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1. OrGMU
lung disease. Acute
pneumonia. Chronic diffuse
lung disease
prof. Polyakova
V.S.

2. The general plan of the structure of
the respiratory system

3. The trachea,
Bronchi,
bronchioles:
cylindrical
ciliated
epithelium

4. The lungs (normal)

6. Aerohematic
barrier
The lumen
of the
capillary
interstitial cells
Pneumocyte
Type II
endothelium
lumen of
the
alveoli
Pneumocyte
Type I
Pneumocyte Type I
endothelium
lumen
of the
alveoli

9. 1. Airborne - with the inhaled air
2. Aspiratsional- from nose and
oropharynx
3. Hematogenous - from distant foci
of infection
4. Сontagious- from a nearby source
of infection

10.  Viruses can penetrate the respiratory
departments lung damage I
pneumocytes and alveolar wall of the
order, causing interstitial
inflammation of a characteristic with
mononuclear infiltrate, and the
cellular immune response.

11. Bacteria damaging the pulmonary
parenchyma and inducing
chemotaxis of white blood cells,
leading to exudative inflammation
with an accumulation of fluid in
the cavities of the alveoli, alveolar
ducts, bronchioles.

12. On a pathogenesis:
-prime(in the absence of pulmonary disease and
diseases of other organs, contributing to its
emergence)
- secondary (diagnosed in individuals suffering
from chronic diseases bronchopulmonary system,
as well as somatical or other extrapulmonary
infectious diseases -aspiration, hypostatic,
postoperative).
According to clinical and morphological features:
lobar pneumonia
bronchopneumonia
Acute interstitial pneumonia

14. As the prevalence of:
unilateral
bilateral
acinar
miliary
focal-drain
segmental
polysegmental
lobar
total

17. Pathogenesis of lobar pneumonia
is associated with the reaction of GNT in respiratory
departments of lungs, including the alveoli and alveolar ducts.
There are two views on the mechanism of lobar pneumonia.
1. Pneumococci get into the upper respiratory tract and cause
sensitization of the whole organism. Under the influence of the
factors permitting aspiration of the pathogen occurs in the
alveoli, it causes a reaction with the development hyperergic
lobar pneumonia.
2.The causative agent of nasopharyngeal penetrates into the
pulmonary parenchyma and organs of the reticuloendothelial
system, where immune responses occur, and then into the
bloodstream. Bacteremia and pneumococcal re-entering the
blood into the lungs lead to damage to the immune complex
microcirculatory vessels with a characteristic alveolar exudative
reaction.

19. Stage lobar pneumonia
Stage of congestion
(inflammatory edema)
Stage of red hepatization
 Stage of gray hepatization
Stage of resolution.

20. Duration - 1 day.
Share (shares) is sealed with a cut surface
flows foamy liquid.
In the alveoli - the exudate contains a large
number of microorganisms isolated alveolar
macrophages, the white blood cells.
Distribution of exudate from the alveoli of the
alveolar passages and pores Cona happening
across lobe.

21. Lobar pneumonia. Stage high tide - with a mixture
of neutrophils edema

22. The second - the fourth day of illness.
Macroscopic picture. the proportion of
light red, liver density, dry the cut, with the
imposition of fibrin.
Microscopic picture. From the picture
due to increased vascular permeability in
the alveoli - a lot of red blood cells and
fibrin strands few polimorfnoya picture of
leukocytes, macrophages.

23. Lobar pneumonia,
stage of red
hepatization

24. Lobar pneumonia, stage of red hepatization

25. Fourth - sixth day of illness.
Startled macroscopic share increased at
a rate of yellowish-gray, heavy, dense,
airless surface on the cut grain. The
pleura is thickened with overlays of fibrin.
Microscopy in the alveoli - the mass of
fibrin, a lot of neutrophils, macrophages.

26. Lobar pneumonia. Stage of gray hepatization

27. Lobar pneumonia. Fibrinous
exudate in the alveoli

28. Ninth - the eleventh day of the disease.
Macroscopic picture .Damaged share
edematous.
Microscopic picture. The destruction and
phagocytosis of fibrinous exudate, removal
of lymphatic drainage of the lung and its
separation from the sputum

29. Complications lobar pneumonia
 Pulmonary: 1) carnification; 2) the
formation of an acute abscess, gangrene of
the lungs;
3) empyema.
 Extrapulmonary: the lymphatic
dissemination, purulent mediastinitis,
pericarditis; when hematogenous -
metastaticheskie brain abscess, purulent
meningitis, severe ulcerative and polypous
ulcerative endocarditis, purulent arthritis,
and others.

31. Carnification of the lung

32. Lobar pneumonia. Organization of fibrin
and proliferation of granulation tissue in
the alveoli.

33. Абсцессы легкого
Lung abscesses

34. Bronchopneumonia

35. Focal pneumonia -
polyetiology disease with diffuse
exudative inflammation of the
lungs and bronchi Most - a
complication of trauma, surgical
interventions, serious diseases.
As an independent disease -
usually in children and old people

36. The term "Bronchopneumonia" as it
shows the connection and sequence of
two phenomena: bronchitis and
pneumonia, ie, we are talking about
1.Aerogenic descending
bronchopulmonary process, but it is not
excluded:
2.Gematotogenic damage bronchial and
lung parenchyma
3.Limfogenic defeat - consecutive chain:
bronhitis- peribronhitis- pneumonia-

37. Etiological factors
(bacteria, viruses, fungi, protozoa)
Violation of the drainage function of bronchi
Congestion in the bronchi and the emergence of a
secret conditions for a downward infection
The appearance of exudate in the alveoli
"BRONCHOGENIC" MECHANISM
Bronchopneumonia

38. Macroscopic picture
 1. Dense airless pockets of various sizes
around the bronchial tubes;
 2. Bronchi filled with liquid contents muddy
gray-red
 3 Most low back and struck the rear
segments (2,6,8,9,10)
 4. The dimensions of the centers may be -
miliary, acinar, lobular, etc.

39. Macroscopic picture
 5. Easy sealed, the pieces sink in
water
 6. Weight increased lung
 7. Lymph nodes (radical,
bifurcation and paratracheal)
increased
 8.Giperemiya mucosa of the
trachea and bronchi

40. Bronchopneumonia

41. lobular bronchopneumonia

42. Focal
confluent
broncho-
pneumonia

43. Features bronchopneumonia
1) the amount of tricks lesions
typically ranges slices (hence the
synonym - lobular pneumonia);
2) inflammatory process in the lung
is closely linked to the defeat of the
bronchial tree, or even a direct
continuation of such lesions (hence
the term pneumonia);

44. Features bronchopneumonia
 3) The exudate is diverse and often
consists of serous fluid doped
leukocytes and alveolar epithelial
cells.
 4) develops most often in the
posterior-lower parts of the lungs;
 5) In most cases, both lungs are
affected.
 6) the affected part feels rather
compact, hepatization this does not
happen.

45. Microscopic picture
 It depends on the type of pathogen
 The total for all of bronchopneumonia:
 1. Formation of the hearth around the small
bronchi, bronchioles with symptoms of bronchitis
and bronchiolitis (serous, mucous, purulent,
mixed)
 2. Spread of inflammation in the respiratory
bronchioles and alveoli.
 3. Inflammatory infiltration of the walls of the
bronchioles, alveoli
 4. On the periphery of the centers - Reg lung
tissue with signs of perifocal emphysema

46. Hearth of bronchopneumonia

47. Lung abscess
Gangrene of lungs
Carnification
Pyopericarditis

48. Pneumococcal pneumonia
The formation of lesions
associated with bronchiolitis,
containing fibrinous exudate.
On the periphery of foci
expressed edema, which show a
large number of pneumococci.
Abscess is not typical

49. Staphylococcal pneumonia
 1. Development after pharyngitis, viral
infection (usually influenza).
 2. Has the typical morphology with
hemorrhagic pneumonia and bronchitis
destructive.
 3. The tendency to suppuration and
necrosis of the alveolar septa.
 4. Development of acute abscesses,
purulent pleurisy, pneumatocele, cysts,
 5. The outcome of the disease - fibrosis

52. Streptococcal pneumonia
 The defeat of the lower lobes.
 Microscopically detected foci of
bronchopneumonia with serous
exudate and leukocyte pronounced
interstitial component.
 The presence of necrotic tissue on the
periphery with streptococci.
 The development of acute abscess,
bronchiectasis, pleurisy.

53. Pneumonia caused by
Pseudomonas aeruginosa
There pneumonia with abscess
formation and pleurisy.
Proceeds from severe
coagulation necrosis and
hemorrhagic component.
The mortality rate is about 50%.

55. Pneumonia caused by E. coli
 The pathogen enters the lungs by
hematogenous infections of the
urinary tract, the gastrointestinal
tract after surgery.
Pneumonia often sided with
hemorrhagic exudate.
Necrosis, abscess formation.

56. . Pneumonia caused by fungi of
the genus Candida
Pockets of pneumonia in various
sizes with accumulations of
polymorphonuclear leukocytes
and eosinophils.
The formation of cavities, where
you can find the threads of the
fungus.
There interstitial inflammation with
subsequent fibrosis.

57. Pneumonia with candidiasis

58. The mycelium of Aspergillus pneumonia in the

59. Acute interstitial
pneumonia

60. Etiology
1. Viruses
2.Mycoplasma
3.Rickettsia
4.Chlamydia
5.Pneumocystis

61. Morphological manifestations
 1. Damage and regeneration of the alveolar
epithelium,
 2. Congestion alveolar capillaries,
 3. Inflammatory infiltration of alveolar walls
 4. accumulation of proteinaceous fluid in
alveolar lumen is often the formation of
hyaline membranes, often mixed with
polimorfono leucocytes and macrophages,
sometimes with characteristic inclusions.
 5. In the end often develops interstitial
fibrosis.

62. Feature viral interstitial pneumonia
 Prevalence of lymphohistiocytic
elements in inflammatory interstitial
infiltrate;
 Characteristic intracellular inclusions
(adenovirus, cytomegalovirus),
multinucleated cells (measles virus);
 Reliable detection of antibodies to the
antigens of viruses when
immunolyuminestsentnom study.

63. Influenza pneumonia. Many desquamated cells in the
alveoli, swelling interalveolyar partitions

64. CMV pneumonia. In the cavity of the alveoli
of the red blood cells and the cells of the
"owl eyes".

65. Mycoplasma pneumonia
 Sided picture of acute interstitial
pneumonia and bronchiolitis
characteristic mononuclear infiltrate;
 When Schick reaction, coloring
Romanovsky-Giemsa in macrophages
visible PAS-positive inclusions
(indirect sign of the presence of
mycoplasma).
 Immunohistochemical detection of
antibodies to the antigens of
Mycoplasma

66. Mycoplasma pneumonia

67. Pneumocystis pneumonia
 happens in patients with
immunosuppression (HIV infection - in
75% of cases);
 picture of diffuse bilateral process with
severe respiratory failure;
 infiltration of the alveolar septa, in the
lumen of alveolar foam Schick-positive
material strands unpainted cysts.
Specific stain Grocott.

68. Pneumocystis pneumonia. The
cavities of the alveoli frothy mass
and giant multinucleated cells.

69. Pneumocystis pneumonia. The cavities of the
alveoli frothy masses

70. Fibrosing alveolitis: sclerosis and lymphohistiocytic
infiltration of alveolar septa

71. «Honeycombed lung»

72. Chronic diffuse lung
disease

73. Chronic diffuse pulmonary
disease
 Chronic nonspecific pulmonary disease
- a group of lung diseases of varying
etiology, pathogenesis and morphology
characterized by the development of
chronic cough with sputum and
paroxysmal or chronic respiratory failure
who are not associated with specific
infectious diseases, especially
tuberculosis of the lungs.

74. Chronic diffuse pulmonary
disease in accordance with the
functional and morphological
features of lesions conducting air
or respiratory portions of the
lungs are divided into 2 groups:
1.Obstruktiv 2.Restriktiv

75. Chronic obstructive pulmonary
disease
-diseases, characterized by
increased resistance to air flow
due to obstruction of any level
(from the trachea to the
respiratory bronchioles). The
main reason obstruktsii-
violation of the drainage function
of bronchi.

76. Restrictive chronic (interstitial)
lung disease
 - which is a decrease of the lung
parenchyma with a decrease in lung
capacity. Underlying: inflammation
and fibrosis respiratory interstitial →
interstitial fibrosis and block blood
barrier with clinical symptoms of
progressive respiratory failure

77. Chronic obstructive
pulmonary disease
(COPD)

78. CLASSIFICATION COPD
 1. Chronic obstructive bronchitis
 2. Bronchoectatic disease
 3. Chronic obstructive pulmonary
emphysema

79. Chronic obstructive bronchitis
– a disease characterized by
hyperplasia and excessive mucus
production of bronchial glands,
leading to the emergence of a
productive cough for at least 3
months per year for 2 years.

80. Prolonged exposure to tobacco smoke,
dust and occupational factors
Violation of the drainage function of bronchi,
loss of cilia on the surface of the bronchi
Stagnation of mucus in the bronchi and the emergence
of condition for growth and influence the microflora
Single and squamous
Metaplasia multi-row
respiratory epithelium
Pathogenesis
Glands →acid instead of neutral MPS → thick mucus, cilia walled
The destruction of the
connective tissue and
smooth elements of all
layers bronchial wall

81. Viscous "plug" the gaps in the bronchi
mucus, playing the role of the nipple
hyperextension
air
alveoli →
development
obstructive
emphysema
Pathogenesis
When calming inflammation around the bronchi
→ pulmonary fibrosis with the deformation of the wall
→ cylindrical bronchiectasis
Uneven
tensile wall
bronchus →
education
saccate
bronchiectasis

82. Cast bronchi, select when you cough
in patients with chronic bronchitis

83. Macroscopic picture
 Due to peribronchial fibrosis bronchial
tubes in the lung sections do not collapse,
they have the form of refined writing goose
feathers.
 In large areas of squamous metaplasia of
the bronchial epithelium presented a milky
white plaques on the mucous membrane -
leukoplakia.
 In the long chronic bronchitis can occur
saccular and cylindrical bronchiectasis -
expansion of the bronchi.

84. Macropreparations, a fragment of light.
Thickening of the walls of the bronchial
tubes, protruding above the surface of
the cut

85. Microscopic picture
 Increasing the number of goblet cells in the
respiratory epithelium.
 Turning multi-row respiratory epithelium in
different areas in the single-row or multi-layer
flat .
 The walls of the bronchi - lymphocytic
infiltration with a mixture of neutrophils, such as
infiltration and fibrosis - around the bronchial
tubes.
 Calcification of cartilage.

86. Goblet cell hyperplasia of
bronchial epithelium

87. Squamous metaplasia of the bronchial
epithelium, moderately severe lymphoid
infiltration of the lamina propria.

88. Chronic bronchitis, lymphocytic
infiltration in bronchial mucosa

89. Dysplasia II degree of bronchial
epithelium.

90. III degree of dysplasia and the site of
hyperplasia of goblet cells

91. Hypertrophy and hyperplasia of submucosal
glands

92. Complications of chronic
obstructive pulmonary disease
Bronchopneumonia
 The formation of foci of
atelectasis
 Obstructive emphysema
 Fibrosis

93. Bronchoectatic
disease

94. A collective definition
Bronchiectasis - (purchased, rarely
congenital) persistent enlargement of
the bronchi with the change of the
anatomical structure of the bronchial
wall by the degradation and / or
violation of neuromuscular tone of the
walls due to inflammation,
degeneration, multiple sclerosis, and
hypoplasia of the structural elements of
the bronchi.

95. Bronchoectatic disease -
acquired disease characterized by
chronic suppurative processes in
the wall of irreversible changes
(expansion and deformation) and
functionally defective bronchi,
predominantly in the lower lung

96. Macroscopic picture
Macroscopically release:
 Cylindrical (diffuse)
Saccular (limited)
Varices (varicose veins look
like) on the background of
chronic bronchitis altered wall.

97. Bronchiectasis have
the form of extensions
to the muco-purulent
contents.

98. Bronchiectasis

99. Macropreparations. A fragment of light: a thick
purulent secretion in the lumen of bronchiectasis

100. Microscopic picture
 Bronchiectasis, lysis of cartilage replacement
bronchial wall with granulation tissue.
 In the cavity of bronchiectasis show purulent
exudate containing microbial body and
desquamated epithelium
 Presented these bare surface epithelium basal
cells, foci of squamous metaplasia and polyposis.
 Hyalinized basement membrane has a corrugated
appearance.
 The walls of the bronchi - lymphocytic infiltration
with a mixture of neutrophils
 Infiltration and fibrosis - around bronchi
 Calcified cartilage

101. «The drum your fingers»

102. Hyperplasia of the wall of the pulmonary artery branches in
secondary pulmonary hypertension

103. Chronic
pulmonary
heart (rear
view):
increased size
of the heart
due to
thickening of
the walls of
both the left
and right
ventricles
greatly.

104. Complications of
bronchiectasis
1)amyloidosis
2)bronchiectasis abscess
3)pulmonary hemorrhage of the erosion of
blood vessels
4)empyema
5)pneumonia

105. Chronic obstructive
pulmonary
emphysema

106. Chronic obstructive pulmonary
emphysema-
disease with the
development of chronic
airway obstruction due to
chronic bronchitis and / or
emphysema

107. Pulmonary emphysema - a
syndrome associated with
the expansion rack
pneumatic spaces distal to
terminal bronchioles, and,
as a rule, in violation of the
integrity of the alveolar
septa

108. Выделяют 4 основных типов
эмфиземы, имеющих 9 синонимов:
 центролобулярная (
центроацинарная,
проксимальноацинарная)
 панлобулярная (панацинарная,
генерализованная)
 локализованная- локальная
(буллезная, дистальноацинарная,
парасептальная)
 перифокальная ( иррегулярная)

109. Центрилобулярная
эмфизема — поражение
центральной части ацинусов.
Преобладает расширение
респираторных бронхиол и
альвеолярных ходов,
периферические отделы
долек относительно
сохранны.

110. Panlobulyarnaya emphysema -
are involved in both central and
peripheral parts of the acini

112. Bullous
emphysema

113. bullous
emphysema

114. Macroscopic picture
Light increased in size, cover their
edges anterior mediastinum, swollen,
pale, soft, do not collapse, cut with a
crunch on the surface can be large
and small bubbles - bulls
Microscopic picture
thinning of interalveolyar partitions

115. pulmonary emphysema

116. Complication
Spontaneous pneumothorax
due to rupture of bullae
emphysema