Lecture 6 Lungs

LUNG
Dr. Aroosha
Introduction
◦ The major function of the lung is to replenish oxygen and excrete carbon dioxide from blood.
◦ Developmentally, the respiratory system is an outgrowth from the ventral wall of the foregut.
◦ The midline trachea develops two lateral out-pocketings, the lung buds.
◦ The right lung bud eventually divides into three main bronchi, and the left into two main bronchi, thus
giving rise to three lobes on the right and two on the left.
◦ The main bronchi branch dichotomously, giving rise to progressively smaller airways, termed
bronchioles, which are distinguished from bronchi by the lack of cartilage and submucosal glands within
their walls. Additional branching of bronchioles leads to terminal bronchioles; the part of the lung distal
to the terminal bronchiole is called an acinus. Pulmonary acini are composed of respiratory bronchioles
(emanating from the terminal bronchiole) that proceed into alveolar ducts, which immediately branch
into alveolar sacs, the blind ends of the respiratory passages, whose walls are formed entirely of alveoli,
the ultimate site of gas exchange
Continued…
◦ There are multiple primary lung diseases that can broadly be divided into those primarily affecting
◦ Airway
◦ Interstitium
◦ Pulmonary vascular system
◦ In reality, disease in one compartment often causes secondary alterations of morphology and function in
other areas.
ATELECTASIS
(COLLAPSE)
Atelectasis
◦ Atelectasis, also known as collapse, is loss of lung volume caused by inadequate expansion of air spaces.
◦ It results in shunting of inadequately oxygenated blood from pulmonary arteries into veins, thus giving
rise to a ventilation perfusion imbalance and hypoxia.
◦ On the basis of the underlying mechanism or the distribution of alveolar collapse, atelectasis is classified
into three forms
◦ Resorption atelectasis
◦ Compression atelectasis
◦ Contraction atelectasis
Resorption atelectasis
◦ Resorption atelectasis occurs when an obstruction prevents air from reaching distal airways. The air
already present gradually becomes absorbed, and alveolar collapse follows. Depending on the level of
airway obstruction, an entire lung, a complete lobe, or one or more segments may be involved
Compression atelectasis
◦ Compression atelectasis (sometimes called passive or relaxation atelectasis) is usually associated with
accumulation of fluid, blood, or air within the pleural cavity, which mechanically collapses the adjacent
lung. This is a frequent occurrence with pleural effusion, caused most commonly by congestive heart
failure (CHF)
Contraction atelectasis
◦ Contraction atelectasis Contraction atelectasis occurs when either local or generalized fibrotic changes in
the lung occur.
◦ Atelectasis (except when caused by contraction) is potentially reversible and should be treated promptly
to prevent hypoxemia.
ACUTE LUNG
INJURY
Acute lung injury
◦ The term acute lung injury encompasses a spectrum of bilateral pulmonary damage (endothelial and
epithelial), which can be initiated by numerous conditions.
◦ Clinically, acute lung injury manifests as (1) acute onset of dyspnea, (2) decreased arterial oxygen
pressure (hypoxemia), and (3) development of bilateral pulmonary infiltrates on the chest radiograph, all
in the absence of clinical evidence of primary left-sided heart failure.
◦ Since the pulmonary infiltrates in acute lung injury are usually caused by damage to the alveolar
capillary membrane, rather than by left-sided heart failure such accumulations constitute an example of
non-cardiogenic pulmonary edema. Acute lung injury can progress to the more severe acute respiratory
distress syndrome.
Acute Respiratory Distress Syndrome
◦ Acute respiratory distress syndrome (ARDS) is a clinical syndrome caused by diffuse alveolar capillary
and epithelial damage.
◦ The usual course is characterized by rapid onset of life-threatening respiratory insufficiency, cyanosis,
and severe arterial hypoxemia that may progress to multi organ failure.
◦ The histologic manifestation of ARDS in the lungs is known as diffuse alveolar damage (DAD).
◦ It should be recalled that respiratory distress syndrome of the newborn is pathogenetically distinct; it is
caused by a primary deficiency of surfactant.
◦ It should be recalled that respiratory distress syndrome of the newborn is pathogenetically distinct; it is
caused by a primary deficiency of surfactant.
Continued…
◦ Clinical Features:
◦ Approximately 85% of patients develop the clinical syndrome of acute lung injury or ARDS within 72
hours of the initiating insult.
◦ . Predictors of poor prognosis include advanced age, underlying bacteremia (sepsis), and the
development of multisystem (especially cardiac, renal, or hepatic) failure.
◦ Should the patient survive the acute stage, diffuse interstitial fibrosis may occur, with continued
compromise of respiratory function.
OBSTRUCTIVE VS.
RESTRICTIVE
DISEASES
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