Title: Pulmonary Infections
1Whether you think that you can, or that you
can't., you are usually right! Henry Ford
2Normal Lung
3Normal Lung
4Normal Lung Tissue
5Chronic Obstructive Pulomary Diseases(COPD)
- Dr. Venkatesh M. Shashidhar
- Associate Professor of Pathology
- Fiji School of Medicine
Commitment to Excellence
6Obstructive Airway Disease
- Localised Mechanical
- Tumours, Trauma, Foreign body collapse
- Diffuse Distal airway diseases.
- COPD chronic
- COPD Definition
- Progressive irreversible airway obstruction with
destruction of parenchyma. - Chronic obstructive bronhitis
- Emphysema
- Mucous plugging.
7COPD Introduction.
- Chronic Slow progress (FEV1lt80, FEV1/CV lt70)
- Stable over several months. (chronic)
- 15 of smokers likely to develop COPD.
- Etiology smoking, pollution. Low birth wt.
- Smoke ?irritation ? mucosal hyperplasia ? excess
mucous ? obstruction, inflammation. - Metaplasia, lack of defense / clearance mech.
- Obstruction, lack of elastic recoil, collapse.
8Pathology 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
9Smoking - Pathology
- Alveolar marcrophage
- CD8 Lymphocytes
- Neutrophils
- Proteases
- Bronchitis.
- Alveolar destruction.
10Pathogenesis Smoke - Lung Dis.
Irritation Inflammation Mucous - Infections
Carcinoma
11Chronic 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.
12COPD
13COPD
14Chronic Bronchitis
15smokers lung Normal Lung
16Emphysema
- 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
17smokers lung Emphysema
18smokers lung Pigmentation
19Emphysema
20Emphysema
21Centrilobular Emphysema
22Emphysema Ruptured alveloli.
23Centrilobular Emphysema
24Centrilobular Emphysema (smoking)
25Pan lobular bullous emphysema
26Local Bullous Emphysema
27Bronchitis Emphysema
- Blue Bloater
- Mild dyspnoea, late
- Infections common
- Cor-pulmonale
- Increased resistance
- Prominent BV, large heart.
- Pink Puffer
- Dyspnoea severe, early
- Occassional
- Rare, late
- Mild increase
- Hyperinflation small heart.
28Complications of COPD
- Cor Pulmonale
- syncope, hypoxia, pedal edema, passive hepatic
congestion, and death. - Acute Exacerbations.
- End-stage lung disease.
- Polycythemia hypoxia.
- Pneumothorax, Infections, Bronchectasis.
29Bronchiectasis
- Permanent dilatation of bronchi.
- Cough, copious purulent sputum.
- Lower lobes common
- Complications
- Pneumonia, empyema, septicemia, meningitis.
- Types
- Cylindrical, Saccular, Fusiform (no significance)
30Pathogenesis - Bronchiectasis
- COPD/Obstruction/Infection.
- Excess Mucous secretion
- Retention of secretion
- Secondary infection
- Destruction of bronchial wall
- Irregular, fixed inflamed dilated bronchus filled
with pus.
31Bronchiectasis
32Bronchiectasis
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35Bronchiectasis
36Bronchiectasis - Adhesions
37Saccular Bronchiectasis
38Summary - COPD
- Progressive, irreversible, obstruction,
destruction. - 3 etiology
- Smoking, pollution, Alpha1 AT Deficiency.
- 3 symptoms
- Cough, Dyspnoea, Hypoxemia
- 3 Diseases
- Chronic Bronchitis, Emphysema, Asthma
39COPD summary
- 3 Complications
- Exacerbations, Cor-pulmonale, End stage lung
disease. - 3 Investigations
- Spirometry (FEV1/VC), PaO2, PCO2.
- 3 grades
- Mild 69-80 FEV1 cough, exertional dysp.
- Mod 40-60 FEV1 - Wheeze, cough, sputum.
- Sev - lt 40 FEV1 - Right Heart Failure.
40"Troubles are often the tools by which God
fashions us for better things." - Henry Ward
Beecher