VTE-3 Case studies Dr. Abdelaty Shawky Assistant professor of pathology.
Chronic obstructive pulmonary diseases (COPD) By Dr. Abdelaty Shawky Assistant professor of...
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Transcript of Chronic obstructive pulmonary diseases (COPD) By Dr. Abdelaty Shawky Assistant professor of...
Chronic obstructive pulmonary diseases (COPD)Chronic obstructive pulmonary diseases (COPD)
ByBy
Dr. Abdelaty ShawkyDr. Abdelaty ShawkyAssistant professor of pathology Assistant professor of pathology
• COPD is a group of lung diseases characterized by increased resistance to air flow due to airway obstruction.
• Includes;1. Chronic bronchitis.1. Chronic bronchitis.2. Emphysema. 2. Emphysema.
1. Chronic bronchitis1. Chronic bronchitis
* Definition: persistent productive cough for at least 3
consecutive months in at least 2 consecutive years.
* Causes:
Chronic irritation of the bronchial mucosa by:
1.Cigarette smoking.
2.Environmental pollution.
3.Chronic inflammation of upper respiratory tract.
* Pathogenesis: Chronic irritation of the bronchial
epithelium by cigarette smoke, environmental chemical…etc
leads to:
a. Epithelial changes: Hyperplasia, squamous metaplasia and
dysplasia.
b. Subepithelial changes:
•Hyperplasia of the mucous glands (increase mucin secretion)
•Hypertrophy of smooth muscle (leading to bronchial spasm).
•In old standing cases, marked fibrosis.
* Gross features: The mucosa is hyperaemic, swollen and
covered by mucus or muco-pus.
* Microscopic examination: Bronchi & bronchioles show:
a.Epithelial changes:
•Hyperplasia, squamous metaplasia and dysplasia.
b. Subepithelial changes:
•Hyperplasia of the mucous glands,
•Chronic inflammatory cells and fibrosis.
•Hypertrophy of the smooth muscle.
* Clinical types of chronic bronchitis:
1. Simple chronic bronchitis: 1. Simple chronic bronchitis: patients have a productive
cough but no physiologic evidence of airflow obstruction.
2. Asthmatic chronic bronchitis: 2. Asthmatic chronic bronchitis: in individuals demonstrating
hyper-reactive airways with intermittent bronchospasm and
wheezing.
3. Obstructive chronic bronchitis: 3. Obstructive chronic bronchitis: in some patients,
especially heavy smokers, who develop evidence of associated
emphysema.
* Complications:
1.Emphysema.
2.Bronchopneumonia.
3.Pulomonary hypertension and core pulmonale
resulting in Rt. sided heart failure.
4.Bronchogenic carcinoma
2. Emphysema2. Emphysema
* Definition:•Permanent dilatation of air spaces distal to the terminal bronchioles accompanied by damage of their walls without obvious fibrosis.
Respiratory acinus = Respiratory bronchioles + alveolar ducts + alveolar sacs.
* Types 1. Centriacinar (centrilobular) emphysema.2. Panacinar (panlobular) emphysema.
Centriacinar (centrilobular) Centriacinar (centrilobular) emphysemaemphysema
Panacinar (panlobular) Panacinar (panlobular) emphysemaemphysema
1. Site of involvement
Central part of the respiratory acinus
(respiratory bronchiole)
the whole respiratory acinus
(RB+AD+alveoli)
Centriacinar (centrilobular) Centriacinar (centrilobular) emphysema emphysema
Panacinar (panlobular) Panacinar (panlobular) emphysema emphysema
2. Pathogenesis2. Pathogenesis - Common (95% of cases).- Affects middle and old ages.- Related to cigarette smoking,
explained by;1. Elastase-antielastase imbalance
theory:Smoking weaken the wall of air spaces by
increasing elastase and decreasing antielastase via;
1. Accumulation of macrophages and neutrophils in the walls of air spaces which are the source of elastase enzyme.
2. Inhibit anti-elastase (α 1 antitrypsin) by oxidants (oxygen free radicals) secreted from neutrophils.
- Rare (5% of cases).- Affects young ages.- Related to congenital deficiency of anti-elastase (congenital α 1 antitrypsin deficiency). Therefore the action of elastase secreted from neutrophils and macrophages becomes unopposed.
Centriacinar (centrilobular) Centriacinar (centrilobular) emphysema emphysema
Panacinar (panlobular) Panacinar (panlobular) emphysema emphysema
2. Chronic bronchitis theory: - It causes emphysema by:Accumulation of macrophages and neutrophils in the walls of air spaces with release of elastase.Bronchial obstruction by the mucous plugs leads to increased intraluminal pressure.
Centriacinar (centrilobular) Centriacinar (centrilobular) emphysema emphysema
Panacinar (panlobular) Panacinar (panlobular) emphysema emphysema
3. Gross features3. Gross features• Upper lobes are first
affected.• Moderate lung
enlargement.• C/S: clusters of dilated air
spaces.
1. Chest: Barrel-shaped chest: Increased antero-posterior diameter. Horizontal ribs. Wide subcostal angle.2. Lungs: Lower lobes of the lungs are first affected. Markedly enlarged lungs. Very light. Pale. (due to vascular compression). Dry.
Centriacinar (centrilobular) Centriacinar (centrilobular) emphysema emphysema
Panacinar (panlobular) Panacinar (panlobular) emphysema emphysema
Consistency: feathery and pit on pressure. (due to loss of elastic tissue) Smooth outer surface with evident rib markings. Emphysematous bullae: coalescent wide air spaces along weak borders e.g. apex, anterior margin and free edge of the base). C/S: diffuse areas of large air spaces.
Centriacinar emphysema
Panacinar emphysema
Emphysematous bollus
Centriacinar (centrilobular) Centriacinar (centrilobular) emphysema emphysema
Panacinar (panlobular) Panacinar (panlobular) emphysema emphysema
4. Microscopic Picture4. Microscopic Picture Dilated respiratory bronchioles only
with normal alveolar ducts and alveoli.
1. Alveoli are:- Few in number, increased in size, distorted in shape.- Some alveolar septa rupture and the alveolar lumens coalesce to each other.2. Alveolar walls are: thin with compressed capillaries and arterioles.
Centriacinar (centrilobular) Centriacinar (centrilobular) emphysema emphysema
Panacinar Panacinar (panlobular) (panlobular) emphysema emphysema
5. Complications5. Complications I. Respiratory system:1. Chronic bronchitis.2. Air embolism.3. Spontaneous pneumothorax (due to rupture of
emphysematous bulla).4. Respiratory failure.
II. C.V.S: Pulmonary hypertension & Rt. sided heart failure.
The The endend