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Quick Review of Pathology for clinicians and senior students.
Chronic Obstructive Pulmonary disorders and pneumoconiosis.

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  1. 1. “ Watch your thoughts; they become words. Watch your words; they become actions. Watch your actions; they become habits. Watch your habits; they become character. Watch your character; it becomes your destiny.” Frank Outlaw
  2. 2. Quick Pathology Review Shashidhar Venkatesh Murthy A/Prof.& Head of Pathology School of Medicine & Dentistry James Cook University Australia. <ul><li>Pathology of </li></ul><ul><li>COPD: </li></ul><ul><ul><li>Bronchitis, Emphysema </li></ul></ul><ul><ul><li>Asthma </li></ul></ul><ul><ul><li>Pneumoconiosis </li></ul></ul><ul><ul><li>ARDS </li></ul></ul><ul><li>System : RS </li></ul><ul><li>Class : Inflammatory disorders </li></ul><ul><li>Topic : COPD, ARDS, Asthma </li></ul>
  3. 3. COPD <ul><li>Aetiology: </li></ul><ul><li>Chronic inflammation of airways (Bronchitis) Alveoli (Emphysema). </li></ul><ul><li>Pathogenesis: </li></ul><ul><li>Irritants (smoke) – inflammation  mucosal hyperplasia  epithelial damage  infection  Destruction. </li></ul><ul><li>Morphology: </li></ul><ul><li>Inflammation, Mucosal hyperplasia, Infection, mucous. </li></ul><ul><li>Smooth muscle hyperplasia, </li></ul><ul><li>Destruction  Chronic Bronchitis &/or emphysema . </li></ul><ul><li>PFT, FEV1, FVC. – irreversible * </li></ul><ul><li>Complications: </li></ul><ul><li>Bronchiectasis, Pneumonia, Lung ca., Pulm. Failure. </li></ul><ul><li>Clinical: </li></ul><ul><li>SOB, chronic cough…. Etc. </li></ul>
  4. 4. What is the Diagnosis ? <ul><li>Silicosis </li></ul><ul><li>Pneumoconiosis. </li></ul><ul><li>Asbestosis. </li></ul><ul><li>Fungal infection (Candida) </li></ul><ul><li>Charcot leyden crystals. </li></ul>
  5. 5. Diagnosis ? <ul><li>Henoch Schonlein purpura. </li></ul><ul><li>Thromboangitis obliterans. </li></ul><ul><li>Extensive Bronchopneumonia </li></ul><ul><li>ARDS </li></ul><ul><li>Polyarteritis nodosa. </li></ul>
  6. 6. ARDS – Shock lung <ul><li>Heavy boggy lungs </li></ul><ul><li>Oozes hemorrhagic fluid. </li></ul><ul><li>Infection + / - </li></ul><ul><li>Microscopically alveoli filled by fibrin, exudate, lipids & dead epithelial cells. </li></ul><ul><li>Hyaline membrane lining alveoli (fibrin deposit) </li></ul><ul><li>Interstitial inflammation. </li></ul>
  7. 7. Diagnosis ? <ul><li>Extensive Bronchopneumonia. </li></ul><ul><li>Idiopathic pulmonary fibrosis. </li></ul><ul><li>Chronic Bronchitis & emphysema. </li></ul><ul><li>COPD with Bronchiectasis. </li></ul><ul><li>COPD due to Silicosis. </li></ul>
  8. 8. <ul><li>Bronchopneumonia with abscess. </li></ul><ul><li>Diffuse pulomonary fibrosis </li></ul><ul><li>Silicotic nodules with Bronchiectasis </li></ul><ul><li>Interstitial pneumonia with abscess. </li></ul><ul><li>Tuberculosis. </li></ul>What is the Diagnosis ?
  9. 9. ? Diagnosis <ul><li>Massive pulmonary embolism. </li></ul><ul><li>Extensive Lobar Pneumonia. </li></ul><ul><li>Diffuse interstitial pneumonia. </li></ul><ul><li>Pulmonary embolism with infarction. </li></ul><ul><li>Bronchopneumonia with abscess. </li></ul>
  10. 10. ? Diagnosis <ul><li>Massive pulmonary embolism. </li></ul><ul><li>Extensive Lobar Pneumonia. </li></ul><ul><li>Diffuse interstitial pneumonia. </li></ul><ul><li>Pulmonary embolism with infarction. </li></ul><ul><li>Bronchopneumonia with abscess. </li></ul>
  11. 11. ? <ul><li>Staphylococcus aureus. </li></ul><ul><li>Streptococcus pneumoniae. </li></ul><ul><li>Candida albicans. </li></ul><ul><li>E.coli. </li></ul><ul><li>Haemophilus influenzae. </li></ul>
  12. 12. ? Diagnosis <ul><li>Massive pulmonary infarction. </li></ul><ul><li>Extensive Lobar Pneumonia. </li></ul><ul><li>Diffuse interstitial pneumonia. </li></ul><ul><li>ARDS. </li></ul><ul><li>Bronchopneumonia with abscess. </li></ul>
  13. 13. ? Diagnosis <ul><li>A1AT deficiency. </li></ul><ul><li>COPD </li></ul><ul><li>Cystic fibrosis. </li></ul><ul><li>ARDS. </li></ul><ul><li>Celiac disease. </li></ul>
  14. 14. ? Diagnosis <ul><li>A1AT deficiency. </li></ul><ul><li>Exposure to silica dust </li></ul><ul><li>Obstruction to sputum clearance. </li></ul><ul><li>Cigarette smoking. </li></ul><ul><li>Exposure to asbestos dust. </li></ul>
  15. 15. 18y black man recurrent wheezing and difficulty breathing. markedly decreased FEV 1 , which improved significantly after he inhaled a few puffs of a β-adrenergic agonist . steroid inhalant was prescribed, which provided much greater relief. Four years later, he presented to the ED with severe shortness of breath of 8 hours' duration. O/E considerable distress ; he could barely talk, Resp rate 30/min. P/E rare wheezing and markedly diminished breath sounds. ABG pH 6.9, PCO 2 88 mm Hg, and PO 2 35 mm Hg . While awaiting therapy, Pt died following cardiac arrest. At autopsy, gross findings were limited to the respiratory tract. The lungs were overinflated, and had focal areas of atelectasis, and many of the bronchi were occluded by thick, tenacious, mucous plugs. ? Final diagnosis <ul><li>ARDS </li></ul><ul><li>Extensive Lobar Pneumonia. </li></ul><ul><li>Diffuse pulmonary fibrosis. </li></ul><ul><li>Right heart failure. </li></ul><ul><li>Status asthamaticus. </li></ul>
  16. 16. Asthma <ul><li>Allegen  Type I hypersensitivity. </li></ul><ul><li>Eosinophilic bronchitis & Spasm* </li></ul><ul><li>Mucous gland hyperplasia. </li></ul><ul><li>Curschmann's spirals: whorls of shed epithelium within mucous plugs </li></ul><ul><li>Charcot-Leyden crystals: crystals within aggregates of eosinophils. </li></ul><ul><li>Thick mucous plug in lumen. </li></ul>
  17. 17. 54y Male plumber presents with 3 year history of productive cough with yellowish green sputum. Occassionally blood stained. Sputum culture showed non specific mixed growth. Image shows his lung specimen. ? Diagnosis <ul><li>A1AT deficiency. </li></ul><ul><li>Bronchopneumonia with abscesses. </li></ul><ul><li>Chronic fungal infection. </li></ul><ul><li>Centrilobular emphysema </li></ul><ul><li>Bronchiectasis </li></ul>
  18. 18. “ Happiness, satisfaction, and success in life depend on making the right choices, the winning choices. There are forces in life working for you and against you. One must distinguish the beneficial forces from the malevolent ones and choose correctly between them” - Wings of Fire : An Autobiography of Dr. APJ Abdul Kalam (1999)
  19. 19. “ It has been my personal experience that the true flavour, the real fun, the continuous excitement of work lie in the process of doing it rather than in having it over and done with. ” - Wings of Fire : An Autobiography of Dr. APJ Abdul Kalam (1999)