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1. Code: SOM1-1 Issue 1/ 2018 Lecture (5) Emphysema Prepared by: Dr.Randa Said Supervised by: A. Prof Dr. Rasha Khairy

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5. Code of conduct Issue 1/ 2018

6. Issue 1/ 2018 By the end of this lecture the student will be able to: Define emphysema . Explain the pathogenesis of emphysema. Describe the pathological features of emphysema. Discuss the types of emphysema. Determine the effects & complications of emphysema. Define chronic bronchitis, explain its aetiology and describe the pathologic features

7. Issue 1/ 2018 CONTENT Definition of emphysema. Pathogenesis and pathologic features of emphysema. Classification of emphysema. Complications of emphysema. Definition, etiology and pathologic features of chronic bronchitis

8. Obstructive airway disease: characterized by an increase in resistance to air flow due to partial or complete obstruction at any level (EXCLUDING tumors and foreign body). Restrictive lung disease: characterized by reduced lung expansion: Chest wall disorders in presence of normal lungs; (obesity, diseases of pleura, neuromuscular disorders) Chronic interstitial lung disease; (pneumoconiosis and interstitial fibrosis) Bronchiectasis Emphysema Chronic bronchitis Bronchial asthma

9. Emphysema 1.Centriacinar 2.Panacinar 3.Paraseptal Definition: Permanent overdistension of air spaces distal to the terminal bronchioles with destruction of their walls. Classified according to its anatomic distrubution within the lobule:

10. Types Of Emphysema Centriacinar (bronchiolar): Distension of the central part of the acinus formed by the respiratory bronchioles while distal alveoli are spared. Lesions are more common and severe in the upper lobes. Common in cigarette smokers and coal workers’ pneumoconiosis . Panacinar ( panlobular ): Distension of the air spaces distal to the terminal bronchiole More common in the lower lung zones . Occurs in alpha 1 antitrypsin deficiency. Paraseptal (Distal acinar ): Proximal part of acinus is normal. Distal part of acinus is affected. Usully subpleural and in the upper half of lung and sometimes forms multiple adjacent dilated air spaces forming cystic structures called bullae. May cause spontaneous pneumothorax in young adults.

11. Emphysema

12. Emphysema Pathogenesis 1.Excessive protease ( elastase ) activity: Excess protease activity  destruction of the elastic tissue of the air spaces diminished elastic recoil progressive distension of the air spaces. Main source of protease are the neutrophils and macrophages. Excess protease activity occurs in : Congenital deficiency of protease inhibitor (alpha 1 antitrypsin deficiency) Cigarette smoking 2. Cigarette smoking Greater number of neutrophils and macrophages in their bronchi Smoking inhibits the release of alpha 1 antitripysin Smoking leads to chronic bronchitis 3. Chronic bronchitis: Swelling of the inflammed bronchial mucosapartial bronchial obstruction Exaggerated obstruction during expiration trapping of much air.

13. Emphysema

14. Emphysema MICROSCOPIC: Marked enlargement and dilatation of the air spaces with thinning and destruction of the alveolar wall. GROSS: Lungs are pale, dry and large. Surface shows indentations at sites of ribs. Bullae may develop.

15. Emphysema Conditions related to emphysema : 1-Atrophic emphysema (senile) Occurs in old age due to senile atrophy of the alveolar walls and decrease in the elastic tissue . 2-Compensatory emphysema Compensatory dilatation of alveoli in near-by areas of loss of lung substance, e.g : next to fibrosis 3-Interstitial emphysema: Accumulation of air in the interstitial tissues of the lung from ruptured alveoli. It may be due severe coughing or trauma. Commonly recovery occurs due to absorption of air.

16. Emphysema Clinical picture: Dyspnea , which becomes progressive If associated with chronic bronchitis there is coughing and wheezing Barrel chest (increased A-P diameter) due to lung overinflation Finger clubbing due to hypoxia Complications: R ight sided heart failure ( cor-pulmonale ) and pulmonary hypertension R espiratory failure leads to acidosis and cyanosis R upture of widened air spaces pneumothorax

17. Chronic bronchitis Definition: Chronic bronchitis is defined clinically as persistent productive cough for at least 3 consecutive months for 2 consecutive years. Chronic bronchitis and emphysema are clinically grouped together under the name of chronic obstructive pulmonary disease (COPD). Etiology: Most important factor is smoking. Chronic upper respiratory infections as sinusitis. May follow repeated acute attacks of acute bronchitis. Causative organisms: Pneumococci, H.influenzae , others

18. Chronic bronchitis MICROSCOPIC: Mucosal hyperplasia of the bronchi and squamous metaplasia Hyperplasia of the submucosal glands Chronic inflammatory cells and fibrosis affecting walls

19. T ypes of emphysema Pathologic features of emphysema Causes & effects of emphysema Causes & pathologic features of chronic bronchitis 17/12/2020

20. Put true or false In emphysema, there is permanent dilatation of the proximal air passage. Interstitial emphysema is accumulation of air in the interstitial tissues of the lung from ruptured alveoli Test your knowledge

21. Put true or false In emphysema, there is permanent dilatation of the proximal air passage ( False ). Interstitial emphysema is accumulation of air in the interstitial tissues of the lung from ruptured alveoli ( true ) Test your knowledge

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