Pathology 1

• The major function of the lung is to replenish oxygen and remove

carbon dioxide from blood
• Lung has 3 lobes on the right and 2 on the left as well as the
bronchi
• Bronchioles are distinguished from bronchi by the lack of carti-
lage and submucosal glands within their walls
• Additional branching of bronchioles leads terminal bronchioles
and the part of the lung which is distal to them is called acinus

• Pulmonary acini are composed of respiratory bronchioles that

proceed into alveolar ducts, walls are formed of alveoli, site of gas
exchange.

• Alveolar epithelium contains a continuous layer of two principal

cell types:
1) flattened, platelike type I
2) rounded type II pneumocytes.

• Alveolar wall structure:

1. Capillary endothelium
2. Alveolar epithelium
3. Alveolar macrophages
4. Pulmonary intestium

• Dyspnea
So the feeling that one cannot breathe well enough or the short-
ness of breath called dyspnea which it’s a normal symptom of
heavy excretion.
And mostly of cases dyspnea is due to asthma, pneumonia and car-
diac ischemia or psychogenic causes such as anxiety so basically
the treatment depends on the cause

• Periodic breathing
-Occur during sleeping (it may occur for healthy person)
-occur for patient with congestive heart failure
- 2 common causes
1) due to living & sleeping at high attitude
2) Due to dysregulation of breathing by CNS
• Breathing (during sleeping)
-controlled by autonomic nervous system by (brain stem)
-neurological problems can trigger periodic breathing

• Atelectasis (collapse)
- it’s a loss of lung volume caused by inadequate expansion of air
space
- Result in shunting in oxygenated blood from pulmonary arteries
into veins
• 3 forms of Atelectasis
3) resorption atelectasis: occurs when obstruction prevents air
from reaching distal airways. (Occurs due to intra bronchial mu-
cous or mucopurulent plugs)
-most common causes are:
bronchial asthma, bronchiectasis, chronic bronchitis, tumor, or
foreign body aspiration, particularly in children

4) Compression atelectasis is usually associated with accumula-

tion of fluid, blood, or air within the pleural cavity
• caused commonly by congestive heart failure
. Leakage of air into the pleural cavity ( (pneumothorax)
open ,closed ,tension)
and during and after surgery.

3) Contraction atelectasis
occurs when either local or generalized fibrotic changes in the lung
or pleura hamper expansion

Acute Respiratory Distress Syndrome

-clinical syndrome caused by diffuse alveolar capillary and epithelial
damage.
-characterized by rapid onset of life-threatening respiratory insuffi-
ciency, cyanosis, and severe arterial hypoxemia that is refractory to
oxygen therapy
- ARDS in the lungs is known as diffuse alveolar damage
The most frequent triggers of ARDS are :
•pneumonia (35%–45%) and sepsis (30%–35%)
•followed by aspiration
•trauma (including brain injury, abdominal surgery, and multiple
fractures)
•pancreatitis
•and transfusion reactions

ARDS should not be confused with respiratory distress syndrome of

the newborn; the latter is caused by a deficiency of surfactant
caused by prematurity.
((In the acute phase of ARDS, the lungs are dark red, firm, airless,
and heavy ))

Diffuse alveolar
damage in acute lung injury and acute respiratory distress syn-
drome. ( alveoli are collapsed <bright pink>)
-Healing stage : resorption of hyaline membranes ,thickening of
alveolar septa containing inflammatory cells, fibroblasts, and colla-
gen.

OBSTRUCTIVE LUNG (AIRWAY) DISEASES

4 disorders:
1) Emphysema
2) chronic bronchitis
3) Asthma
4) Bronchiectasis

Emphysema: it’s a chronic obstructive airway disease and charac-

terized by abnormal permanent enlargement of the air spaces distal
to the terminal bronchioles

Types of it:
1)Centriacinar : central or proximal are affected by respiratory bron-
chioles, while distal alveoli are spared (common in cigarette smok-
ers)
2) Panacinar: Acine are enlarged, occurs in lower lung zones
3) Distal Acinar: proximal surface is normal but distal is involved
4) Irregular: Acine are irregular involved
Pulmonary emphysema: enlargement of the airspaces, with de-
struction of alveolar septa but without fibrosis.

Patients with uncomplicated emphysema present with

•increased chest volumes,
•dyspnea
•relatively normal blood oxygenation

CHRONIC BRONCHITIS
•defined as persistent productive cough for at least 3 consecutive
months in at least 2 consecutive years.
•Cigarette smoking is the most important underlying risk factor; air
pollutants also contribute.
•Chronic airway obstruction largely results from small airway dis-
ease (chronic bronchiolitis) and coexistent emphysema

enlargement of mucussecreting  glands, goblet cell metaplasia, and

bronchiolar wall fibrosis

Asthma
•is characterized by reversible bronchoconstriction caused by air-
way hyper responsiveness to a variety of stimuli.
•Atopic asthma most often is caused by a TH2 and IgE mediated
immunologic reaction to environmental allergens and is character-
ized by early-phase (immediate) and late-phase reactions.
•Triggers for non atopic asthma are less clear but include viral infec-
tions and inhaled air pollutants, which also can trigger atopic
asthma.
•Eosinophils are key inflammatory cells found in almost all subtypes
of asthma; eosinophil products (such as major basic protein) are re-
sponsible for airway damage.

Types of Asthma:
1)Atopic This is the most common type of asthma, usually begin-
ning in childhood
2) Non-atopic do not have evidence of allergen sensitization, and
skin test results usually are negative
3) Drug-Induced Asthma
4) Occupational Asthma This form of asthma is stimulated by fumes
and organic and chemical dusts.

Bronchial biopsy specimen from an asthmatic patient showing

sub–basement membrane fibrosis, eosinophilic inflammation, and
smooth muscle hyperplasia.

Bronchiectasis
•the permanent dilation of bronchi and bronchioles caused by de-
struction of smooth muscle and the supporting elastic tissue; it typi-
cally results from or is associated with chronic necrotizing infections

The conditions that most commonly predispose to bronchiec-

tasis include:
•Bronchial obstruction
•Congenital or hereditary conditions:
1.Cystic fibrosis,
2.Necrotizing, or suppurative, pneumonia,
3.Primary ciliary dyskinesia and
4.Immunodeficiency states

The airways may be dilated to as much as four times their usual di-
ameter
Bronchiectasis in a patient with cystic fibrosis who underwent lung
resection for transplantation. Cut surface of lung shows markedly
dilated bronchi filled with purulent mucus that extend to sub pleural
regions.

•Bronchiectasis is characterized by severe, persistent cough asso-

ciated with expectoration of mucopurulent, sometimes fetid, sputum
•Other common symptoms: dyspnea, rhinosinusitis, and hemopty-
sis.
•severe complications of bronchiectasis, such as brain abscess,
amyloidosis, and cor pulmonale, occur less frequently now than in
the past.