Emphysema Pathophysiology
Tobacco smoke, Air Pollution Inherited -1 Anti-trypsin Deficiency
Inflammation of the Airway Epithelium Inhibition of Endogenous AntiProteases
Infiltration of Inflammatory Cells & Release of Cytokines
(Neutrophils, Macrophages, Lymphocytes, Leukotrines, Interleukins)
Increased Protease Activity with Breakdown of Elastin in Connective Tissue of Lungs (Elastases, Cathepsins, etc.)
Irreversible Enlargement of the Air Spaces distal to the Terminal Bronchioles
Destruction of Alveolar Walls & Septa and Loss of Elastic Recoil of Bronchial Walls
(EMPHYSEMA)
Loss of Fibrous & Muscle Tissue A Portion of the Capillary Bed of an Alveolus has been eliminated.
Breakdown of Alveolar Elasticity Alveoli cannot support the Increased Air Volume in the Acinus
airways to keep them open
Change in
Dyspnea on Decreased Tactile Inability of the Alveoli to recoil
Airway Size
Exertion Fremitus on Palpation normally after expanding
Amount of air that can be
expired is diminished
Lungs become Chest X-Ray Crackles & Wheezing Bronchiolar Collapse on Expiration
less Compliant
Air Trapping
Barrel Chest, Hyperresonance
Pulmonary Function Test on Chest Percussion Increased Pulmonary
Inability of the Lungs to Vascular Resistance
Circulate Sufficient Air Overdistended Lungs Hyperinflation of the Alveoli
ECG
Airway Calibration Increased Total Lung Capacity Bullae (air spaces) will be formed Pulmonary Hypertension
is Decreased And Residual Volume adjacent to the Pleura (blebs)
Right Ventricular Hypertrophy
Ruptured Bullae and Blebs (Cor Pulmonale)
Part of Each Inspiration is Trapped Arterial Blood Gas
Spontaneous Pneumothorax
Hypoventilation Decreased Oxygenation Prolonged Hypoxia Electrocardiography Chest X-Ray
Chest X-Ray
Decreased Chest Expansion Tachypnea Clubbing of Fingers & Toes
LEGEND:
Black Text usual pathway
Square Dotted Line Clinical Manifestations
Gray Text Complications
Dash Dot Line with Diamond Arrow Laboratory & Diagnostic Tests