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INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

www.indiandentalacademy.com
Lung
Type I
pneumocyte

Type I
pneumocyte
Alveolar
space

Capillary
lumen
Type II
pneumocyte
Endothelium
www.indiandentala...
Pneumonia
• Pathology:
– Alveolar

–

• Bronchopneumonia
(Streptococcus pneumoniae,
Haemophilus influenza,
Staphylococcus ...
Pulmonary infections
Predisposing factors
• Decreased cough reflex
• Injury to cilia
• Decreased function of
alveolar macr...
Lung abscess
• Localized suppurative necrosis
• Organisms commonly cultured:
–
–
–
–
–

Staphylococci
Streptococci
Gram-ne...
Pulmonary tuberculosis
• Caused by Mycobacterium
tuberculosis.
• Transmitted through inhalation
of infected droplets
• Pri...
Pulmonary tuberculosis
• Secondary

– Infection (mostly through
reactivation) in a previously
sensitized individual.
– Pat...
Opportunistic pneumonias
• Infections that affect
immunosuppressed patients
• Associated disorders:
– AIDS
– Iatrogenic
• ...
Chronic obstructive pulmonary disease (COPD)

Chronic bronchitis

• Definition
– Persistent cough with sputum
production f...
Chronic obstructive pulmonary disease (COPD)

Emphysema

• Destructive enlargement of
airspaces distal to terminal
bronchi...
Bronchiectasis
• Dilatation of bronchi
and bronchioles
secondary to chronic
inflammation
• Associated conditions
–
–
–
–

...
Bronchial Asthma
• Chronic inflammatory disorder of the airways resulting
in contraction of bronchial muscle
• Types
– Ext...
Atelectasis
• Collapse or incomplete expansion
of part or all of the lung
• Types:
– Resorption (obstruction of airway).
–...
Pulmonary edema
Oncotic pressure

Hydrostatic pressure
Normal
Hydrostatic pressure

Oncotic pressure

Causes:
- Heart fail...
Diffuse alveolar damage
• Acute respiratory distress syndrome
(respiratory failure and arterial
hypoxemia refractory to O2...
Pulmonary embolism
• Most emboli arise in veins from the
legs
• Large emboli (10%) are a cause of
sudden death
• Small emb...
Pulmonary hypertension
• Secondary (most common):
– Chronic obstructive pulmonary
disease
– Chronic interstitial pulmonary...
Hypersensitivity pneumonitis
• Immunologically mediated disorder affecting
airways and interstitium.

Farmer’s lung
Thermo...
Usual interstitial pneumonia /
idiopathic pulmonary fibrosis
• Progressive fibrosing disorder of of unknown cause
• Adults...
Pneumoconioses
• Disorders caused by inhalation
of inorganic elements,
primarily metals.
• Injury is determined by:
– Leng...
Carcinoma of the Lung
• 6.5 % of all deaths
• #1 cause of cancer deaths in males & females
– 31% of male cancer deaths in ...
Lung cancer

Lung cancer in
males

www.indiandentalacademy.com

Lung cancer in
females
Cancer Deaths estimated for 2004
Sites

New Cases

Deaths

ALL

1,368,300

563,700

Lung

173,770

160,440

Colon-Rectum

...
Smoking-related diseases

www.indiandentalacademy.com
Annual death rate for lung cancer

www.indiandentalacademy.com
Causes of Lung Cancer
• 85-95% smoking
• 1%asbestos + smoking (estimate)
• Rare arsenic, chromium, mustard gas, nickel,
vi...
www.indiandentalacademy.com
Classification of Lung Carcinoma
(Major Types)
• Squamous cell carcinoma
35%
• Adenocarcinoma
30%
• Small cell carcinoma
2...
Squamous cell carcinoma

•
•
•
•
•
•
•

Frequency: 35%
Smoking: X 25 (increased risk)
Males > females
Survival (5 years): ...
www.indiandentalacademy.com
Adenocarcinoma

•
•
•
•
•

Frequency: 30%
Smoking: X 3 (increased risk)
Males < females
Survival (5 years): 15 - 20%
Perip...
Bronchioloalveolar carcinoma

•
•
•
•
•

Frequency: 2 %
Smoking: yes
Males = females
Survival (5 years): 25 a 40 %.
Presen...
Small cell carcinoma

•
•
•
•

Frequency: 25 %
Smoking: 95% of patients
Males >> females
Survival (5 years): 1 - 5 %.
www....
www.indiandentalacademy.com
Large Cell Carcinoma
• Frequency: 10 %
• Gross
– Peripheral lesion

• Microscopic
– Wastebasket group of tumors that do no...
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
100
pa tie nts

35
ope ra ble

25-30
re se cte d for cure
8-12
survive for 5 ye a rs
( 3 0 % of those re se cte d for cure...
Mesothelioma
• Mesothelioma:
– Malignant tumor of
mesothelial cells
– Highly malignant
neoplasm with short
survival
– Most...
Thank you
For more details please visit
www.indiandentalacademy.com

www.indiandentalacademy.com
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Pulmonary infections /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

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Pulmonary infections /certified fixed orthodontic courses by Indian dental academy

  1. 1. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. Lung Type I pneumocyte Type I pneumocyte Alveolar space Capillary lumen Type II pneumocyte Endothelium www.indiandentalacademy.com
  3. 3. Pneumonia • Pathology: – Alveolar – • Bronchopneumonia (Streptococcus pneumoniae, Haemophilus influenza, Staphylococcus aureus) • Lobar (Streptococcus pneumoniae) Interstitial (Influenza virus, Mycoplasma pneumoniae) • Pathogenesis – Inhalation of air droplets – Aspiration of infected secretions or objects – Hematogenous spread www.indiandentalacademy.com
  4. 4. Pulmonary infections Predisposing factors • Decreased cough reflex • Injury to cilia • Decreased function of alveolar macrophages • Edema or congestion • Retention of secretions www.indiandentalacademy.com
  5. 5. Lung abscess • Localized suppurative necrosis • Organisms commonly cultured: – – – – – Staphylococci Streptococci Gram-negative Anaerobes Frequent mixed infections • Pathogenesis: – – – – – Aspiration Pneumonia Septic emboli Tumors Direct infection www.indiandentalacademy.com
  6. 6. Pulmonary tuberculosis • Caused by Mycobacterium tuberculosis. • Transmitted through inhalation of infected droplets • Primary – Single granuloma within parenchyma and hilar lymph nodes (Ghon complex). • Infection does not progress (most common). • Progressive primary pneumonia • Miliary dissemination (blood stream). www.indiandentalacademy.com
  7. 7. Pulmonary tuberculosis • Secondary – Infection (mostly through reactivation) in a previously sensitized individual. – Pathology • Cavitary fibrocaseous lesions • Bronchopneumonia • Miliary TB Fibrocaseous www.indiandentalacademy.com Miliary Granuloma Mycobacterium
  8. 8. Opportunistic pneumonias • Infections that affect immunosuppressed patients • Associated disorders: – AIDS – Iatrogenic • Cancer patients • Transplant recipients Aspergillus Pneumocystis carinii www.indiandentalacademy.com Cytomegalovirus
  9. 9. Chronic obstructive pulmonary disease (COPD) Chronic bronchitis • Definition – Persistent cough with sputum production for: – at least 3 months, – in at least 2 consecutive years. • Pathology – Inflammation of airways – Hyperplasia of mucous producing cells – Squamous metaplasia – Injury to cilia www.indiandentalacademy.com
  10. 10. Chronic obstructive pulmonary disease (COPD) Emphysema • Destructive enlargement of airspaces distal to terminal bronchioles • Two main types Normal acinar unit Centriacinar emphysema – Centriacinar • Destruction of central portion with sparing of distal airways • Upper lobes > lower • Cause: smoking – Panacinar • Unform injury • Lower lobes > upper • Cause: alpha-1-antitrypsin deficiency Panacinar emphysema www.indiandentalacademy.com Neutrophils Alpha-1-AT
  11. 11. Bronchiectasis • Dilatation of bronchi and bronchioles secondary to chronic inflammation • Associated conditions – – – – Obstruction Cystic fibrosis Immotile cilia syndromes Necrotizing pneumonia www.indiandentalacademy.com
  12. 12. Bronchial Asthma • Chronic inflammatory disorder of the airways resulting in contraction of bronchial muscle • Types – Extrinsic (atopic, allergic). • Allergens: food, pollen, dust, etc. – Intrinsic (non-atopic) • Initiated by infections, drugs, pollutants, chemical irritants ATOPIC ASTHMA Allergen IgE Mucus secretion Mast cell Epithelial cell injury Muscle contraction Mucus secretion Muscle contraction Release of inflammatory mediators Recruitment of leukocytes Acute phase www.indiandentalacademy.com Late-phase
  13. 13. Atelectasis • Collapse or incomplete expansion of part or all of the lung • Types: – Resorption (obstruction of airway). – Compressive (pleural effusion or pneumothorax) www.indiandentalacademy.com
  14. 14. Pulmonary edema Oncotic pressure Hydrostatic pressure Normal Hydrostatic pressure Oncotic pressure Causes: - Heart failure - Mitral stenosis Hydrostatic pressure Causes: - Infections - Aspiration - Drugs - Radiation Oncotic pressure www.indiandentalacademy.com Microvascular injury Causes: - Nephrotic syndrome - Liver diseases
  15. 15. Diffuse alveolar damage • Acute respiratory distress syndrome (respiratory failure and arterial hypoxemia refractory to O2 therapy). • Basic lesions: injury to pneumocytes and endothelial cells by: – Oxygen-derived free radicals – Activated neutrophils and macrophages – Loss of surfactant. • Etiology: – – – – Exudative stage Infections (viral) Gas inhalation or liquid aspiration Drugs, chemical, radiation Hypotension, sepsis, trauma • Pathology: – Acute (exudative) stage – Proliferative or organizing stage Proliferative stage www.indiandentalacademy.com
  16. 16. Pulmonary embolism • Most emboli arise in veins from the legs • Large emboli (10%) are a cause of sudden death • Small emboli (70%) may be: – Clinically silent – Cause infarctions (in patients with heart failure). – Cause hemoptysis • Medium sized emboli (20%) generally cause infarctions. www.indiandentalacademy.com Infarct
  17. 17. Pulmonary hypertension • Secondary (most common): – Chronic obstructive pulmonary disease – Chronic interstitial pulmonary disorders – Chronic heart failure – Recurrent pulmonary emboli Expected luminal opening in normal individual Plexiform changes • Primary (idiopathic) www.indiandentalacademy.com
  18. 18. Hypersensitivity pneumonitis • Immunologically mediated disorder affecting airways and interstitium. Farmer’s lung Thermophilic actinomycetes in hay Pigeon Air-condition lung breeder’s Thermophilic bacteria www.indiandentalacademy.com
  19. 19. Usual interstitial pneumonia / idiopathic pulmonary fibrosis • Progressive fibrosing disorder of of unknown cause • Adults 30 to 50 y/o • Respiratory and heart failure (cor pulmonale) ~ 5 y www.indiandentalacademy.com
  20. 20. Pneumoconioses • Disorders caused by inhalation of inorganic elements, primarily metals. • Injury is determined by: – Length of exposure – Physicochemical characteristics – Host factors • Carbon dust - Coal worker’s pneumoconiosis: – Anthracosis – Simple coal worker’s pneumoconiosis – Progressive massive fibrosis • Silicosis – Silicotic nodules • Asbestos – Asbestosis (pulmonary fibrosis) – Pleural disease (fibrous plaques, mesothelioma). www.indiandentalacademy.com
  21. 21. Carcinoma of the Lung • 6.5 % of all deaths • #1 cause of cancer deaths in males & females – 31% of male cancer deaths in 2001 • 90,367 deaths – 25% of female cancer deaths • 65,506 deaths www.indiandentalacademy.com
  22. 22. Lung cancer Lung cancer in males www.indiandentalacademy.com Lung cancer in females
  23. 23. Cancer Deaths estimated for 2004 Sites New Cases Deaths ALL 1,368,300 563,700 Lung 173,770 160,440 Colon-Rectum 146,940 56,808 Breast 217,440 40,580 Prostate 230,110 29,900 www.indiandentalacademy.com
  24. 24. Smoking-related diseases www.indiandentalacademy.com
  25. 25. Annual death rate for lung cancer www.indiandentalacademy.com
  26. 26. Causes of Lung Cancer • 85-95% smoking • 1%asbestos + smoking (estimate) • Rare arsenic, chromium, mustard gas, nickel, vinyl chloride, bis (chloromethyl) ether • Speculation – 0.3-3% passive smoking – 3-14% radon www.indiandentalacademy.com
  27. 27. www.indiandentalacademy.com
  28. 28. Classification of Lung Carcinoma (Major Types) • Squamous cell carcinoma 35% • Adenocarcinoma 30% • Small cell carcinoma 25% www.indiandentalacademy.com
  29. 29. Squamous cell carcinoma • • • • • • • Frequency: 35% Smoking: X 25 (increased risk) Males > females Survival (5 years): 15 - 20% Arises in bronchial squamous metaplasia Centrally located May cavitate www.indiandentalacademy.com
  30. 30. www.indiandentalacademy.com
  31. 31. Adenocarcinoma • • • • • Frequency: 30% Smoking: X 3 (increased risk) Males < females Survival (5 years): 15 - 20% Peripheral www.indiandentalacademy.com
  32. 32. Bronchioloalveolar carcinoma • • • • • Frequency: 2 % Smoking: yes Males = females Survival (5 years): 25 a 40 %. Presentation: – Single or multiple tumor nodules – Miliary tumor – “Pneumonic form” www.indiandentalacademy.com
  33. 33. Small cell carcinoma • • • • Frequency: 25 % Smoking: 95% of patients Males >> females Survival (5 years): 1 - 5 %. www.indiandentalacademy.com
  34. 34. www.indiandentalacademy.com
  35. 35. Large Cell Carcinoma • Frequency: 10 % • Gross – Peripheral lesion • Microscopic – Wastebasket group of tumors that do not fit the criteria of a squamous cell carcinoma, adenocarcinoma, or small cell carcinoma • Prognosis – Similar to adenocarcinoma www.indiandentalacademy.com
  36. 36. www.indiandentalacademy.com
  37. 37. www.indiandentalacademy.com
  38. 38. www.indiandentalacademy.com
  39. 39. 100 pa tie nts 35 ope ra ble 25-30 re se cte d for cure 8-12 survive for 5 ye a rs ( 3 0 % of those re se cte d for cure ) www.indiandentalacademy.com
  40. 40. Mesothelioma • Mesothelioma: – Malignant tumor of mesothelial cells – Highly malignant neoplasm with short survival – Most patients (70%) have an asbestos exposure history • Asbestos exposure also increases the risk of pulmonary cancer • Smoking is not related to mesothelioma www.indiandentalacademy.com
  41. 41. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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