Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Chronic bronchitis

34,998 views

Published on

Target: UG medical students.

Published in: Health & Medicine
  • Login to see the comments

Chronic bronchitis

  1. 1. CHRONICBRONCHITIS Dr.CSBR.Prasad, M.D. CSBRP-Nov-2012
  2. 2. Chronic Bronchitis - gist Damage to air ways caused mainly by chemicals Sources: Cigarette smoke, Industrial gases, Motor vehicle exhaust et.c.Definition: Persistent productive cough for at least 3 months in at least 2 consecutive years with out any identifiable cause. CSBRP-Nov-2012
  3. 3. Chronic Bronchitis Damage to air ways caused mainly by chemicals Sources: Cigarette smoke, Industrial gases, Motor vehicle exhaust et.c. CSBRP-Nov-2012
  4. 4. Chronic BronchitisImportance: CB may progress to COLD Result in cor pulmonale & heart failure Result in metaplasia / dysplasia > Carcinoma CSBRP-Nov-2012
  5. 5. CHRONIC BRONCHITISDEFINITION: Persistent productive cough for at least 3 months in at least 2 consecutive years with out any identifiable cause. Chronic asthmatic bronchitis – intermittent bronchospasm and wheezing. CSBRP-Nov-2012
  6. 6. CHRONIC BRONCHITISPathogenesis: Chronic irritation by inhaled substances (Tobacco smoke-90%, grain, cotton, Si dust) Microbiologic infections – trigger exacerbations Middle-aged men – more common Smokers – 4 to 10x more common CSBRP-Nov-2012
  7. 7. CHRONIC BRONCHITISFeatures of CB:Initially: Hypersecretion of mucus (Proteases from PMNs) Hypertrophy of submucosal glands in trachea and bronchiWith chronicity: Marked increase in goblet cells of small airwaysIncrease in globlet cells and hypertrophy of submucosal glands are of protective metaplastic reaction against the irritantsIrritants > EGF receptor stimulation > up regulation of MUC 5AC gene (a mucin gene) CSBRP-Nov-2012
  8. 8. CHRONIC BRONCHITISHypersecretion of mucus is the basis for smaller air way obstruction CSBRP-Nov-2012
  9. 9. CHRONIC BRONCHITISCigarette smoke: Plays primary initiating roleRole of infection: Plays a secondary role CSBRP-Nov-2012
  10. 10. CHRONIC BRONCHITISAction of Cigarette smoke:1. Interferes with ciliary motility2. Direct damage to epithelium3. Inhibits alveolar leucocytes to clear bacteria CSBRP-Nov-2012
  11. 11. Figure 15-9 Schematic representation of evolution of chronic bronchitis (left) and emphysema (right).CSBRP-Nov-2012
  12. 12. CHRONIC BRONCHITISMorphology: Hyperemia and edema of mucus membranes Excessive mucus / mucopurulent secretion layers the epithelial surfaces CSBRP-Nov-2012
  13. 13. CHRONIC BRONCHITISSMALL AIRWAYS SHOW: Goblet cell metaplasia with mucous plugging Clustering of pigmented alveolar MØ Inflammatory cell infiltration Fibrosis of the bronchiolar wall Bronchiolitis obliterans Bronchial epithelium may exhibit squamous metaplasia and dysplasia CSBRP-Nov-2012
  14. 14. CHRONIC BRONCHITISCharacteristic histological feature: Lymphocytic infiltration Enlargement of mucin secreting glands of trachea and bronchi i.e. Increased size of mucous glands REID Index: Normal is 0.4 Ratio of the thickness of the mucous gland layer to the thickness of the wall between the epithelium and the cartilage CSBRP-Nov-2012
  15. 15. CSBRP-Nov-2012Chronic inflammatory cells infiltration in submucosa of bronchus
  16. 16. CSBRP-Nov-2012
  17. 17. CSBRP-Nov-2012
  18. 18. Reid’s Index REID Index bc/adCSBRP-Nov-2012
  19. 19. CSBRP-Nov-2012
  20. 20. CSBRP-Nov-2012
  21. 21. CSBRP-Nov-2012
  22. 22. CHRONIC BRONCHITISClinical feature: Persistent productive cough Over the period the patient develops dyspnea on exertion With further progression – patient develops hypercapnea, hypoxemia and mild cyanosis They may land in emphysema Long standing cases – cor pulmonale and cardiac failure Death may occur due to respiratory infections CSBRP-Nov-2012
  23. 23. E N Dgoto Bronchiectsis CSBRP-Nov-2012

×