RESPIRATORY SYSTEM: EMPHYSEMA, CHRONIC BRONCHITIS
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This document discusses emphysema and chronic bronchitis. Emphysema is defined as the irreversible enlargement of airspaces distal to terminal bronchioles. It can be classified as centriacinar, panacinar, or paraseptal. Chronic bronchitis is defined as cough with sputum production for at least three months in two consecutive years. Both conditions are obstructive lung diseases that are often caused by smoking and air pollution. Emphysema damages lung tissue through an imbalance between proteases and anti-proteases like alpha-1 antitrypsin. Chronic bronchitis involves chronic inflammation of the bronchi.
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RESPIRATORY SYSTEM: EMPHYSEMA, CHRONIC BRONCHITIS
- 1. EMPHYSEMA CHRONIC BRONCHITIS Dr Vijay Shankar S
- 2. Plan • Obstructive Vs restrictive diseases • Chronic obstructive pulmonary diseases( COPD) • Emphysema • Definition • Types • Pathogenesis • Morphology • Clinical course • chronic bronchitis • Definition • Pathogenesis • Morphology • Clinical course • Emphysema Vs chronic bronchitis
- 3. Pretest !!
- 5. 1 1 Which disease among the following is an example of restrictive lung disease A. Chronic bronchitis B. Bronchiectasis C. Bronchial asthma D. pneumoconiosis
- 6. 2. The type of emphysema associated with alpha 1 antitrypsin deficiency A. Centriacinar emphysema B. Panacinar emphysema C. Paraseptal emphysema D. Irregular emphysema
- 7. • 3. The normal Reid index is A. 0.4 B. 0.5 C. 0.6 D. 0.7
- 9. BASED ON PULMONARY FUNCTION TESTS OBSTRUCTIVE DISEASE RESTRICTIVE DISEASE Increase in the resistance To airflow Due to partial or complete obstruction at any level Reduced expansion of lung parenchyma, with decreased total lung capacity 1. Chronic bronchitis 2. Emphysema 3. Bronchial asthma 4. Bronchiectasis 1. Chest wall disorders 2. Acute/chronic interstitial & infiltrative diseases.
- 10. Emphysema
- 11. • Definition – irreversible enlargement of airspaces distal to terminal bronchiole. • Classification Overinflation??
- 14. Incidence • 4th leading cause of morbidity and mortality in the UNITED STATES!! • Worldwide India ranks 2nd !! In prevalance • M> F ?
- 15. Etiology • Tobacco smoking • Atmospheric pollution • Infection • Genetic factor
- 16. PATHOGENESIS Protease Anti -Protease Elastase : derived from neutrophils Digests the lung parenchyma!! Alpha 1 – AT: synthesized by liver. Present in serum, tissue fluids & macrophages. PROTEASE – ANTIPROTEASE HYPOTHESIS
- 18. PACK YEARS • (Packs smoked per day) x (years as a smoker) or • (number of cigarettes smoked per day x number of years smoked)/20
- 19. Gross
- 27. Bullous emphysema with large subpleural bullae
- 29. Centriacinar emphysema. Central areas show marked emphysematous damage (E), surrounded by relatively spared alveolar spaces.
- 30. Panacinar emphysema involving the entire pulmonary architecture.
- 31. This lung, from a patient with alpha 1- antitrypsin deficiency, shows large, irregular air spaces and a markedly reduced number of alveolar walls. section of normal lung at the same magnification
- 34. EMPHYSEMA •Hyperventilates and less hypoxemia(Pink) •Minimal cyanosis •Purse lip breathing •Dyspnea •Hyperresonance on chest percussion •Orthopneic •Barrel chest •Extertional dyspnea •Prolonged expiratory time •Speaks in short jerky sentences •Anxious •Use of accessory muscles to breathe •Thin appeance “PINK PUFFER”
- 37. Chronic Bronchitis • Defn • Etiology a) smoking b) Atmospheric pollution c) occupation d) Infection e) Familial & Genetic factor
- 39. Normal and chronic bronchitis
- 40. REID INDEX It is a ratio bc / ad Normal : 0.4 Chronic bronchitis: increased
- 42. CHRONIC BRONCHITIS •Color dusky to cyanotic •Recurrent cough with sputum •Hypoxia •Hypercapnia •Acidosis •Edematous •Increased respiratory rate •Exertional dyspnea •Corpulmonale •Use of accessary muscles to breathe “BLUE BLOATER”
- 46. Emphysema and Chronic Bronchitis Predominant Bronchitis Predominant Emphysema Age (yr) 40–45 50–75 Dyspnea Mild; late Severe; early Cough Early; copious sputum Late; scanty sputum Infections Common Occasional Respiratory insufficiency Repeated Terminal Cor pulmonale Common Rare; terminal Airway resistance Increased Normal or slightly Elastic recoil Normal Low Chest radiograph Prominent vessels; large heart Hyperinflation; small heart Appearance Blue bloater Pink puffer
- 47. Post test !!
- 48. 1 1 Which disease among the following is called as restrictive lung disease A. Chronic bronchitis B. Bronchiectasis C. Bronchial asthma D. pneumoconiosis D
- 49. 2. The type of emphysema associated with alpha 1 antitrypsin deficiency A. Centriacinar emphysema B. Panacinar emphysema C. Paraseptal emphysema D. Irregular emphysema B
- 50. • 3. The normal Reid index is A. 0.4 B. 0.5 C. 0.6 D. 0.7 A
Editor's Notes
- EMPHYSEMA, A - CENTRILOBULAR (UPPER ZONES); AND B - PANACINAR (LOWER ZONES) - In centrilobular emphysema only the central or proximal portions of the respiratory lobule (respiratory bronchial) is involved. The distal alveoli are spared. It usually involves the upper lobe and is the most common type of emphysema. Associated with smoking and coal dust. In panacinar (panlobular) emphysema, there is involvement of the complete respiratory lobule (all alveoli are involved of a respiratory lobule). Typically involves the lower zones and anterior margins of the lung. Associated with alpha 1-antitrypsin deficiency. Slide 24 of 64