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Pulmonary Pathologies: An Advanced Overview, Exams of Pathophysiology

A.T. Still University of Health Sciences (ATSU)Pathophysiology

A concise overview of advanced pulmonary pathologies, including restrictive and obstructive disorders, acute respiratory failure, pneumothorax, pulmonary edema, ards, asthma, copd, pneumonia, and tuberculosis. It outlines key definitions, classifications, causes, and pathological hallmarks of each condition, making it a valuable resource for medical students and healthcare professionals seeking a quick review of pulmonary diseases. The document also covers specific aspects such as the phases of ards, cellular changes in asthma and chronic bronchitis, and types of pneumonia.

Typology: Exams

2024/2025

Available from 08/09/2025

DrShirley
DrShirley ๐Ÿ‡บ๐Ÿ‡ธ

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Advanced Patho Pulmonary
What are 2 broad categories of pulmonary diseases? -
1. Restrictive vs. obstructiveโ˜‘๏ธ๎˜‚
2. Infectious vs. non-infectious
What is a restrictive disorder? -
- Restrictive disorders refer to the inability of the person to breathe in adequate amounts ofโ˜‘๏ธ๎˜‚
air.
- Individuals have LOW lung volumes on the PFT
- Lung volumes are essentially the amount of air the lungs contain a given time during respirations
What are examples of restrictive disorders? -
aspiration, pulmonary fibrosis, atelectasis, bronchiectasis, bronchiolitis, and pulmonary โ˜‘๏ธ๎˜‚
edema
What is an obstructive disorders? -
- Obstructive disorders refer to the inability of the person to completely exhale that air โ˜‘๏ธ๎˜‚
which is inhaled.
- on PFTs, people have high lung volumes bc they are retaining air in the lungs
Examples of obstructive disorders -
asthmaโ˜‘๏ธ๎˜‚
COPD
Acute Respiratory Failure are classified into what 2 main types? -
1. Hypoxemia Respiratory failureโ˜‘๏ธ๎˜‚
2. Hypercapnic Respiratory failure
What is the main dysfunction of actue respiratory failure? -
The main dysfunction is an impairment in diffusion which results in low O2 levels or the โ˜‘๏ธ๎˜‚
accumulation of CO2
Hypoxemia Respiratory Failure -
defined as PaO2 of </= 50 mmHgโ˜‘๏ธ๎˜‚
Hypercapnic Respiratory Failure -
defined as PCO2 >/= 50 mmHgโ˜‘๏ธ๎˜‚
What does acute respiratory failure result from? -
- ARF may result from direct injurt to the lungs or may simply be triggered by an injury of โ˜‘๏ธ๎˜‚
dysfunction to one or more body systems or organs
- Can also occur as a post-operative complication secondary to anesthesia or narcotics
What is pneumothorax? -
- A pneumothorax is the prescense of air or gas in the pleural spaceโ˜‘๏ธ๎˜‚
- The air in the thoracic cavity may press on the lungs and cause it to collapse completely, or it may
be a small amount of air that does not cause any difficulties
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Advanced Patho Pulmonary

What are 2 broad categories of pulmonary diseases? - โ˜‘๏ธ 1. Restrictive vs. obstructive

  1. Infectious vs. non-infectious What is a restrictive disorder? - โ˜‘๏ธ - Restrictive disorders refer to the inability of the person to breathe in adequate amounts of air.
  • Individuals have LOW lung volumes on the PFT
  • Lung volumes are essentially the amount of air the lungs contain a given time during respirations What are examples of restrictive disorders? - โ˜‘๏ธ aspiration, pulmonary fibrosis, atelectasis, bronchiectasis, bronchiolitis, and pulmonary edema What is an obstructive disorders? - โ˜‘๏ธ - Obstructive disorders refer to the inability of the person to completely exhale that air which is inhaled.
  • on PFTs, people have high lung volumes bc they are retaining air in the lungs Examples of obstructive disorders - โ˜‘๏ธ asthma COPD Acute Respiratory Failure are classified into what 2 main types? - โ˜‘๏ธ 1. Hypoxemia Respiratory failure
  1. Hypercapnic Respiratory failure What is the main dysfunction of actue respiratory failure? - โ˜‘๏ธ The main dysfunction is an impairment in diffusion which results in low O2 levels or the accumulation of CO Hypoxemia Respiratory Failure - โ˜‘๏ธ defined as PaO2 of </= 50 mmHg Hypercapnic Respiratory Failure - โ˜‘๏ธ defined as PCO2 >/= 50 mmHg What does acute respiratory failure result from? - โ˜‘๏ธ - ARF may result from direct injurt to the lungs or may simply be triggered by an injury of dysfunction to one or more body systems or organs
  • Can also occur as a post-operative complication secondary to anesthesia or narcotics What is pneumothorax? - โ˜‘๏ธ - A pneumothorax is the prescense of air or gas in the pleural space
  • The air in the thoracic cavity may press on the lungs and cause it to collapse completely, or it may be a small amount of air that does not cause any difficulties

What are 2 main types of pneumothorax? - โ˜‘๏ธ 1. spontaneous pneumothorax

  1. secondary pneumothorax Spontaneous pneumothorax - โ˜‘๏ธ - Occur in young, tall thin males
  • They may also occur as a result of bleb rupture in person who have emphysema Secondary pneumothorax - โ˜‘๏ธ - caused by trauma --> tension pneumothorax Tension pneumothorax - โ˜‘๏ธ - secondary pneumothorax
  • tension pneumothorax occurs when air becomes trapped in the thoracic cavity and cannot escape.
  • The site of injury on the pleural membrane acts as a one way valve and only lets air in to the thoracic cavity. What does the person with tension pneumothorax s/sx? - โ˜‘๏ธ - complete lung collapse
  • This can occurs the individual will have a deviated trachea, SOB, and HPT What is pulmonary edema? - โ˜‘๏ธ - Pulmonary edema is the accumulation of water in the pulmonary alveolar sacs
  • This prevents the proper exchange of gases and leads to dyspnea, chest pain, and hypoxia
  • Often individuals will have orthopnea or paraoxysmal noctural dyspnea What is the most common cause of pulmonary edema? - โ˜‘๏ธ - The most common cause is left sided HF
  • In left sided HF the backup of blood to the lungs increases capillary hydrostatic pressure which pushes fluid into the alveolar sac What is acute respiratory distress syndrome? - โ˜‘๏ธ - Acute respiratory distress syndrome is a type of RF which results from massive lung inflammation and disseminated alveolar capillary damage What damage does acute respiratory distress syndrome do? - โ˜‘๏ธ This damage significantly impairs gas exchange and the patient will have significant issues with oxygenation What disease can increase the risk of Acute Respiratory Distress Syndrome? - โ˜‘๏ธ PNA, sepsis, massive trauma, burns, aspirations, DIC, and pancreatitis What are the pathologic hallmarks of ARDS? - โ˜‘๏ธ -Diffuse alveolar capillary damage
  • poor gas exchange
  • severe pulmonary edema
  • hypoxemia What are the 3 phases of ARDs? -

S/sx of asthma in children - โ˜‘๏ธ -runny noses

  • low grade fevers
  • expiratory wheezing
  • faint breath sounds
  • barrel chest
  • In severe cases they may have retractions, nasal flaring, and accessory muscle use what are 2 types of COPD? - โ˜‘๏ธ they are both associated with cigarette smoking
  • Emphysema
  • Chronic bronchitis Pathologic hallmarks of emphysema? - โ˜‘๏ธ - dilation of the airways and the destruction of the alveolar walls
  • both of these defects will cause a decrease in the eleastic recoils -As a result, air is trapped in teh lungs and cannot be completely exhaled.
  • As teh amount of air trapped increases, the thoracic cavity changes shape to accomodate for the increased lung volumes (amount of air) and becomes the shape of the barrel Manifestation of emphysema - โ˜‘๏ธ - hypoxia, cyanosis, and respiratory acidosis
  • These patients tend to have pursed lipped breathing and use the tripod position to help improve their breathing
  • They tend to have a high metabolic rate bc they have shallow, rapid breathes adn burn a lot of calories.
  • Individuals tend to be thin Chronic bronchitis - โ˜‘๏ธ - a condition marked by the presence of a productive cough which occurs over the course of the minimum of 3 consecutive months for 2 yrs What happens to cellular change in chronic bronchitis? - โ˜‘๏ธ - The mucus secreting cells in the airways undergo a hyperplasia and secrete excessive amounts of mucus
  • this mucus can be hard to clear, may plug the airway and impair oxygenation What is pneumonia? - โ˜‘๏ธ - PNA is an inflammatory and/or infectious process which results in the accumulation of inflammatory exudate in the alveolar sacs Causes of PNA? - โ˜‘๏ธ - bacterial
  • viral
  • funal organism
  • aspiration Types of PNA? - โ˜‘๏ธ 1. community acquired PNA
  1. Healthcare- associated PNA
  2. Hospital- acquired PNA Community Acquired PNA - โ˜‘๏ธ - PNA which occurs outside the healthcare system
  • Common bacterial causes include: streptococcus pneumoniae, staphylococcus Aureus, Streptococcus pyogenes, Klebsiella pneumoniae, Haemophilus influenza Streptococcus Pneumoniae - โ˜‘๏ธ - Most common cause of PNA
  • Is is seen more frequently in the elderly and debilitated patients such as those who are malnourished or have cardiopulmonary diseases Straphylococcus Aureus - โ˜‘๏ธ - Often arises as a complication from influenza or a viral PNA
  • This is mainly seen in elderly, debilitated hospitalized pts and those persons w/chronic lung disease Streptococcus Pyogenes - โ˜‘๏ธ - Occurs as a complication of a viral infection such as influenza or measles Klebsiella PNA - โ˜‘๏ธ - Common in hospitalized debilitated pts, diabetics, or alcoholics
  • Elderly infected with this bacteria have a high mortality Haemophilus Influenza - โ˜‘๏ธ - commonly seen in infants and children
  • It commonly occur in those adults with COPD Healthcare - Associated PNA - โ˜‘๏ธ - dx in any individual who has had contact w/the healthcare system
  • Person who have received infusion therapy or dialysis or have resided in a nursing home w/thin 90 days of the dx are said to have healthcare- associated PNA Hospital Acquired PNA - โ˜‘๏ธ - one which is dx 48 hours after being admitted to the hospital
  • common causes include gram - bacteria such as Klebsiella, Pseudomonas aerugonisoa, and E.coli.
  • These organisms also have common ones implicated in health care associated PNA What is Tb? - โ˜‘๏ธ -Tuberculosis is a pulmonary infection which occurs worldside and most commonly in disadvantaged populations What causes Tb? - โ˜‘๏ธ Tb is caused by the mycobacterium tuberculosis and is spread via air droplets containing organism Primary infection tuberculosis -
  • COPD may also cause PAH and is the most common pulmonary condition to do so
  • PE may cause PAH Patho of pulmonary arterial hypertension - โ˜‘๏ธ - patho includes and over abundance of vasoconstrictors and an insufficient amount of vasodilators. This imbalance causes a constriction of the pulmonary artery
  • There are changes in teh precapillary pulmonary arteries which make them resistant to vasodilation.
  • There are increased level of Ca which causes vasoconstriction, phosphodiesterases which increase cellular proliferation, increased serotonin levels which cause vasoconstriction all of which add to the pathogenesis of this disoder. The Higher pressure in the pulmonary artery causes the R ventricle to work harder. It has to push aganist the increased pressure. The right V will compensate for the increased work load by enlarging and will eventually fail, causing cor pulmonale Clinical manifestation of PAH - โ˜‘๏ธ - on CXR one will see an enlarged right ventricle and pulmonary artery
  • Non - specific manifestations : fatigue, chest pain, tachypnea, dyspnea on exertion, palpitations and cough
  • They will have signs of R sided HF as well Cor Pulmonale - โ˜‘๏ธ - This condition is secondary to pulmonary artery HTN.
  • The right ventricle is normal physiology is not made to push aganist high pressures.
  • In the setting of PAH, it has to push aganist the higher pulmonary artery pressure and eventually fails
  • The person will have sx of right sided HF What happens to the cellular change in asthma? - โ˜‘๏ธ - cellular level changes include bronchial smooth muscle hypertrophy, goblet cell hyperplasia, thickening and hyalinization of the basement membranes, proliferation of eosinophils, and bronchial mucous plugs