellular microbes (e.g. mycobacteria, herpes) & microbes with low virulence
Term
Streptococcus pneumonia
Definition
-Most common cause of community acquired pneumonia
-gram positive
-lancet shaped diplococci
Term
Haemophilus influenzae
Definition
-Pleomorphic, gram negative
-Major cause of life-threatening acute lower respiratory tract infections & meningitis in children
-Colonizes pharynx: encapsulated (5%) & unencapsulated (95%) encapsulated
-Encapsulated secretes haemocin that kills unencapsulated
-pilli for adherence
-secretes anti-ciliary factor & protease against IgA (major respiratory Ig)
-capsule prevents opsonization
-Cause of pink eye
-most common bacterial cause of acute exacerbation of COPD
Term
Moraxella catarrhalis
Definition
-2nd most common bacterial cause of acute exacerbation of COPD
-1 of 3 common cause of otitis media in children
Term
Staphylococcus aureus
Definition
-important cause of secondary bacterial pneumonia following viral respiratory illnesses
-assoc with hi incidence of complications
-IV drug users - high risk of developing staph pneumonoia in assoc w/ endocarditis
Term
Klebsiella pneumoniae
Definition
-most frequent cause of Gram Negative bacteria
-affects malnourish & debilitated (chronic alcoholics)
-Thick & gelatinous sputum
Term
Pseudomonas aeruginosa
Definition
-most common cause of hospital-acquired infections
-opportunistic in cystic fibrosis
-common in neutropenics
Term
Legionella pneumophila
Definition
-agent of Legionnaire's Disease
-causes Pontiac Fever (self-limiting URI)
-transmission: inhilation of aerosolized or aspiration of contaminated water
-organ transplants are susceptible
Term
2 patterns of anatomic distribution in bacterial pneumonia:
Definition
-LOBULAR BRONCHOPNEUMONIA - patchy consolidation of lung
-LOBAR PNEUMONIA - fibrinosuppurative consolidation of large portion of a lobe/entire lobe
Term
Complications of pneumonia:
Definition
1 - tissue destruction/necrosis ==> abscess
2. spread of infxn to pleural cavity --> empyema (intrapleural fibrinosuppurative rxn)
-bacteremic dissemination to heart valves, pericardium, brain, spleen, joints
Term
4 stages of lobar pneumonia:
Definition
CONGESTION - lung is heavy, boggy & red; vascular engorgement, intra-alveolar fluid w/ few neutrophils
RED HEPATIZATION - massive confluent exudation w/ neutrophils, red cells, fibrin filling alveolar spaces
GRAY HEPATIZATION - progressive disintegration of red cells & persistance of fibrinosupprative exudate; gray-brown, dry surface
RESOLUTION - enzymatic digestion of consolidated exudate - debris is resorbed, expectorated or rearranged
Term
Primary atypical pneumonia characteristics
Definition
-acute febrile respiratory disease
-patchy inflammatory changes in lungs confined to alveolar septa & pulmonary interstitium
-moderate amount of sputum & no physical findings of consolidation
Term
Most common cause of primary atypical pneumonia
Definition
Mycoplasma pneumoniae
-common among children & young adults
Term
Commmon morphology of community-acquired atypical pneumonias
Definition
interstitial inflammatory reaction, localized within walls of alveoli
-alveolar septar are widened & edematous w. monoculear inflammatory infiltrate
Term
Influenza Virus characteristics
Definition
-ssRNA - 8 helices
-Hemagluttinin & Neuraminidase
-2 clearance mechanisms: cytotoxic T cels & Intracellular anti-influenza protein Mx1 induced in macrophages by IFN alpha & gamma
Term
Influenza epidemic vs influenza pandemic
Definition
EPIDEMIC - predominates througout the world @ given time **antigenic drift** mutations of H & N
-PANDEMIC - longer, more widespread **antigenic shift** H & N are replaced with Animal segments thru recombination
Term
Avian Influenza / H5N1
Definition
-severity of the dzs b/c it spreads thruout body - not limited to lung
-H protein can be cleaved by ubiqutous proteases
Term
Viral URIs morphology:
Definition
-mucosal hyperemia
-swelling w/ predominantly lymphomonocytic & plasmacytic infiltration of submucosa
Term
Human Metapneumovirus (MPV)
Definition
-paramyxovirus
-upper & lower respiratory functions
-indistinguishable from RCV
Term
Severe Acute Respiratory Syndrome (SARS)
Definition
-Incubation period 2 days
-dry cough, malalise, myalgia, fever, chill
-coronavirus
-transmission by wild masked palm civets
Term
More common cause of hospital acquired infections:
Definition
-Gram Negative Rods: Enterobacter, pseudomonas
-Staph aureus
Term
Aspiration Pneumonia
Definition
-aspiration of gastric contents
-pneumonia is party chemical and partly bacterial
Term
What is a pulmonary abcess?
Definition
Local suppurative process within lung, characterized by necrosis of lung tissue
Term
Introduction of abscess forming pathogens via:
Definition
-aspiration of infective material
-antecedent primary lung infection
-septic embolism
-neoplasia
-miscellaneous - trauma, spread of neighboring infection
Term
Primary cryptogenic lung anscesses
Definition
abscess without any explanation
Term
Where are pulmonary abscesses due to aspiration more common?
Definition
right side - more vertical right main bronchus
Term
Cardinal histologic change in abscesses
Definition
suppurative destruction of lung parenchyma within central area of cavitation
Term
Histoplasmosis, Blastomycosis, Coccidiodiomycosis have in common:
Definition
-Caused by Fungi
-granulomatous diseases resembling TB
-has regional distribution
Term
Histoplasma capsulatum
Definition
-inhalation contaminated with bird/bat dropping
-intracellular parasite of macrophages
-granulomas undergo fibrosis - concentric calcification with tree-bark appearance
-Missippi River, Ohio River, Carribbean
Term
Fulminant disseminated histoplasmosis
Definition
immunosuppressed individuals
-no granuloma formation - instead focal accumulations of mononuclear phagocytes filled with fungal yeasts
Term
Blastomyces dermatidis
Definition

-soil inhabiting, dimprophic fungus

-macrophages have limited available to destroy it

-Central & Southeast USA

Term
How does IS fight histoplasmosis?
Definition
-Controlled by helper T cells & secrete IFN-Gamma to activate macrophages to kill
-histoplasma induces macrophages to secrete TNF - recruits and stimulates macrophage to kill
Term
Coccidiomycosis
Definition
-delayed-type hypersensitivity to fungus
-blocks fusion of phagosome & lysosome (resistant to intracellular killing)
-Far West & South West
Term
Bacterial & Tubercular infections are more likely at ...
Definition
higher CD4+ counts >200
Term
Pneumocytistis pneumonia is at what CD4+ count
Definition
Below 200 cells
Term
Cytomegalovirus & Mycobacterium avium occur at what CD4+ level?
Definition
<50
Term
What can cause pleural effusion?
Definition
-increase hydrostratic pressure
-increased vascular permeability
-decreased osmotic pressure
-increased intrapleural negative pressure
-decreased lymphatic drainage
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