• Emphysema

    by  • 23/05/2013 • Respiratory

    Emphysema (‘pink puffer’):

    1. p/c: thin, barrel chested, no cough, pursed lip breathing, accessory muscle use, tripod sitting position, hyper-resonant chest, wheeze, wasted and cachexic.
    2. Pathology:
      1. o Alveolar septal damage (distal to terminal bronchiole) leaving empty spaces in lung = reduced vascular bed/alveolar contact = minor hypoxia (still perfusing=pink)
      2. o Elastic damage of lungs = reduced radial traction on bronchioles = collapsing bronchioles on expiration (due to positive pleural pressure) = pursed lips (=gradual release of pressure to increase intra-bronchial pressure and hold airways open.
      3. o Compensation for reduced perfusion by hyperventilation (=makes pt cachexic).

     

    Centri-acinar/lobular emphysema:

    1. o Distension and damage of lung tissue is concentrated around the respiratory bronchioles – alveoli are unchanged.
    2. o Common. Cause = smoking! Most damage in upper lobes of lung.

     

    Pan-acinar emphysema:

    1. o Distension and destruction appear to involve the whole acinus (from respiratory bronchioles to alveoli).
    2. o In extreme cases, lung becomes mass of bullae.
    3. o Severe airflow limitation
    4. o Ventilation perfusion mismatch
    5. Occurs partly because of damage and mucus plugging of smaller airways
    6. Rapid expiratory closure of smaller airways due to lack of elastic recoil
    7. Fall in pO2
    8. Increase in work of respiration
    9. o Cause = alpha-1-antitrypsin deficiency. Most damage in lower lobes and anterior margins.

     

    Irregular emphysema:

    1. o Scarring and damage affecting the lung parenchyma patchily 
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