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EMPHYSEMACHRONIC BRONCHITIS
Dr Vijay Shankar S
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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
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Pretest !!
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1
1 Which disease among the following is an example of restrictive lung disease
A. Chronic bronchitisB. BronchiectasisC. Bronchial asthmaD. pneumoconiosis
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2. The type of emphysema associated with alpha 1 antitrypsin deficiency
A. Centriacinar emphysemaB. Panacinar emphysemaC. Paraseptal emphysemaD. Irregular emphysema
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• 3. The normal Reid index is
A. 0.4B. 0.5C. 0.6D. 0.7
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BASED ON PULMONARY FUNCTION TESTS
OBSTRUCTIVEDISEASE
RESTRICTIVEDISEASE
Increase in the resistanceTo airflow
Due to partial or complete obstruction at any
level
Reduced expansion of lung parenchyma,
with decreasedtotal lung capacity
1. Chronic bronchitis
2. Emphysema
3. Bronchial asthma
4. Bronchiectasis
1. Chest wall disorders
2. Acute/chronic interstitial & infiltrative diseases.
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Emphysema
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• Definition– irreversible enlargement of airspaces
distal to terminal bronchiole.• Classification
Overinflation??
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Incidence
• 4th leading cause of morbidity and mortality in the UNITED STATES!!
• Worldwide India ranks 2nd!! In prevalance
• M> F ?
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Etiology• Tobacco smoking• Atmospheric pollution• Infection • Genetic factor
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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
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PACK YEARS
• (Packs smoked per day) x (years as a smoker)
or
• (number of cigarettes smoked per day x number of years smoked)/20
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Gross
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Bullous emphysema with large subpleural bullae
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Centriacinar emphysema. Central areas show marked emphysematous damage (E), surrounded by relatively spared alveolar spaces.
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Panacinar emphysema involving theentire pulmonary architecture.
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This lung, from a patient with alpha 1-antitrypsin deficiency, shows large, irregular airspaces and a markedly reduced number of alveolar walls.
section of normal lung at the same magnification
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CLINICAL FEATURES
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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”
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CHRONIC BRONCHITIS
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Chronic Bronchitis
• Defn\• Etiology
a) smokingb) Atmospheric pollutionc) occupationd) Infectione) Familial & Genetic factor
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Normal and chronic bronchitis
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REID INDEX
It is a ratio
bc / ad
Normal : 0.4
Chronic bronchitis: increased
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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”
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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
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Post test !!
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1
1 Which disease among the following is called as restrictive lung disease
A. Chronic bronchitisB. BronchiectasisC. Bronchial asthmaD. pneumoconiosis
D
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2. The type of emphysema associated with alpha 1 antitrypsin deficiency
A. Centriacinar emphysemaB. Panacinar emphysemaC. Paraseptal emphysemaD. Irregular emphysema
B
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• 3. The normal Reid index is
A. 0.4B. 0.5C. 0.6D. 0.7
A
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