Pathophysiology Emphysema

Emphysema Pathophysiology Inherited α-1 Anti-trypsin Deficiency

Tobacco smoke, Air Pollution

Inflammation of the Airway Epithelium

Inhibition of Normal Endogenous AntiProteases

Infiltration of Inflammatory Cells & Release of Cytokines (Neutrophils, Macrophages, Lymphocytes, Leukotrines, Interleukins)

Increased Protease Activity with Breakdown of Elastin in Connective Tissue of Lungs (Elastases, Cathepsins, etc.)

Irreversible Enlargement of the Air Spaces distal to the Terminal Bronchioles

Destruction of Alveolar Walls & Septa and Loss of Elastic Recoil of Bronchial Walls (EMPHYSEMA)

Loss of Fibrous & Muscle Tissue Breakdown of Alveolar Elasticity

Change in Airway Size

A Portion of the Capillary Bed of an Alveolus has been eliminated. Increased Air Volume in the Acinus

Alveoli cannot support the airways to keep them open Dyspnea on Exertion

Decreased Tactile Fremitus on Palpation

Amount of air that can be expired is diminished Lungs become less Compliant

Inability of the Alveoli to recoil normally after expanding

Crackles & Wheezing

Chest X-Ray

Bronchiolar Collapse on Expiration

Air Trapping Barrel Chest, Hyperresonance on Chest Percussion

Pulmonary Function Test Inability of the Lungs to Circulate Sufficient Air

Overdistended Lungs

Airway Calibration is Decreased

Increased Pulmonary Vascular Resistance Hyperinflation of the Alveoli

Bullae (air spaces) will be formed adjacent to the Pleura (blebs)

Increased Total Lung Capacity And Residual Volume

Ruptured Bullae and Blebs Part of Each Inspiration is Trapped

ECG Pulmonary Hypertension

Right Ventricular Hypertrophy (Cor Pulmonale)

Arterial Blood Gas Spontaneous Pneumothorax

Hypoventilation

Decreased Oxygenation

Prolonged Hypoxia

Electrocardiography Chest X-Ray

Decreased Chest Expansion

LEGEND: Black Text – usual pathway Square Dotted Line – Clinical Manifestations Gray Text – Complications Dash Dot Line with Diamond Arrow – Laboratory & Diagnostic Tests

Tachypnea

Clubbing of Fingers & Toes

Chest X-Ray