Topic: Bronchitis, Pneumonia Faculty: Pathology Course: Nursing

1. Bronchitis, Pneumonia
Dr. Salman Ansari(MBBS)
Tutor, Dept. of Pathology
Kanachur Institute of Medical Sciences

2. ● Chronic Bronchitis
● Pneumonia

4. ALVEOLI

5. CHRONIC
BRONCHITIS

6. Chronic Bronchitis
Definition: Persistent cough with sputum
production for at least 3 months in 2 consecutive
years
● It is a type of Chronic Obstructive Pulmonary
Disease(COPD)

7. Causes
● Cigarette smoking 🚬
● Air pollution: SO2, NO2
● Occupational dust exposure(mining)
● Respiratory tract infections

8. Pathogenesis
Irritation by inhaled air pollutants
Excess mucus secretion
Hypertrophy of submucosal glands
and hyperplasia of goblet cells

9. Irritation by inhaled air pollutants
● Tobacco smoke
● Dust
● Cotton
● Sulfur dioxide
● Nitrogen dioxide
● Silica
Inflammation
of airways
Lymphocytes,
neutrophils

10. Excess mucus secretion
● Neutrophils → stimulate hypertrophy of submucosal
glands in large airways
● Increase in goblet cells in small airways → lead to
excess mucus production which blocks small airways

11. GOBLET GOBLET CELL

14. 1) Increase in size of
submucosal glands
2) Increase in number of
goblet cells
Increased mucus
production

15. Morphology
Gross:
● Thickening of mucus membranes
● Excessive mucus secretion

17. Microscopy:
● Chronic inflammation: many lymphocytes
● Increased size of submucosal glands(hypertrophy)
● More number of goblet cells(hyperplasia)

19. Clinical features
● Middle aged males,
heavy smokers
● Persistent cough with
sputum - since many
years
● Dyspnea on exertion -
shortness of breath
● Wheezing - noisy
breathing

21. Diagnosis
- Clinical: Cough with sputum production for ___ months for
__ years
- CXR
- CT chest
- Pulmonary function tests

22. Complications
● Long-standing chronic bronchitis → Cor
pulmonale(right sided heart failure)
● Respiratory failure
● pneumothorax

23. PNEUMONIA

24. Pneumonia
Definition: Defined as infection of the lung parenchyma
● Alveoli get filled with exudates
● Lung becomes solid - “consolidation of lung”

25. Causes
Causative agent:
Viruses
Bacteria like:
- Streptococcus pneumoniae or Pneumococcus
- Haemophilus influenzae
- Staphylococcus aureus
Route of infection: through respiratory tract, bloodborne or locally

27. Classification of pneumonia
Morphological classification
1. Lobar pneumonia
2. Bronchopneumonia

29. Lobar pneumonia
- Affects whole lobe or part of the lobe
- Usually affects lower lobes of lung
- Causative agent: Bacteria such as Pneumococcus

31. Stages of lobar pneumonia
1. Congestion
2. Red hepatisation
3. Gray hepatisation
4. Resolution

32. 1. Congestion
- Lasts for less than 24 hours
- Multiplication of pneumococcus in alveoli
- Widespread edema
- Gross features:
- lung is heavy, boggy and red
- Cut section: blood-stained frothy fluid
- Microscopy:
- Dilated and congested capillaries
- Alveoli filled with eosinophilic fluid with few neutrophils,
RBCs and numerous bacteria

33. 2. Red hepatisation
- Lasts for 2-3 days
- Acute inflammatory response seen - many neutrophils
Gross:
- Red, firm and granular lobe
- It looks like liver in consistency(hepatisation)
Microscopy:
- Inflammatory exudate - many neutrophils and RBCs in
alveoli

36. 3. Gray hepatisation
Gross:
- Affected lobe looks grayish in colour
- Cut section: gray, moist and granular appearance
Microscopy:
- RBCs begin to break down
- Neutrophils replaced by macrophages
- Exudate made of fibrin and pus - “fibrinosuppurative”

38. 4. Resolution
Gross:
- Contents of alveoli become liquefied
- Cut section: frothy lung
Microscopy:
- Exudate in alveoli gets digested by macrophages
- Capillaries return to normal

41. Bronchopneumonia
- Inflammation affects the airways mainly
- Patchy areas of consolidation in same or several lobes of
lung

43. Morphology
Gross:
- Patchy consolidation in one lobe or many lobes
- Bilateral commonly
- lower lobes affected
- Affects bronchi and bronchioles mainly
Microscopy:
- Exudate rich in neutrophils

44. Clinical features
- High fever, chills
- Cough with mucopurulent sputum
- Pleuritic pain
- Dyspnea - shortness of breath

46. Diagnosis
- CBC: ↑ WBC
- Chest X-ray: consolidation
- Sputum examination
- Blood culture

48. Complications of pneumonia
- Lung abscess formation
- Empyema: collection of pus in pleural space
- Fibrosis of lung - called “honeycomb lung”
- Can spread to brain(meningitis), heart(infective
endocarditis), kidneys, spleen

52. For notes,
scan:
References:
● Ramadas Nayak - Textbook of Pathology for Allied
Health Sciences
● Purnima S. Rao - Textbook of Pathology & Genetics for
Nursing
Questions:
salman.s.ansari92@gmail.com
For PPT, scan: