Pulmonary Emphysema. Pathomorphology, outcomes, complications

1. Theme:
"Pulmonary Emphysema.
Pathomorphology, outcomes,
complications "
Done By: Myrzakhanov Yerik
3course GMF 348 group
Checked By: Abishev Zhasulan
Zhumataevich
Semey 2013

2. Plan
 Introduction
 Pulmonary Emphysema
 Pathological anatomy of chronic diffuse
obstructive emphysema

3. Introduction
 The main cause of the disease - chronic bronchitis, which
implies a chronic infection. Chronic bronchitis usually
develops between the ages of 30 and 60 years and occurs
more often in men than in women. In fact, the result is
the formation of chronic bronchitis emphysema.
 Smoking, air pollution by various dust particles and some
working conditions, such as those associated with the
constant inhalation of coal dust or asbestos particles and
silicon, also contribute to the development of the
disease.? At the same time, emphysema, leading to severe
respiratory failure may develop without preceding
respiratory disease, i.e primary.

4. Pulmonary Emphysema - (from the
Greek. emphysao – swell, inflated)
respiratory disease characterized by
abnormal enlargement of airspaces
distal bronchioles accompanied by
destructive morphological changes of
alveolar walls, one of the most frequent
forms of chronic nonspecific pulmonary
diseases.

6. The following types of emphysema:
Chronic obstructive diffuse
Chronic lobular (perifocal, scar)
Vicarious (compensatory)
Primary (idiopathic)
Senile (emphysema in the elderly)
Interstitial

7. Etiology and pathogenesis
 There are two groups of causes leading to the development of
emphysema
 The first group includes factors that violate the elasticity and
strength of the structural elements of the lung: pathological
microcirculation, changes in the properties of surfactant,
congenital deficiency of alpha-1-antitrypsin, gaseous substances
(cadmium compounds, nitrogen oxides, etc.), as well as tobacco
smoke, dust particles in inhaled air. These causes may lead to
the development of primary always diffuse emphysema. The
basis of the pathogenesis of pathological reorganization of the
entire respiratory lung; weakening of the elastic properties of
the lung leads to the fact that during exhalation and therefore
increase intrathoracic pressure small bronchi without their
cartilaginous skeleton and devoid of elastic recoil of the lung,
passively fallen down , thus increasing bronchial resistance and
expiratory pressure increase in the alveoli . Inspiratory
bronchial permeability in primary emphysema is not violated.

8.  Factors contribute to the second group of high pressure in the
lungs and respiratory department reinforce stretching alveoli,
alveolar ducts and respiratory bronchioles. The highest value
among them is airway obstruction that occurs in chronic
obstructive bronchitis. This disease is becoming a major cause of
secondary or obstructive pulmonary emphysema, as it was when it
created the conditions for the formation of the valve mechanism
of distension of the alveoli. Thus, the reduction in intrathoracic
pressure during inspiration, causing passive stretching of the
bronchial lumen , reduces the degree of bronchial obstruction
available ; positive intrathoracic pressure during exhalation causes
additional compression of bronchial branches and exacerbating
already existing bronchial obstruction , helps delay the inspired air
in the alveoli and hyperinflation . Important to the spread of the
inflammatory process to the adjacent bronchioles alveoli with the
development of alveolitis and destruction of interalveolar septa .

9.  In the context of the insolvency of the stroma
of the lung (particularly elastic) included the so-called
valve mechanism.
 It boils down to the fact that the mucus plug
formed in the lumen of the small bronchi and
bronchioles in chronic diffuse bronchitis,
inspiratory air passes into the alveoli, but do not
let him out when you exhale.
 The air accumulates in the acini of the cavity
expands, which leads to diffuse obstructive
emphysema.

11. Pathological anatomy of chronic
diffuse obstructive emphysema
 Lungs increased in size, cover their edges
anterior mediastinum, swollen, pale, soft, do
not collapse, can be cut with a crunch.
 Of the bronchi, the walls of which are
thickened, squeezed muco-purulent
exudate.

12.  Bronchial mucosa full-blooded,
marked hypertrophy of the muscular
layer of uneven terminal bronchioles
and small bronchi, the appearance of
the mucosa of the last large number
of goblet cells.

13. Normal respiratory
bronchioles
Sharply enhanced
respiratory bronchioles
in emphysema

14.  If the overall picture is dominated by changes in
the bronchioles, the expanded proximal acinar
(respiratory bronchioles 1st and 2nd order).
 This is called emphysema centeracinar.
 In the presence of inflammatory changes mainly
in the larger bronchi (eg, intralobular) bloating
and expansion affect the whole acinus and then
talk about panatsinarnoy emphysema.

15. Sharply enhanced respiratory
bronchioles in emphysema

16. Acinar walls stretching
leads to stretching and
thinning of the elastic
fibers, expanding
alveolar ducts, alveolar
septa change.
Alveolar walls become
thinner and
straightened, *Kohn
pores dilate capillaries
zapustevayut.
*This so-called alveolar pores Kohn,
creating the possibility of penetration
of air from the alveoli into one
another.

17. There is a strong
expansion of conducting
air and flattening of the
respiratory bronchioles
and alveolar sacs
shortening.
Consequently there is a
sharp decrease in the
area of gas exchange and
ventilation disturbed
lung function.

18.  The capillary network in the acinus of
respiratory reduced until the complete
disappearance of capillaries, resulting in
the formation of the capillary unit.
 Overgrowth occurs mezhalveolyarnyh
capillaries collagen fibers and the
development of intracapillary sclerosis.

19. Obstructive
emphysema,
intracapillary sclerosis
overgrowing the capillary
lumen (SCCR) collagen
fibers (LLR). CNN - the
endothelium, Ep - alveolar
epithelium, BM -
basement membrane air-blood
barrier, PA -
clearance alveoli. X15
000.

20.  It is sometimes observed the formation of new
I not typical built capillaries, which has adaptive
value.
 Thus, in chronic obstructive pulmonary
emphysema occurs prekapilljarnyh the pulmonary
hypertension leading to cardiac hypertrophy
(cor pulmonale). Patients suffering from chronic
emphysema, at a certain stage of the disease
become cardiopulmonary patients.

23. Complications
 - Respiratory failure;
 - Heart failure;
 - Pneumothorax (air to the chest).
 Any of the complications leading to
disability of the patient.

24. Conclusion
 The term "emphysema" refers to pathological processes in the
lung, characterized by a high content of air in the lung tissue, a
chronic lung disease characterized by respiratory failure and
pulmonary gas exchange. In recent years, the frequency of
emphysema increases, especially among the elderly.
 Pulmonary Emphysema, along with chronic obstructive
bronchitis and bronchial asthma refers to a group of chronic
obstructive pulmonary disease (COPD). All these diseases are
accompanied by bronchial obstruction, which accounts for the
similarity of some of their clinical picture.

25. Reference
 http://www.medchitalka.ru/patologicheskaya_anat
omiya/kollagenovye_bolezni/17852.html
 http://www.eurolab.ua/encyclopedia/morbid-anatomy/
33164/
 http://ru.wikipedia.org/wiki/%D0%AD%D0%BC%
D1%84%D0%B8%D0%B7%D0%B5%D0%BC%D0
%B0_%D0%BB%D1%91%D0%B3%D0%BA%D0%
B8%D1%85
 Легкие // Энциклопедический словарь
Брокгауза и Ефрона: В 86 томах (82 т. и 4
доп.). — СПб., 1890—1907.