Respiratory Pathology

CHPA 22013

Dr. P.A.D.H.J. Gunathilaka

BAMS (Honours) (1st Class) (UOK)
Lecturer (Probationary)
Department of Roga Vignana
Gampaha Wickramarachchi University of Indigenous Medicine
 Summary
 1. Atelectasis
 2. Obstructive lung diseases
 3. Restrictive lung diseases
 4. Vascular lung diseases
 5. Pulmonary infections
 6. Lung tumors
 7. Pleural lesions
 8. Lesions of upper RT
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 1. Atelectasis
= inadequate expansion of airspaces (collapse)
 ventilation - perfusion imbalance – hypoxia

 Atelectasis is a term that refers to a collapse in the alveoli of the

lungs.
 It could be a total collapse of an entire lung or a partial collapse
in one or more lobes.
 It can occur in newborn infants due to a lack of surfactant.
 Atelectasis also occurs as an important postoperative
complication of abdominal surgery, because of mucous
obstruction of a bronchus and diminished respiratory movement
resulting from postoperative pain.
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 Atelectasis

Primary Atelectasis Secondary Atelectasis

Compressive

Obstructive/Absorptive

Contraction
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Primary Atelectasis
 Atelectasis in the newborn or primary atelectasis is defined as
incomplete expansion of a lung or part of a lung.

 Stillborn infants have total atelectasis, while the newborn

infants with weak respiratory action develop incomplete
expansion of the lungs and clinical atelectasis.

 The common causes are prematurity, cerebral birth injury,

CNS malformations and intrauterine hypoxia.

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Secondary Atelectasis
 Secondary atelectasis is the term used for reduction in lung
size of a previously expanded and well aerated lung.
 Secondary atelectasis in children and adults may occur from
various causes such as compression, obstruction, contraction
and lack of pulmonary surfactant.

1. Compressive atelectasis
 Pressure from outside causes compressive collapse e.g. by
massive pleural effusion, haemothorax, pneumothorax,
intrathoracic tumor, high diaphragm and spinal deformities.
 Involves sub-pleural regions and affects lower lobes more
than the central areas.

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2. Obstructive/absorptive atelectasis
 Obstruction of a bronchus or many bronchioles causes
absorption of oxygen in the affected alveoli followed by collapse
e.g. by viscid mucus secretions in bronchial asthma, chronic
bronchitis, bronchiectasis, bronchial tumors and aspiration of
foreign bodies.
 Generally less severe than the compressive collapse and is
patchy.

3. Contraction collapse.
 This type occurs due to localized fibrosis in lung causing
contraction followed by collapse.

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Atelectasis. The right lung of an infant is pale and expanded by air; the left lung is
collapsed.

Gross - Pleural surfaces are wrinkled. The affected lobe is airless, purple in colour
(bluish red) due to reduced heamoglobin
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 2. Obstructive lung diseases

  resistance due to partial / complete obstruction

at any level
  expiratory flow rate (FEV1)
 1. Bronchial asthma
 2. Chronic obstructive pulmonary disease
– 2a. Emphysema
– 2b. Chronic bronchitis / Bronchiolitis
 3. Bronchiectasis
 4. Cystic fibrosis

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 Bronchial asthma
= episodic reversible bronchospasm
basis: tracheobronchial hyperreactivity chronic inflammation of bronchi
expiratory difficulty lung hyperinflation

 Asthma is a disease of airways that is characterized by increased

responsiveness of the tracheobronchial tree due to a variety of
stimuli resulting in widespread spasmodic narrowing of the air
passages which may be relieved spontaneously or by therapy.
 Asthma is an episodic disease manifested clinically by paroxysms of
dyspnoea, cough and wheezing.
 However, a severe and unremitting form of the disease termed
status asthmaticus may prove fatal.
 Bronchial asthma is common and prevalent worldwide.
 Commonly starts in childhood between the ages of 3 and 5 years
and may either worsen or improve during adolescence. 16
Based on the stimuli initiating bronchial asthma, two broad etiologic
types are traditionally described.

1. Extrinsic asthma (allergic, atopic)

– type I hypersensitivity reaction to extrinsic antigens
– most common, familial predisposition
– diet proteins, herbal pollen, animal hair, mites

2. Intrinsic asthma (non-atopic)

– drugs, viral infection

A third type is a mixed pattern in which the features do not fit

clearly into either of the two main types. 17
Pathophysiology

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Classically asthma has three characteristics:
1. Airflow limitation which is usually reversible spontaneously or
with treatment
2. Airway hyper responsiveness to a wide range of stimuli
3. Bronchial inflammation with T lymphocytes, mast cells,
eosinophils with associated plasma exudation, oedema,
smooth muscle hypertrophy, matrix deposition, mucus
plugging and epithelial damage.

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The diagnosis of asthma is predominantly clinical and based on a characteristic history.
There is no single satisfactory diagnostic test for all patients with asthma.
• Lung function tests (Peak expiratory flow rate, Spirometry)
• Exercise tests
• Blood and sputum tests
• Chest X-ray - There are no diagnostic features of asthma on the chest X-ray 22
Asthma – Gross appearance of the lung

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A section of lung from a patient who died
in status asthmaticus reveals a bronchus
containing a luminal mucous plug,
submucosal gland hyperplasia and smooth
muscle hyperplasia (arrow).

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Higher magnification shows hyaline thickening of the subepithelial basement membrane

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Thank you

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