slide 120, lobar pneumonia slide 120, lobar...
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Slide 120, Lobar PneumoniaSlide 120, Lobar Pneumonia Slide 120, Lobar PneumoniaSlide 120, Lobar Pneumonia
Slide 172, Interstitial PneumoniaSlide 172, Interstitial Pneumonia Slide 172, Interstitial PneumoniaSlide 172, Interstitial Pneumonia
53 Year53 Year--Old SmokerOld Smoker EmphysemaEmphysema
Pink pufferPink pufferBarrel chestBarrel chest
HyperinflationHyperinflationTrapped airTrapped air
ThinThinLots of calories just to Lots of calories just to breathbreath
Rapid respirationsRapid respirationsPursed lipsPursed lipsCOPDCOPD
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Chromic BronchitisChromic Bronchitis
Also a chronic obstructive Also a chronic obstructive disease disease Chronic cough with Chronic cough with mucus production for 3 mucus production for 3 months.months.May lead to emphysema May lead to emphysema (especially in smokers).(especially in smokers).COPDCOPDLarger airway narrowingLarger airway narrowingIncreased secretionsIncreased secretions
Goblet cell hyperplasiaGoblet cell hyperplasia
Blue bloaterBlue bloaterCyanoticCyanotic
ClubbingClubbing
Hypertrophic Hypertrophic osteoarthropathyosteoarthropathySoft tissue and Soft tissue and periosteal boneperiosteal boneEmphysemaEmphysemaLung cancerLung cancerHeart defectsHeart defects
Anion GapAnion Gap EmphysemaEmphysema
Large airspacesLarge airspacesTrapped in air the Trapped in air the dilated alveolidilated alveoli
causes compression of causes compression of smaller airwayssmaller airwaysHyperinflationHyperinflation
Changes are Changes are irreversibleirreversible
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EmphysemaEmphysema Chronic BronchitisChronic Bronchitis
Chronic BronchitisChronic Bronchitis COPDCOPD
HematocritHematocrit??Ulcer?Ulcer?Complications?Complications?Other conditions?Other conditions?
Premature InfantPremature Infant
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Fetal LungFetal Lung
Hyaline Membrane vs. ARDSHyaline Membrane vs. ARDS
Pathogenesis?Pathogenesis?Differs from ARDS?Differs from ARDS?Toxemia and placenta?Toxemia and placenta?History?History?WhatWhat’’s this?s this?
Placental InfarctsPlacental Infarcts
43 Year43 Year--Old WomanOld Woman
Long termLong termFeverFeverCoughCoughBlood?Blood?CavitaryCavitary
TB Chest XTB Chest X--RayRay
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TB Chest XTB Chest X--RayRay TuberculosisTuberculosis
Mycobacterium tuberculosis Mycobacterium tuberculosis (most cases)(most cases)
Type IV hypersensitivityType IV hypersensitivityGranulomaGranuloma
Primary infectionPrimary infectionPulmonaryPulmonaryPerhaps goes lymphaticsPerhaps goes lymphaticsHopefully it stops here.Hopefully it stops here.
Secondary TBSecondary TBInternal reactivationInternal reactivationPerhaps years laterPerhaps years laterNot all patientsNot all patients
Granuloma FormationGranuloma Formation Primary TBPrimary TB
Secondary or Reactivation TBSecondary or Reactivation TB TuberculosisTuberculosis
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Granulomas of TBGranulomas of TB
Caseous granulomasCaseous granulomasGiant cellsGiant cellsInert bugInert bug
Disseminated TBDisseminated TB
Skin TestSkin Test
PPDPPDInjected intradermallyInjected intradermallyRead in 2 daysRead in 2 daysMeasure swellingMeasure swelling
Not rednessNot redness
Positivity maybe life Positivity maybe life longlong
35 Year35 Year--Old ArtistOld Artist
FeverFeverSudden onsetSudden onsetPleurodyniaPleurodyniaSOBSOBDullnessDullnessCBCCBCSputum?Sputum?
Pulmonary InfectionsPulmonary Infections
PneumoniaPneumoniaInfection in the alveolar spacesInfection in the alveolar spaces
BacteriaBacteriaTBTB
Interstitial tissueInterstitial tissueVirusVirusMycoplasmaMycoplasma
AbscessAbscessBronchitisBronchitisBronchiolitisBronchiolitisPleuritisPleuritis
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Bacterial PneumoniaBacterial Pneumonia
Streptococcal pneumoniaeStreptococcal pneumoniae Acute Bacterial PneumoniaAcute Bacterial Pneumonia
Gram Negative BugsGram Negative Bugs
Typically from body floraTypically from body flora‘‘OpportunisticOpportunistic’’ infectionsinfections
Compromised hostCompromised hostAlcoholicAlcoholic
AspirationAspiration
ChemotherapyChemotherapyTracheostomyTracheostomyBroad spectrum antibiotics that change host Broad spectrum antibiotics that change host floraflora
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Klebsiella PneumoniaKlebsiella Pneumonia
Gram negative rodGram negative rodVery mucoid capsuleVery mucoid capsule
AspirationAspirationHead down in the gutterHead down in the gutter
Rusty sputumRusty sputumHigh feverHigh fever
Pulmonary AbscessPulmonary Abscess
StaphylococcusStaphylococcusAspiration of gastric Aspiration of gastric materialmaterialHole withHole withAirAir--fluid levelfluid level
PneumoniaPneumoniaBxBx??Spread within the Spread within the lungs?lungs?CBC, immature cells?CBC, immature cells?Outcome?Outcome?
35 Year35 Year--Old SmokerOld Smoker
Pack year?Pack year?CoughCoughBlood?Blood?
Bronchiogenic CarcinomaBronchiogenic Carcinoma
Squamous in most casesSquamous in most casesChronic irritant leads to Chronic irritant leads to squamous metaplasia.squamous metaplasia.Continued exposure leads Continued exposure leads to dysplasia and to dysplasia and eventually cancer.eventually cancer.Very aggressive.Very aggressive.Surgery is about it.Surgery is about it.Poor response to Poor response to chemotherapy ands chemotherapy ands radiationradiation
Pulmonary CytologyPulmonary Cytology
Exfoliative cytologyExfoliative cytologyCough it upCough it upWash it outWash it out
Bronchoscopic biopsyBronchoscopic biopsy
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Metaplasia, Dysplasia, CancerMetaplasia, Dysplasia, Cancer Basic Patterns of Bronchiogenic CarcinomaBasic Patterns of Bronchiogenic Carcinoma
What Lung Cancer What Lung Cancer Can DoCan Do
Obstruct bronchus causing Obstruct bronchus causing pneumonia pneumonia Spread widelySpread widelyOdd hormonal activityOdd hormonal activity
Small cell makes ADH and Small cell makes ADH and ACTHACTHSquamous cell makes PTHSquamous cell makes PTH
Multiple sclerosis like Multiple sclerosis like symptomssymptoms
Even without brain metsEven without brain mets
PancoastPancoast’’s tumor s tumor -->>HornerHorner’’s syndromes syndrome
Metastatic Cancer to LungMetastatic Cancer to Lung
Can come from Can come from anywhereanywhereMicroscopic looks like Microscopic looks like tumor of origintumor of originSpreads by bloodSpreads by blood
Isolated masses Isolated masses -->>
Spreads by lymphaticsSpreads by lymphaticsDiffuse involvementDiffuse involvement
58 Year58 Year--Old Old AsthamticAsthamtic
CushingsCushings??Pulmonary studies?Pulmonary studies?CholecystectomyCholecystectomy??
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AsthmaAsthmaBronchoconstrictionBronchoconstriction
EpisodicEpisodicReversibleReversibleVarious stimuliVarious stimuli
Extrinsic AsthmaExtrinsic AsthmaType I hypersensitivityType I hypersensitivityIgEIgEAtopic most frequentAtopic most frequent
Other manifestationsOther manifestations
IntrinsicIntrinsicTriggers are nonimmuneTriggers are nonimmune
AspirinAspirinViral infectionsViral infectionsColdColdStressStress
Asthma, SensitizationAsthma, Sensitization
Sensitization of CD4 Sensitization of CD4 cellscells
The TThe THH2 class2 class
TTHH2 cells release 2 cells release cytokinescytokines
ILIL--4, IL4, IL--5 & IL5 & IL--1313Cause production IgECause production IgEGrowth of mast cellsGrowth of mast cells
Histamine producersHistamine producersActivation of eosinophilsActivation of eosinophils
Typically see 2 phases Typically see 2 phases to an attackto an attack
Early, 30Early, 30--60 minutes60 minutesLate, 4Late, 4--8 hours8 hours
Asthma, ReactionAsthma, Reaction
Asthma, LongAsthma, Long--termterm WhatWhat’’s happening?s happening?
Blood pressure?Blood pressure?Deterioration?Deterioration?Pneumonia, factors?Pneumonia, factors?Death?Death?Histological changesHistological changes
BronchiBronchiEmphysema?Emphysema?