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CHRONIC PULMONARY
EMPHYSEMA
•Airway obstruction disease
Extensive alveolar
destruction
Trapping of excess air in lungs
Obstruction
Etiological factor
Destruction
Long term smoking
Pathological changes in the lungs
•Chronic infection due to irritant smoke
•a. (partial paralysis of the cilia of the respiratory epithelium by the
nicitine effects.
mucus retention
•b.Stimulation of excess mucus
•c. Inhibition of alveolar macrophages
Less control of infection
• Infection+ Inflammation
Of bronchioles
•Obstruction of airways
Chronic obstruction of
airways
Difficult expiration
Entrapment of air in alveoli
and overstretching
Lung infection
50-80 % of alveolar wall
destruction
• Abnormalities of emphysema
• Increased air way resistance leads to
increased work of breathing
• Loss of alveolar walls leads to decreased
diffusing capacity
• Abnormal ventilation perfusion ratioin
Physiological shunt
same lung
Physiological dead space(
Va/q)
• Loss of alveolar wall
No. of pulm. capill
Pulm. Vasular
resistance
Pulmonary
hypertension
Right heart failure
• Over years
Hypoxia and hypercapnia
Can cause air
hunger
death
Pulmonary emphysema
• It is one of the obstructive respiratory
diseases in which lung tissue is
extensively damaged. This literally means
that air is trapped in the lungs. Causes
are:
• Chronic infection caused by inhaling
smoke or other irritants.
•
Infection causes
Partial paralysis of the rssp.
Epithelium (nicotine).
Mucus is not removed
Alveolar macrophages
are also inhibited
•Infection causes excess mucous and inflammatory edema causes chronic
obstruction of the smaller alveoli
•This causes entrapment of air in the alveoli leading to overstretching of
the alveoli leading to the destruction of 50 – 80 % of the alveolar walls.
•Abnormalities produced:
•Bronchial obstruction causing increased airway resistance. The work of
breathing is massively increased especially during expiration.
• Loss of alveolar walls greatly decreases
the diffusion capacity of the lung.
• Extensively abnormal ventilation-perfusion
ratios
• Loss of alveolar walls causes loss of
pulmonary capillaries causing pulmonary
hypertension leading to right sided heart
failure
• Hypoxia , hypercapnia.
Tuberclosis
•
Constrictive lung disease;
Etiology:
tubercle bacilli lead to tissue reaction in lungs lead to
1) Macrophage invasion
2) Walling off of lesion by fibrous tissue leading to
tubercle formation which causes further prevention of
transmission of tubercle bacilli in lungs of walling off
process
If untreated in 3% walling off fails
Massive destruction of lung tissue
Large abcess cavities
Late stages= increase fibrous tissue and decrease function
of lung tissue.
• Results:
Increase work of breathing by respiratory
membrane
Decrease vital capacity
Decrease breathing capacity
Decrease respiratory membrane surface area
Increase thickness of respiratory membrane
Decrease pulmonary diffusion capacity
Abnormal ventilation perfusion ratio in lungs
leading to decrease pulmonary difference of
Oxygen and Carbon dioxide.
pneumonia
• It is an infection of
pulmonary parenchyma.
• Caused by
viruses,fungi,and
parasites.
• It may involve primarily
the interstetium or alveoli
• Involvement of entire lobe
is called LOBAR
PNEUMONIA
• Involvement of alveoli
contiguous to bronchi is
called
BRONCHOPNEUMONIA
Pneumonia
• Consolidation of lung occurs i.e, alveoli
are filled with blood cells and fluids
• Pulmonary membrane becomes inflamed
and porous so leaking occurs.
Abnormalities of function
• Early stage; localized pneumonia
1) Decrease total surface area of
respiratory membrane
2) Decrease V/Q ratio
Result: hypoxemia and hypercapnia