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Pulmonary Infections

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Pink Puffers normal ABG pattern. Types: Centrilobular smoking ... Pink Puffer. Dyspnoea severe, early. Occassional. Rare, late. Mild increase ... – PowerPoint PPT presentation

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Title: Pulmonary Infections


1
Whether you think that you can, or that you
can't., you are usually right! Henry Ford
2
Normal Lung
3
Normal Lung
4
Normal Lung Tissue
5
Chronic Obstructive Pulomary Diseases(COPD)
  • Dr. Venkatesh M. Shashidhar
  • Associate Professor of Pathology
  • Fiji School of Medicine

Commitment to Excellence
6
Obstructive 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.

7
COPD 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.

8
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

9
Smoking - Pathology
  • Alveolar marcrophage
  • CD8 Lymphocytes
  • Neutrophils
  • Proteases
  • Bronchitis.
  • Alveolar destruction.

10
Pathogenesis Smoke - Lung Dis.
Irritation Inflammation Mucous - Infections
Carcinoma
11
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.

12
COPD
13
COPD
14
Chronic Bronchitis
15
smokers lung Normal Lung
16
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

17
smokers lung Emphysema
18
smokers lung Pigmentation
19
Emphysema
20
Emphysema
21
Centrilobular Emphysema
22
Emphysema Ruptured alveloli.
23
Centrilobular Emphysema
24
Centrilobular Emphysema (smoking)
25
Pan lobular bullous emphysema
26
Local Bullous Emphysema
27
Bronchitis 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.

28
Complications of COPD
  • Cor Pulmonale
  • syncope, hypoxia, pedal edema, passive hepatic
    congestion, and death.
  • Acute Exacerbations.
  • End-stage lung disease.
  • Polycythemia hypoxia.
  • Pneumothorax, Infections, Bronchectasis.

29
Bronchiectasis
  • Permanent dilatation of bronchi.
  • Cough, copious purulent sputum.
  • Lower lobes common
  • Complications
  • Pneumonia, empyema, septicemia, meningitis.
  • Types
  • Cylindrical, Saccular, Fusiform (no significance)

30
Pathogenesis - Bronchiectasis
  • COPD/Obstruction/Infection.
  • Excess Mucous secretion
  • Retention of secretion
  • Secondary infection
  • Destruction of bronchial wall
  • Irregular, fixed inflamed dilated bronchus filled
    with pus.

31
Bronchiectasis
32
Bronchiectasis
33
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34
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35
Bronchiectasis
36
Bronchiectasis - Adhesions
37
Saccular Bronchiectasis
38
Summary - COPD
  • Progressive, irreversible, obstruction,
    destruction.
  • 3 etiology
  • Smoking, pollution, Alpha1 AT Deficiency.
  • 3 symptoms
  • Cough, Dyspnoea, Hypoxemia
  • 3 Diseases
  • Chronic Bronchitis, Emphysema, Asthma

39
COPD 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
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