8. Pulmonary Vascular Disease
• Edema
– Hydrodynamic or cardiogenic
– Microvascular Injury
• Adult Respiratory Distress Syndrome
– Diffuse Alveolar Damage
• Impair respiratory function
• Predisposes to infection
9. Pulmonary Edema
• Hemodynamic Edema
–Increased HP
• Microvascular Injury
–Injury to capillaries of alveolar septa
–Important contributor in the
development of ARDS
10.
11.
12.
13. ARDS
• Diffuse alveolar capillary damage
• Respiratory failure
• Arterial hypoxemia refractory to O2 therapy
• Several causes: sepsis, trauma, cancer,
inhaled gases
• Differs from Hyaline Membrane of the
Newborn – deficient surfactant
18. Pulmonary Embolism, Hemorrhage &
Infarction
• Occlusion of pulmonary circulation
• Predisposing factors: bed-ridden, risk-associated
conditions, etc.
• Embolic from other sites: deep veins of legs
• Potential consequences: size, site, cardiovascular
status
– Respiratory compromise
– Cardiovascular compromise
19.
20. Pulmonary Hypertension
• Normal: 1/8 of mean systemic pressure
• ¼ or above is Pulmonary HPN
• Primary or Idiopathic
• Secondary – lung disease, left-sided heart
disease, recurrent emboli
• Endothelial dysfunction and injury with trigger
mechanisms – persistent vasoconstriction
21.
22.
23. • Impaired defense mechanisms
• Lowered general resistance of the host
– Loss or suppression of the cough reflex
– Injury to the mucociliary apparatus
– Interference with the phagocytic or bactericidal
action of alveolar macrophages
– Pulmonary congestion and edema
– Accumulation of secretions
Pulmonary Infections
24. • Defects in innate immunity and humoral
immunodeficiency
→Pyogenic infections
• Cell-mediated immune defects
→intracellular microbes
→very low virulence
25. Pulmonary Infections
• Morphology
– Lobar Pneumonia
– Lobular Pneumonia or Bronchopneumonia
– Atypical Pneumonia
– Necrotizing Pneumonia and Lung Abscess
• Where?
– Community Acquired
– Hospital Acquired or Nosocomial Infection
• Time/Duration: Acute and Chronic
• Etiologic Agent
• Immunocompromised Host
• Aspiration Pneumonia
26.
27.
28.
29.
30.
31.
32.
33. Necrotizing Pneumonia and
Lung Abscess
• Anaerobic bacteria with or without
mixed aerobic infection
• S. aureus, K. pneumoniae, S.
pyogenes. Type 3 pneumococcus
43. Aspiration Pneumonia
• Markedly debilitated patients
• Unconscious
• Repeated vomiting
• Abnormal gag and swallowing reflexes
• Partly chemical and partly bacterial (more than
one organisms; aerobes>anaerobes)
• Necrotizing, fulminant course
• Abscess formation as one of complications
44.
45. Pneumonia in Immunocompromised Host
• CMV, P. carinii, M. avium-
intracellulare
• Invasive aspergillosis and
candidiasis
• “Usual” bacteria, viral and fungal
organisms
46.
47. Chronic Obstructive Pulmonary Disease
(COPD)
–Increased resistance to air flow
Restrictive Pulmonary Disease
–Reduced expansion of the lung parenchyma
60. Irregular Emphysema
• Irregular involvement of
the acinus
• Associated with scarring
Others:
Bullous Emphysema
Interstitial Emphysema
61.
62. Emphysema
• Imbalance between proteases and their
inhibitors
• Tobacco – recruit neutrophils, stimulate
release and enhance activities of
enzymes, inactivation of antitrypsin
63.
64. Chronic Bronchitis
• Persistent productive cough
• At least 3 months
• At least 2 consecutive years
• Morphology: hyperemia and edema of mucous
membranes, mucinous secretions and casts,
hypertrophy of mucous glands with airway
plugging, inflammation and fibrosis, squamous
metaplasia/dysplasia
65.
66. Bronchial Asthma
• Increased responsiveness to various
stimuli
• Paroxysmal contraction of airway
passages
–Extrinsic (Reagin-mediated,
Allergen)
–Intrinsic (Idiopathic or precipitated
by other factors, non-atopic or
non-reaginic)
98. Hypersensitivity Pneumonitis
• Immunologically-mediated
• Inhaled dusts or antigens
– Farmer’s lung: actinomyces spores in hay
– Pigeon’s breeder’s lung: feathers, excreta
– Humidifier/Air-conditioner: HS, asthma, allergic
bronchopulmonary aspergillosis
– Idiopathic chronic eosinophilic pneumonia: focal
consolidation of lymphocytes and eosinophils; steroid
responsive
99. Bronchiolitis Obliterans – Organizing
Pneumonia
• Response to chronic infectious or inflammatory
injury of the lungs
• Cough, dyspnea, recent RTI
• Loose fibrous tissue plugs within bronchioles
and organizing pneumonia
• Improve gradually or with steroid therapy
