K12 - Patologi Paru-2011
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Transcript of K12 - Patologi Paru-2011
Respiratory System Block
DEPARTEMEN PATOLOGI ANATOMI Fakultas Kedokteran Universitas Sumatera Utara Medan-2011
TUBERCULOSIS
… TUBERCULOSIS
… TUBERCULOSIS
PRIMARY PULMONARY TUBERCULOSIS, Ghon complex
• The gray-white parenchymal focus (under pleura in the lower part of upper lobe)
• Hilar lymph nodes with caseation (on the left)
GHON COMPLEX
HISTOLOGICALLYSites of active involvement are marked by a
characteristic :
That forms both tubercles
&
THE MORPHOLOGIC SPECTRUM OF TUBERCULOSIS
A characteristic tubercle at low magnification :Central caseation surrounded by epithelioid &
multinucleated giant cells.
(D, Courtesy of Dr. Dominick Cavuoti, Department of Pathology, University of Texas Southwestern Medical School, Dallas, TX.)
Central caseation surrounded by epithelioid & multinucleated giant cells.
(D, Courtesy of Dr. Dominick Cavuoti, Department of Pathology, University of Texas Southwestern Medical School, Dallas, TX.)
In immunocompetent individuals, tubercular granulomas might not show central
caseation
(D, Courtesy of Dr. Dominick Cavuoti, Department of Pathology, University of Texas Southwestern Medical School, Dallas, TX.)
In immunosuppressed individuals, tuberculosis may not elicit a granulomatous response
("nonreactive tuberculosis“)
(D, Courtesy of Dr. Dominick Cavuoti, Department of Pathology, University of Texas Southwestern Medical School, Dallas, TX.)
… TUBERCULOSIS
Secondary pulmonary tuberculosis
The upper parts of both lungs are riddled with :•Gray-white areas of caseation & •Multiple areas of softening & cavitation.
Cavitary Tuberculosis• When necrotic tissue is
coughed up cavity
• Typical for large granulomas
• More common in the secondary reactivation tuberculosis - upper lobes.
Tuberculous Granulomas
… TUBERCULOSIS
• The cut surface shows numerous gray-white granulomas
Miliary tuberculosis of the spleen
Lymphadenitis
Adrenal TB - Addison Disease
Testes TB Orchitis
TB Peritonitis + Liver Miliary TB
TB Brain – Caudate
TB Intestine
Prostate TB
Spinal TB - Potts Disease
• Foreign body granuloma• Fat necrosis• Fungal infections• Sarcoidosis• Crohn’s disease
Granuloma / LH giant cell is not pathagnomonic of TB…!
PNEUMONIA
PNEUMONIA
PNEUMONIA
The Anatomic distribution of bronchopneumonia & lobar pneumonia
BRONCHOPNEUMONIA (Pathogenesis)
… Bronchopneumonia (Pathogenesis)
• Infant & old • Weakness patient
– Carcinoma, cardiac failure, chronic kidney failure, traumatic cerebrovascular
• Acute bronchitis• Chronic obstruction respiratory tract, or • Cystic fibrosis & • Post operative
BRONCHOPNEUMONIA
LOBAR PNEUMONIA
PNEUMONIA (STADIUM)
… PNEUMONIA (STADIUM)
… PNEUMONIA (STADIUM)
… PNEUMONIA (STADIUM)
SPECIAL PNEUMONIA
PNEUMONIA NON-INFECTIONASPIRATION
… PNEUMONIA NON INFECTION
LIPID PNEUMONIA
… PNEUMONIA NON INFECTION
• EOSINIPHYLIC PNEUMONIA
OBSTRUCTION LUNG DISEASE
LOCAL OBSTRUCTION LUNGDISEASE
DIFUSE OBSTRUCTION LUNG DISEASE
CHRONIC BRONCHITIS
Severe
• Hypercapnia• Hypoxia & cyanosis (blue bloaters)]
Chronic Bronchitis
NormalCD/AB = 0.4
Reid Index
= Ratio of thickness of mucous gland layer (CD) to the thickness between the epithelium and the cartilage (AB) (normally 0.4).
• The closer to 1 means ↑ thickness & correlated to progression of disease
Chronic Bronchitis
• Clinical course• Bronchi & bronchioles are obstructed by mucus plugs
• bronchiolitis obliterans.
• In long-standing cases,
• squamous metaplasia & dysplasia (precancerous)
• predisposes for squamous cell carcinoma
??
EMPHYSEMA
EMPHYSEMA
A.Diagram of normal structures within the acinus, the fundamental unit of the lung. A terminal bronchiole (not shown) is immediately proximal to the respiratory bronchiole.
B. Centriacinar emphysema with dilation that initially affects the respiratory bronchioles.
C. Panacinar emphysema with initial distention of the peripheral structures (i.e., the alveolus and alveolar duct); the disease later extends to affect the respiratory bronchioles.
ASTHMA
BRONCHUS IRRITABLE (+) BRONCHUS SPASM
MUCOUS (>>) OBSTRUCTION DYSPNOE
TYPE : - ATOPIC - NON ATOPIC - ASPIRINE INDUCED - OCCUPATIONAL - ALLERGIC (ASPERGILLUS)
Bronchial Asthma
NON ATYPIC ASTHMA
T. RESP. INFECTION CHRONIC BRONCHITIS
ALLERGEN TEST (-) LOCAL IRRITATION BRONCHUS
CONSTRICTION
ASPIRINE INDUCED ASTHMA
MECHANISM (?)
+/- PROSTAGLANDINE DECREASE / LEUKORINE INCREASE RESP. TR. IRRITABLE
RHINITIS, NASAL POLYPS,
URTICARIA (+)
OCCUPATIONAL ASTHMA
REACTIVE HYPERSENSIVITY (ALLERGEN)
DYSPNOE COUGH (CHRONIC) ALLERGEN :
- WOOD
- CHEMICAL
- ETC
ASPERGILLUS BRONCHITIS ALLERGY
SPORA ASPERGILLUS FUMIGATUS HYPERSENSITIVITAS REAC. DYSPNOE MUCOUS GLOBULE ASPERGILLUS
HYPAE (+)
BROCHIECTASIS.
ETIO : - BRONCHUS OBSTRUCTION
- INFECTION (SEVERE) - CONGENITAL (<<<)
BRONCHUS & BRONCHIOLUS DILATATION COUGH (CHRONIC), DYSPNOE, SPUTUM (>>>)
+ BLOOD
BRONCHIECTASIS CLINIC :
- LOBUS INFERIOR + INFECTION - CLUBBING FINGER
COMPLICATION PNEUMONIA, EMPIEMA, SEPTICAEMIA, MENINGITIS, ABSCESS METASTASIS
(CEREBRAL), AMYLOID (+)
Bronchiectasis Gross
Distended peripheral bronchi (Due to weakening of wall)
LUNG NEOPLASMA
PRIMARY LUNG CA ANOTHER LUNG NEOPLASMA
- BENIGN
- MALIGNANT SECONDARY LUNG
NEOPLASMA
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George Lorimer1867-1937, Editor of "Saturday Evening Post"