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Chapter 8

Copyright 2012, 2006, 2000, 1996 bySaunders, an imprintof Els evier Inc.

The Respiratory System

Normal Respiratory System

2Copyright 2012, 2006, 2000, 1996 bySaunders, an imprintof Els evier Inc.

Sagittal Section of Pharynx



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Coronal Section of Larynx


Histology of Bronchi & Alveoli


Air Exchange in Lungs



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Overview of Major Lung Diseases

z Infectious diseases

z Immune diseasesz Environmentally induced diseasesz Circulatory diseases


z Tumors

Acute Upper Respiratory Infections


Acute Inflammation of Larynx



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Pneumonia


Bronchopneumonia


Lobar Pneumonia



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Interstitial Pneumonia


Common Causes of Pneumonia

z Bacteria Streptococcus pneumoniae

Haemophilus influenzae

Staphylococcus aureus

Mycobacterium tuberculosis


z ruses Influenza

z Fungi Aspergillus flavus

Candida albicans

Pneumocystis jiroveci

z Bacteria-like organisms Mycoplasma pneumoniae

Pathogenesis of PulmonaryInfections

z Inhalation of aerosol particlesz Aspiration of infected secretions from upper

respiratory tract

z Aspiration of regurgitated gastric contents


z Hematogenous spread


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Histologic Appearance ofBronchopneumonia


Complications of Pneumonia


Clinical Features of Pneumonia

z Systemic signs of infection: fever, chills,prostration

z Local signs of irritation: cough

z Airway obstruction: shortness of breath


(dyspnea), rapid breathing (tachypnea)z Inflammation & tissue destruction:

expectoration of rusty sputum, hemoptysis


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Causes of Atypical Pneumonia

z Viruses

z Mycoplasma pneumoniaez Pneumocystis carinii


Pulmonary Tuberculosis

z Primary infectionz Secondary infectionz Extrapulmonary dissemination


Ghons Complex



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Tuberculosis: Lymphatic Spread


Tuberculosis: HematogenousSpread


Tuberculosis: SpreadThrough Airways



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Chronic Obstructive PulmonaryDisease (COPD)

z Chronic bronchitis

z Bronchiectasisz Emphysema


Bronchiectasis


Emphysema



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COPD: Emphysema (Pink Puffer)


COPD: Chronic Bronchitis(Blue Bloater)


Expiratory Air Obstruction & AirExpiratory Air Obstruction & AirTrappingTrapping

An interactive video titled Expiratory AirwayAn interactive video titled Expiratory AirwayObstruction and Air Trapping in COPD canObstruction and Air Trapping in COPD canbe viewed by clicking Studentbe viewed by clicking Student

Resources/Prepare for Class, Clinical orResources/Prepare for Class, Clinical or


Lab/Animations. Instructors can clickLab/Animations. Instructors can clickInstructor Resources/Prepare for Class,Instructor Resources/Prepare for Class,Clinical or Lab/Animations.Clinical or Lab/Animations.


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Comparison of Chronic Bronchitis &Emphysema


Immune Diseases

z Allergic rhinitisz Asthmaz Sarcoidosisz Hypersensitivity pneumonitis


Asthma

z Extrinsicz Intrinsicattacks precipitated by:

Physical factors

Exercise


syc oogc s ress Chemical irritants, air pollution Bronchial infection Aspirin


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Pathogenesis of Asthma


Histopathology of Asthma


Allergy & AsthmaAllergy & Asthma

An interactive video titled Allergy andAn interactive video titled Allergy andAsthma can be viewed by clicking StudentAsthma can be viewed by clicking StudentResources/Prepare for Class, Clinical orResources/Prepare for Class, Clinical or

Lab/Animations. Instructors can clickLab/Animations. Instructors can click


Instructor Resources/Prepare for Class,Instructor Resources/Prepare for Class,Clinical or Lab/Animations.Clinical or Lab/Animations.


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Sarcoidosis


Hypersensitivity Pneumonitis


Pathogenesis: HypersensitivityPneumonitis



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Pneumoconioses

z Coal-workers lung

diseasez Silicosisz Asbestosis


Asbestosis

z Pulmonary fibrosisz Pleural fibrosis, pleural plaquesz Lung cancerz Mesothelioma


Asbestosis (Contd)



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Causes of Dyspnea


Disturbances of Ventilation

z Suffocationz Drowningz Ventilatory failure

Loss of neural control


Failure of respiratory muscles Chest wall diseases Airway obstruction

Causes of Adult RespiratoryDistress Syndrome (ARDS)



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Pathogenesis: ARDS


Atelectasis


Neoplasms

z Carcinoma of the larynxz Lung cancer



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Carcinoma of the Larynx


Lung Carcinoma

z Most common malignant tumor of internalorgans in U.S.

z Most often related to cigarette smokingz Rare before age of 40, but incidence rises


with agez Poor prognosis

Effects of SmokingEffects of Smoking

An interactive video titled Effects ofAn interactive video titled Effects ofSmoking can be viewed by clicking StudentSmoking can be viewed by clicking StudentResources/Prepare for Class, Clinical orResources/Prepare for Class, Clinical or

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Histogenesis of Lung Carcinoma


Lung Cancer


Histopathology of Lung Tumors

z Squamous cell carcinomaz Adenocarcinomaz Large-cell undifferentiated carcinoma

z Small-cell carcinoma


z Tumors of mixed patternz Carcinoidz Mesothelioma__________________________________Note: Tumors can be central (hilar) or peripheral (subpleural)


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Clinical Features of Lung Cancer

z Bronchial irritation

z Local extension into mediastinum or pleuralcavity: pleural effusion

z Distant metastases


z Systemic effects of neoplasiaz Paraneoplastic syndromes

Metastatic Cancer in Lungs

z Most common malignant tumor of lungsz May present as:

Solitary lesion Multiple lesions (cannonballs on x-ray films)


use nvovemen o ungs

Metastases of Lung Carcinoma



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Metastases of Lung Carcinoma(Contd)


Pleural Diseases


Mesothelioma


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