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Flashcards in pulmonary vascular disease and pleural disease Deck (19)
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what is pulmonary circulation?

- there is a dual supply through pulmonary arteries and bronchial arteries
- low pressure system so has thin walls and a low incidence of arteriosclerosis
- pulmonary artery receives entire cardiac output so it acts as a filter


what is pulmonary oedema?

- accumulation of fluid in the lungs - interstitium and alveolar spaces
- causes a restrictive pattern of disease


what are the causes of pulmonary oedema?

1. haemodynamic (increased hydrostatic pressure
2. due to cellular injury eg alveolar lining cells and alveolar endothelium, localised = pneumoina, generalised = adult respiratory distress syndrome


what is ARDS?

- diffuse alveolar damage syndrome
- also called shocked lung
- causes include sepsis, diffuse infection (virus, mycoplasma), severe trauma, oxygen


what is the pathogenesis of ARDS?

- injury (eg bacterial endotoxin)
- infiltration of inflammatory cells
- cytokines
- oxygen free radicals
- injury to cell membranes


what is the pathology of ARDS?

- fibrous exudate lining alveolar walls (hyaline membranes)
- cellular regeneration
- inflammation


what is the outcome of ARDS?

- death
- resolution
- fibrosis (chronic restrictive lung disease)


what is neonatal RDS?

- deficient in surfactant (type 2 alveolar lining cells )
- increased effort in expanding lung = physical damage to cells


what is an embolus?

- a detached intravascular mass carried by the blood
- most emobli are thrombi (form within the blood stream), others include gas, fat, foreign bodies and tumour clumps


what are the risk factors for PE/DVT?

- factors in vessel wall (eg endothelial hypoxia)
- abnormal blood flow (venous stasis)
- hypercoaguable blood (cancer patients, post-MI)


why can a clinically silent small emboli be dangerous?

- it can be recurrent and lead to pulmonary hypertension


what are the mechanism of pulmonary hypertension?

- hypoxia (vascular constriction)
- increased flow through pulmonary circulation (congenital heart disease)
- blockage (PE) or loss (emphysema) of pulmonary vascular bed
- back pressure from left sided heart failure


what is the morphology (what does it look like) of pulmonary hypertension?

- medial hypertrophy of arteries
- intimal thickening (fibrosis)
- atheroma
- right ventricular hypertrophy
- extreme cases(congenital heart disease, primary pulmonary hypertension) - plexogenic change/necrosis


what is cor pulmonale?

- (heart disease because of lung disease)
- pulmonary hypertension complicating lung disease
- right ventricular hypertrophy
- right ventricular dilation
- right heart failure (swollen legs, congested liver etc)


what is the pleura?

- a mesothelial surface lining the lungs and mediastinum
- mesothelial cells designed for fluid absorption
- hallmark of disease is the effusion


what is transudate pleural effusion?

- low protein
- cardiac failure
- hypoproteinaemia
- passive process


what is exudate pleural effusion?

- high protein
- pneumonia, TB, connective tissue disease, malignancy (primary or metastatic)
- active process


what is purulent effusion?

- full of acute inflammatory cells
- known as empyema
- can be chronic


what is mesothelioma?

- asbestos related
- mixed epithelial/mesenchymal differentiation
- dismal prognosis