Disorders of the Respiratory System

Lecture Outlines

• Anatomy of the Respiratory System

• Disorders of the Respiratory System

• Alveolar Disorders Impeding Respiration

• Infections

• Obstructive Lung Diseases

• Restrictive Lung Diseases

• Lung Cancer
Respiratory System
 Lung
Histology
Bronchiole

Alveoli

Type 2

Type 1-Pneumocyte
 Alveolar Gas Exchange:

Co2

O2

5
Disorders of the Respiratory System

• Alveolar Disorders Impeding Respiration

• Infections
• Obstructive lung diseases
• Restrictive lung diseases
Alveolar Disorders Impeding Respiration

1. Atelectasis
2. Neonatal Respiratory distress
3. Pulmonary Edema
4. Alveolar Proteinosis
1) Atelectasis
A collapse of alveoli resulting is airless lung

Three forms
• Resorption atelectasis occur due to
bronchial obstruction, such as a tumor.

• Compression atelectasis associated

pneomothorax (abnormal collection of air
or gas in the pleural space that separates
the lung from the chest wall).

• Contraction atelectasis occur due to

pulmonary fibrosis or lesion of the pleura.
Atelectasis

• Atelectasis caused by
airway obstruction
and absorption of air
from the involved
lung area on the left
and by compression
of lung tissue on the
right.

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 Histopathology (Atelectasis)

Normal Lung Atelectasis

2) Neonatal Respiratory distress
• Usually affect premature infants
• Incomplete expansion of the lung due to underproduction of
surfactant
• Due to collapse of the alveoli ( gas exchange take place in the alveolar
duct)
• Since the alveolar duct is not lined by pneumocytes, the inhaled
oxygen damage their cell lining.
• The dead cells leave a denuded surface which is covered with fibrin
exudate (hyaline membrane)
Histopathology
3) Pulmonary edema
• Pulmonary edema is a condition
caused by excess fluid in the
lungs.

• Transudate develop due to

increase pressure in pulmonary
vein

• Most often occur in heart failure

4) Alveolar Proteinosis

• Rare disease that may

impede gas exchange
• Due to formation of Ab to
(GM-CSF) which impair the
function of alveolar MǾ and
the accumulation of
gelatinous surfactant in the
alveoli.

Alveoli are filled with finely granular

eosinophilic material
Disorders of the Respiratory System

• Alveolar Disorders Impeding Respiration

• Infections
• Obstructive lung diseases
• Restrictive lung diseases
Respiratory Infections
Lower respiratory tract infection- Pneumonia
• Inflammation of alveoli

• Classification of pneumonia based on:

• Causative agent: Bacterial, viral, fungal,

other.

• Anatomical location : Lobar / Broncho

pneumonia

• Symptoms: Fever, cough, dyspnoea.

• Complications: Spread septicemia, abscess,

scarring.

• Epidemiological data:
• Hospital-acquired
• Community acquired
 Pathogenesis of Pneumonia
• In response to the infection, alveoli fill
with some RBCs, neutrophils, and fluid
from surrounding tissues
• Sputum is often rust-colored from blood
coughed up from lungs

• Diagnosis:
Gram stain and culture of bacterium from
sputum

• Treatment: Penicillin

• Vaccine available, usually for children and

elderly patients
 Broncho-pneumonia – Lobar-pneumonia
• Extremes of age.
• Secondary, in sick.
• Both genders.
• Klebsiella, E.coli
• Patchy, basal, bilateral.
• Around Small Bronchi
• Not limited by anatomic
boundaries.
• Usually bilateral.
• Middle age – 20-50
• Primary in a healthy adult.
• males common.
• 95% pneumococcus
• Entire lobe consolidation
• Diffuse
• Limited by anatomic boundaries.
• Usually unilateral
Potential Pathogens
Streptococcus pneumoniae
Most common cause of bacterial
pneumonia
• Gram Positive Cocci
• Surrounded by capsule
• 83 serotypes distinguished by
capsules
• Symptoms:
• High fever
• Difficulty breathing
• Chest pain
• Lungs have reddish
appearance due to dilated
blood vessels
 Other Pneumonia Etiologies
Smaller players in causing pneumonia
• Klebsiella pneumoniae
• Gram-negative enteric
• Destroys lungs
• Very degenerative
• Associated with alcoholics
• Haemophilus influenzae
• Vaccine available
• Mycoplasma pneumoniae
• Causes milder type of pneumonia
(Atypical / walking pneumonia)
• No cell wall – no treatment with PCN
Individuals Most Susceptible to pneumoniae

• Elderly
• Alcoholics – alcohol will
suppress immune system
• Those with viral infection
• Chronically ill
• AIDS or immunosuppressed
patients
• Smokers
• Patients with chronic
respiratory disease e.g.
bronchial asthma.
 Normal

Pneumonia Histopathology:
Pulmonary tuberculosis
• Tuberculosis is a chronic inflammation
caused by Mycobacterium tuberculosis

• Microscopically, the characteristic lesion in

tuberculosis is the tuberculosis granuloma
GRANULOMATOUS INFLAMMATION
 Pulmonary tuberculosis
Symptoms:
• Low grade fever
• Chronic cough
• Tiredness
• Night sweat

• High risk individuals

• Elderly, Infants
• People with weakened immune systems, e.g AIDS ,
chemotherapy ,diabetes, or medicines that weaken the
immune system
• Poverty
• Malnutrition
• Overcrowding

Treatment: long term (at least 6 months) of antibiotics, often

multiple antibiotics required for several years
Disorders of the Respiratory System
• Alveolar Disorders Impeding Respiration
• Infections
• Obstructive lung diseases
1. Aspiration
2. Cystic Fibrosis
3. Asthma
4. COPD

• Restrictive lung diseases

Obstructive Lungs diseases

1)
Obstructive Lungs diseases

2) Cystic fibrosis
Histopathology
3) Asthma
•
• Asthma is a chronic lung disease that obstructs
airflow

• The obstruction is reversible

• It involves difficulty in breathing due to

• Inflammation (swelling)
• Mucus in the airways
• Tightening of muscles around the airways
(Broncho-constriction)

• Symptoms:
• Dyspnea – difficulty breathing
• Wheezing
• Chest tightness
• Cough – chronic cough may be the only
symptom
• Sputum (mucus) production
Triggers of asthma
Pathophysiology
Asthma
Morphology:

Asthma Microscopy
1. Mucous Plugs +eosinophils
2. Goblet cell hyperplasia
3. Inflammation + Eosinophils
4. Smooth muscle hyperplasia
5. Mucous gl. Hyperplasia.
Classical histological findings in bronchial asthma

1) Inflammation 2) Bronchial (luminal) narrowing

3) Increased Mucous 4) Smooth muscle hyperplasia

Dr Ahmed Malki, 2014

 Treatment

• The goal of treatment is to avoid the substances that trigger Asthmatic

symptoms ,
• Control airway inflammation (administration of steroids)
• Administration of bronchodilators to widen the airway and
 4) Chronic Obstructive Pulmonary diseases- COPD
• Chronic, irreversible airway obstruction with destruction
of bronchi & alveoli.
• Clinical: 1) Emphysema, 2)Chronic bronchitis,
• Smoking / pollution – commonest cause
• 15% smokers develop COPD.
• Finally leads to lung failure or Cancer.

Irritation  Inflammation  Mucous  Infections  destr. COPD  Cancer

 Chronic Obstructive Pulmonary diseases- COPD
1) Emphysema
• is a long-term, progressive disease
of the lungs that primarily causes
shortness of breath due to over-
inflation of the alveoli

Pathogenesis:
• In emphysema the lungs lose their
elasticity
• Exhalation becomes active due to
decreased elasticity of the lungs,
the pressure increases and
bronchioles collapse, so alveoli are
filled with residual air.
Emphysema
• Manifestations include the following:
• Tachypnea (increased respiratory rate):
Because that is effective in maintaining
arterial blood gases, one does not usually
see hypoxia or cyanosis until the end
stages of the disease.
• Barrel chest from prolonged expiration.
• Possible long-term consequences,
including core pulmonale , respiratory
failure.
The alveoli filled with residual air because of
emphysema

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Histopathology
 2) Chronic Bronchitis
• Clinically defined as chronic cough for
more that 3 months
• Caused by chronic irritation
• Associated with smoking
• Hyperplasia of goblet cell
• Increased number of alveolar
macrophages
• Lymphocytes and fibrosis
• Squamous metaplasia
• Chronic bronchitis sufferers are often
referred to as “blue bloaters” as a result
of the cyanosis and peripheral edema
that is often present
Chronic Bronchitis: Histopathology
Normal Chronic Bronchitis
• Squamous
Metaplasia.

• mucous
gland.
Hyperplasia
Combined  COPD (common)
COPD: Overlap of Clinical syndromes

COPD
Normal - COPD

CB

Emphysema
Disorders of the Respiratory System

• Alveolar Disorders Impeding Respiration

• Infections
• Obstructive lung diseases
• Restrictive lung diseases
Restrictive Lung diseases

• The lung volumes are reduced

either because of:

1. Fibrosis
2. Diseases of the pleura
3. Chest wall or neuromuscular
apparatus.
Lung Cancer

• Common & fatal cancer (internal malignancy)

• Significant increase in incidence.. (developing
countries*)

• 90% of lung cancers are related to smoking..!

(passive smoking in 5%)
• Poor prognosis ~ 5% 5y survival

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Types of lung cancer
Types of lung cancer
• Small cell
• Non-small cell
• Less common 15% of cases
• More common 85%
• Faster growth
• Slow growth & Spread
• Metastize rapidly
• Subtypes:
• High mortality
• Adenocarcinomas
• Subtypes:
• Squamous cell
• Small cell carcinoma carcinomas
• Combined small cell • Large cell carcinomas
carcinoma
Symptoms
• Chronic cough
• Permanent chest pain
• Blood cough
• Shortness of breath
• Wheezing
• Repeated infections
• Neck and face swelling
• Loss of appetite/weight loss
• Fatigue
• Non-small cell carcinoma
• Adenocarcinomas
Non-small cell carcinoma- Squamous cell
carcinomas
Non-small cell carcinoma- Large cell carcinomas
Small cell carcinoma/Oat cell cancer
Clinical features & complications.

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• Acknowledgement