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— Paul Valery

Normal Lung

Normal Lung

BRONCHIECTASIS
Bronchiectasis is a disease characterised by permanent dilatation of bronchi and bronchioles caused by destruction of the muscle and elastic tissue.

CAUSES:
CONGENITAL:Cystic fibrosis,Kartageners syndrome POST-INFECTIOUS:as a complication of pneumonia BRONCHIAL OBSTRUCTION:due to foreign body,tumor,mucus impaction

Etiopathogenesis
Obstruction and Infection are the two major influences MORPHOLOGY Affects lower lobes ,bilaterally The bronchi and bronchioles are dilated upto 4 times the normal size - Cylindrical or tube like - Fusiform - Saccular or sac like -

The bronchioles are markedly dilated and extend upto the pleural surface HISTOLOGY  The walls of the bronchi and bronchiles show dense inflammation,with desquamation and ulceration of the wall.  Fibrosis of the wall in chronic cases
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CLINICAL COURSE Persistent cough, with foul smelling bloody sputum Dyspnea COMPLICATIONS Cor pulmonale(Heart failure) Lung abscess,metastatic abscess Amyloidosis

CHRONIC BRONCHITIS


Defined clinically Presence of persistent cough with sputum production for atleast 3 months in atleast 2 consecutive years,in the absence of any other identifiable cause.

TYPES


Simple chronic bronchitis Asthmatic bronchitis-with associated wheezing Obstructive bronchitis-with associated features of emphysema

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PATHOGENESIS
SMOKING
4-10 times more common in heavy smokers Smoke and other irritants cause Hypertrophy of submucosal glands--hypersecretion of mucus Increase in goblet cells predisposition to infection

MORPHOLOGY
Bronchi and bronchioles show hyperemia,edema and are covered by mucopulurent secretions Microscopy: Enlargement of submucous glands and and chronic inflammation Reid index :normally 0.4 In chronic bronchitis 

COMPLICATIONS Cor pulmonale

ASTHMA
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Is a chronic inflammtory disorder of the airways that causes recurrent episodes of wheezing,breathlessness,chest tightness and cough,particularly at night and /or in the early morning. Widespread BRONCHOCONSTRICTION Due to INFLAMMATION which causes increased hyper responsiveness to variety of stimuli.

ETIOLOGY
Gentic predisposition to Type I hypersensitivity  Acute and chronic inflammation of airways  Bronchial hyper-responsiveness TH2 Helper T cells –secrete Interleukinsstimulate B cells –IgE Antibodies
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What is Asthma? Hypersensitivity – Allergy , Type I of airways of lungs - Bronchi Allergens – in the air, mast cell IgE ab. Inflammation of airways – Bronchitis. Genetic, Environmental, Race, Age. High in industrial cities 4-19%, Increasing incidence …!

Asthma Mechanism:
• Allergy • Inflammation Of Bronchi • Obstruction • Mucous Plugs

Epidemiology/pathology

Normal

Asthma

Barnes PJ

Lung in Asthma with Mucous plugs

Mucous plug in asthma:

Asthma Microscopic Pathology
Obstructed Inflammed Bronchi

Asthma - Bronchial morphology
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inflammation Eosinophils Gland hyperplasia Mucous plug in lumen Hypertrophy of muscle layer

Summary:
Immune system – Humoral, Cell Med, Non-sp  Antigen & Antibody  Primary & Secondary Response (slow/rapid) Hypersensitivity/Autoimm
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Disease
Chronic Bronchitis Bronchiectasi s Asthma

Site
Bronchus

Pathologic Finding
Mucous gland hyperplasia, Hypersecretion

Etiology Tobacco Air pollutants Persistent infection

Signs/
symptoms

Cough sputum Cough, purulent Sputum, fever Episodic wheezing , Cough, dyspnoe a

Bronchus

Dilatation of bronchi and bronchioles Smooth muscle hyperplasia, excess mucus inflammation

Bronchus

immunologi c or undefined cause

Emphysema

Acinus

Dilatation of acinus

Tobacco Air pollutants

Cough, dyspnoe a

The only place where success comes before work is in a dictionary…!
Vidal Sassoon


				
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