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Upper resp tract infections Epiglottitis Wegeners granulomatosis Allergic reactions Paranasal & aural polyps Nasal & aural papillomas Laryngeal papillomatosis Squamous cell carcinomas Lethal midline granuloma Otitis media Otosclerosis
. Pneumonia
. Emphysema . COPD
. Pulmonary embolism
. Diffuse alveolar damage . Hyaline mambrane disease
. Atelectasis
. Pneumothorax . Pleural effusion
. Pneumoconiosis
. Sarcoidosis . Bronchogenic carcinoma . Mesothelioma
I.
Viral nasal cavity & paranasal sinuses = common cold - mucosa edematous - infilt acute/ chronic inflamatory cells (2nd inf bacterial : increase in neutrophils) - excess fluid production
Candidosis Epiglotitis
Acute Epiglotitis
Wegeners granulomatosis
- unknown cause - involves : URT, lungs, kidneys - characterized : vasculitis, granulomatous inflamation rhinorrhea, sinusitis, & malaise histol : necrotizing granulomas, multinucleated giant cells, chronic vasculitis.
ALLERGIC REACTIONS
- edema, eosinophilic infiltration - rhinorrhea and stuffy nose - larynx may be narrowed
Ex : infection or allergy
Nasal Polyps
TUMORS
A. BENIGN
Anaplastic NPC
- squamous origin - China >>, EBV related - often become evident owing to metastases Obstructions late in the course of the disease
Transtional Cell Ca Lymphoepithelioma : poorly diff. SCC from URT area which
has metastasized to a regional lymph nodes LARYNGEAL SCC - in smokers hoarseness -on true vocalcords & anterior commissure
2. Lethal Midline Granuloma ( Polymorphic reticulosis ) is characterized by respiratory tract ulcerating & necrotizing lesions 3. Extramedullary plasmacytomas
URT : the nasal cavity, nasopharynx, paranasal sinuses histol : plasma cell proliferation
eventually develop multiple myeloma
II. EAR
INFLAMATION
Otosclerosis
is a process of bone resorption & replacement by fibrous tissue, which is later replace by immature bone - autosomal dominant abnormality - causes hearing loss in the young & middle aged
TUMORS
A. BENIGN * Squamous papilloma * Schwannoma ( n. VIII = acoustic neurinoma )
- hearing loss, vertigo & ringing in the ears - Tx : surgical removal
B. MALIGNANT
SCC
- of the external ear related sun exposure - of the auditory canal are agressive
* Pulmonary sequestrations
a portion of lung receives a blood supply directly from the aorta & has no connection to the rest of the lung
1-antitrypsin deficiency
- is a biochemical deficiency of a protease inhibitor - The phenotype PiZZ has markedly seru level of hepatic origin enzyme, may result in panacinar emphysema
The Lung
are ingeniously constructed to carry out their cardinal function, the exchange of gases between inspired air and the blood Alveolar wall : - capillary endothelium - basement membrane (yellow) - alveolar epithelium : -Type I pneumocyte - Type II pneumocyte - alveolar macrophages - pores of Kohn
INFLAMATORY CONDITIONS
BRONCHITIS a. Acute bronchitis
- usually a viral URT infection, - bacterial superinfection may be present
b. Chronic bronchitis
- chronic cough productive sputum due to excessive mucus production - histol : hyperplasia of the mucous glangs, mucous cells - is due to chronic irritation or infection, especially from smoking
BRONCHIAL ASTHMA
The patient has repeated episodes of bronchospasm with expiratory wheezing & cough. Alergic (extrinsic) : - 50% of cases of asthma - begins in young adult, history of allergic rhinitis, elevated Ig E levels -antigens presipitating : pollens, animal dander, molds
b. Nonallergic (intrinsic) - no identifiable offending antigen, Ig E levels are normal - starts in later adulthood c. Occupational asthma ( dusts, gases, fumes) d. Exercise, Viral Infection, aspirin ingestion may induce asthma attacks
ASTHMA ALLERGIC
BRONCHIECTASIS
is an irreversible dilatation of bronchi & bronchioles with an accompaniying infection marked by sputum production. Ex : damaging acute infection bronchial obstruction ( foreign object, tumor, mucus ) congenital/ hereditary conditions : congenital bronchiectasis cystic fibrosis, immune deficiency immotile cilia
Kartagener syndrome
Bronchiectasis
Sinusitis
Situs inversus There is a defect in ciliary motility, associated with structural abnormalities of cilia.
Males : tend to be infertile, owing to ineffective
EMPHYSEMA
EMPHYSEMA
BRONCHIOLITIS OBLITERANS-ORGANIZING PNEUMONIA ( BOOP) -occurs as a result of several insult such as : viral and bacterial infections
Pulmonary embolism, hemorrhage & infarction Occlusions of the pulmonary arteries by blood clot are almost always embolic in origin. Large vessel in situ thromboses are rare, develop only in the presence of : * pulmonary hypertension * pulmonary atherosclerosis * heart failure Pulmonary emboli thrombi in the deep veins of the leg ( >95%) Total occlusion in the great vessels fatal sudden death
ARDS =
Terjadi akibat cedera akut pada alveolus. : cedera sel transudasi cairan kedlm alveolus&edema paru, fibrin menutupi epitel yg rusak.
NRDS =
Terjadi akibat kurangnya pembentukan surfaktan paru oleh pneumosit tipe II, paru gagal mengembang, alveolus kolaps, cedera epitel fibrin
ARDS
: a syndrome caused by diffuse alveolar capillary damage. Characterized clinically : The rapid onset of severe life-threatening respiratory insufficiency Cyanosis Severe arterial hypoxemia : * that is refractory to oxygen therapy * that may progress to extrapulmonary multisystem organ failure.
ARDS
Morphology ARDS
Acute edematous stage :
* lungs are heavy, firm, red,and boggy * congestion, interstitial & intra-alveolar edema, and inflamation * fibrin deposition = alveolar hyaline membranes
ARDS