Pulmonary Infections

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Whether you think that you can, or that you
can't., you are usually right! Henry Ford
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Normal Lung
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Normal Lung
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Normal Lung
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Pathology of Smoking

• Irrefutable evidence - smoking ? disease
• gt4000 chemicals, 43 carcinogens.
• Range of non-neoplastic and neoplastic dis.
• Chronic bronchitis, emphysema common.
• Ca bladder, Pancreas, cervix, larynx.
• Gastritis, PUD, IHD, HPTN, atherosclerosis risk
  factor.
• Arteriosclerosis Bergers

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Pathogenesis Smoke - Lung Dis.
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COPD

• Dr. Venkatesh M. Shashidhar
• Senior Lecturer in Pathology
• Fiji School of Medicine

Commitment to Excellence
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Obstructive Airway Disease

• Localised Mechanical
• Tumours, Trauma, Foreign body.
• Diffuse Distal airway diseases.
• Bronchitis, Bronchiectasis, Emphysema Asthma.
• Acute Chronic

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COPD - Classification

• Chronic Bronchitis
• Bronchiectasis
• Emphysema
• Asthma

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Chronic Bronchitis

• Productive Cough gt3 months in 2 years.
• Smoking / pollution - major cause.
• Acute Chronic inflammation of mucosa
• Lack of cilia - retention of secretions
• Increased mucous glands viscid mucous.
• Frequent secondary infections
• inflammation? retention? infection? obstruction
  cycle.

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Pathogenesis - Bronchiectasis

• Smoking irritation of mucosa
• Mucous secretion Cough, Obstruction
• Metaplasia ? loss of ciliated epithelium ?
• Retention of secretion
• Secondary infection
• Recurrent Inflammation
• Destruction of bronchial wall ? irregular, fixed
  dilated bronchus filled with pus.

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Chronic Bronchitis
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Bronchiectasis
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smokers lung Emphysema
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smokers lung Normal Lung
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smokers lung Pigmentation
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Bronchitis Emphysema

• Blue Bloater
• Mild dyspnoea, late
• Infections common
• Corpulmonale
• Increased resistance
• Prominent BV, large heart.

• Pink Puffer
• Dyspnoea severe, early
• Occassional
• Rare, late
• Mild increase
• Hyperinflation small heart.

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Emphysema

• Alveolar wall destruction, Dyspnoea, RHF.
• Pink Puffers normal ABG pattern.
• Types
• Centrilobular smoking
• Panlobular congenital - ?1 antitrypsin
  deficiency
• Paraseptal irregular subpleural, scarring
• Other
• Interstitial emphysema Air leak.
• Senile Emphysema

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Emphysema
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Centrilobular Emphysema
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Emphysema Features.
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Centrilobular Emphysema
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Centrilobular Emphysema
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Pan lobular bullous emphysema
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Local Bullous Emphysema
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Bronchiectasis

• Permanent dilatation of bronchi.
• Obstruction, inflammation, infection, destruction
  Obstruction...
• Lower lobes common
• Complications
• Pneumonia, empyema, septicemia, meningitis.
• Types
• Cylindrical, Saccular, Fusiform (no significance)

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Saccular Bronchiectasis
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Bronchiectasis
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Bronchiectasis - Adhesions
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Bronchiectasis
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Summary - COPD

• Chronic diffuse obstruction with destruction of
  lung structure.
• Cough, Dyspnoea, Hypoxemia, Right Heart Failure.
• Four Major diseases
• Chronic Bronchitis
• Emphysema
• Bronchiectasis
• Asthma

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"Troubles are often the tools by which God
fashions us for better things." - Henry Ward
Beecher