8. Pulmonary Vascular Disease
⢠Edema
â Hydrodynamic or cardiogenic
â Microvascular Injury
⢠Adult Respiratory Distress Syndrome
â Diffuse Alveolar Damage
⢠Impair respiratory function
⢠Predisposes to infection
9. Pulmonary Edema
⢠Hemodynamic Edema
âIncreased HP
⢠Microvascular Injury
âInjury to capillaries of alveolar septa
âImportant contributor in the
development of ARDS
10.
11.
12.
13. ARDS
⢠Diffuse alveolar capillary damage
⢠Respiratory failure
⢠Arterial hypoxemia refractory to O2 therapy
⢠Several causes: sepsis, trauma, cancer,
inhaled gases
⢠Differs from Hyaline Membrane of the
Newborn â deficient surfactant
18. Pulmonary Embolism, Hemorrhage &
Infarction
⢠Occlusion of pulmonary circulation
⢠Predisposing factors: bed-ridden, risk-associated
conditions, etc.
⢠Embolic from other sites: deep veins of legs
⢠Potential consequences: size, site, cardiovascular
status
â Respiratory compromise
â Cardiovascular compromise
19.
20. Pulmonary Hypertension
⢠Normal: 1/8 of mean systemic pressure
⢠Ÿ or above is Pulmonary HPN
⢠Primary or Idiopathic
⢠Secondary â lung disease, left-sided heart
disease, recurrent emboli
⢠Endothelial dysfunction and injury with trigger
mechanisms â persistent vasoconstriction
21.
22.
23. ⢠Impaired defense mechanisms
⢠Lowered general resistance of the host
â Loss or suppression of the cough reflex
â Injury to the mucociliary apparatus
â Interference with the phagocytic or bactericidal
action of alveolar macrophages
â Pulmonary congestion and edema
â Accumulation of secretions
Pulmonary Infections
24. ⢠Defects in innate immunity and humoral
immunodeficiency
âPyogenic infections
⢠Cell-mediated immune defects
âintracellular microbes
âvery low virulence
25. Pulmonary Infections
⢠Morphology
â Lobar Pneumonia
â Lobular Pneumonia or Bronchopneumonia
â Atypical Pneumonia
â Necrotizing Pneumonia and Lung Abscess
⢠Where?
â Community Acquired
â Hospital Acquired or Nosocomial Infection
⢠Time/Duration: Acute and Chronic
⢠Etiologic Agent
⢠Immunocompromised Host
⢠Aspiration Pneumonia
26.
27.
28.
29.
30.
31.
32.
33. Necrotizing Pneumonia and
Lung Abscess
⢠Anaerobic bacteria with or without
mixed aerobic infection
⢠S. aureus, K. pneumoniae, S.
pyogenes. Type 3 pneumococcus
43. Aspiration Pneumonia
⢠Markedly debilitated patients
⢠Unconscious
⢠Repeated vomiting
⢠Abnormal gag and swallowing reflexes
⢠Partly chemical and partly bacterial (more than
one organisms; aerobes>anaerobes)
⢠Necrotizing, fulminant course
⢠Abscess formation as one of complications
44.
45. Pneumonia in Immunocompromised Host
⢠CMV, P. carinii, M. avium-
intracellulare
⢠Invasive aspergillosis and
candidiasis
⢠âUsualâ bacteria, viral and fungal
organisms
46.
47. Chronic Obstructive Pulmonary Disease
(COPD)
âIncreased resistance to air flow
Restrictive Pulmonary Disease
âReduced expansion of the lung parenchyma
60. Irregular Emphysema
⢠Irregular involvement of
the acinus
⢠Associated with scarring
Others:
ď Bullous Emphysema
ď Interstitial Emphysema
61.
62. Emphysema
⢠Imbalance between proteases and their
inhibitors
⢠Tobacco â recruit neutrophils, stimulate
release and enhance activities of
enzymes, inactivation of antitrypsin
63.
64. Chronic Bronchitis
⢠Persistent productive cough
⢠At least 3 months
⢠At least 2 consecutive years
⢠Morphology: hyperemia and edema of mucous
membranes, mucinous secretions and casts,
hypertrophy of mucous glands with airway
plugging, inflammation and fibrosis, squamous
metaplasia/dysplasia
65.
66. Bronchial Asthma
⢠Increased responsiveness to various
stimuli
⢠Paroxysmal contraction of airway
passages
âExtrinsic (Reagin-mediated,
Allergen)
âIntrinsic (Idiopathic or precipitated
by other factors, non-atopic or
non-reaginic)
98. Hypersensitivity Pneumonitis
⢠Immunologically-mediated
⢠Inhaled dusts or antigens
â Farmerâs lung: actinomyces spores in hay
â Pigeonâs breederâs lung: feathers, excreta
â Humidifier/Air-conditioner: HS, asthma, allergic
bronchopulmonary aspergillosis
â Idiopathic chronic eosinophilic pneumonia: focal
consolidation of lymphocytes and eosinophils; steroid
responsive
99. Bronchiolitis Obliterans â Organizing
Pneumonia
⢠Response to chronic infectious or inflammatory
injury of the lungs
⢠Cough, dyspnea, recent RTI
⢠Loose fibrous tissue plugs within bronchioles
and organizing pneumonia
⢠Improve gradually or with steroid therapy