> For the complete documentation index, see [llms.txt](https://thisispiggy.gitbook.io/my-wiki/llms.txt). Markdown versions of documentation pages are available by appending `.md` to page URLs; this page is available as [Markdown](https://thisispiggy.gitbook.io/my-wiki/01-step-1/pulmonary/10-obstructive.md).

# 10 Obstructive

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Pulmonary/obstructive%20disease%20FEV,%20FVC,%20FEV/FVC/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/HylgFxz.jpg)

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Pulmonary/obstructive%20lung%20disease%20causes/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/JVqt3kN.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/C1O2nTE.jpg)

## Chronic Bronchitis

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Pulmonary/chronic%20bronchitis%20diagnosis%20criteria%20and%20risks/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/d3u4TL0.jpg)

* completely arbitrary clinical definition

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Pulmonary/chronic%20bronchitis%20pathogenesis,%20biopsy,%20symptoms,%20complications/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/d8SOpYe.jpg)

* a lot of mucous and glands
* normally: mucous layer 0.4 of total bronchiole wall. > 0.5 = severe bronchitis

![](https://f001.backblazeb2.com/file/wikiFiles/kZCX5Ey.jpg)

* cough from inflammation
* wheezing from obstruction
* crackles from mucous

![](https://f001.backblazeb2.com/file/wikiFiles/ckMZX0L.jpg)

* left filled with mucous
* left become hypoxemic 
* 100% O2 will not help

![](https://f001.backblazeb2.com/file/wikiFiles/ZaT7v7V.jpg)

## Emphysema

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Pulmonary/emphysema%202%20causes,%20differences,%20pathogenesis/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/QcrxG9K.jpg)

* think smoke rising up to upper lobe

![](https://f001.backblazeb2.com/file/wikiFiles/SuFVkJi.jpg)

* acinus: "berry"
* smoker: branch portion, centriacinar or centrilobular
* deficiency: everything

![](https://f001.backblazeb2.com/file/wikiFiles/c2Q9FVM.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/A5GcZcG.jpg)

* bronchus collapse during exhalation

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Pulmonary/emphysema%20biopsy,%20gross,%20xray/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/pvojSGD.jpg)

* big white space, thin septa (tissue dividing space)
* left lower: black spots, evidence of centrilobular damage

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Pulmonary/emphysema%20symptoms/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/TiORQci.jpg)

* hyperventilation: to get remaining functioning alveoli to do more work
* hyperventilating = more work = weight loss

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Pulmonary/emphysema%20lung%20and%20FRC%20volume%20graph/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/Lt7jE19.jpg)

* emphysema: blue line shift to left, less elastic recoil
* FRC shift up, higher volume at end of quiet breath, barrel chest

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Pulmonary/chronic%20bronchitis%20vs%20emphysema/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/OvQstGp.jpg)

### AAT

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Pulmonary/AAT%20inheritance,%20pathogenesis,%20symptoms,%20classic%20case,%20age%20of%20onset,%20CI/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/J2Ysqfu.jpg)

* balance elastase

![](https://f001.backblazeb2.com/file/wikiFiles/oCT546d.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/upZ6cM5.jpg)

* smoking: 60s-70s

## COPD

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Pulmonary/COPD%20is,%20causes/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/KXbhpt8.jpg)

* usually just include chronic bronchitis and emphysema; asthma has its own treatment

## Asthma

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Pulmonary/asthma%20pathogenesis,%20association/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/0mbQxqY.jpg)

* reversible: go back after acute episode
* overreact to stimulus and bronchorestrict

![](https://f001.backblazeb2.com/file/wikiFiles/C1O2nTE.jpg)

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Pulmonary/asthma%20triggers,%20aspirin%20trigger%20pathogenesis%20and%20treatment/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/aZOmIPA.jpg)

* cold

![](https://f001.backblazeb2.com/file/wikiFiles/lwsadKC.jpg)

* triggered by taking aspirin
* triad: asthma, rhinosinusitis, nasal polyposis

![](https://i.imgur.com/hQDIxnA.jpg)

* Swollen ASA umpire: aspirin “pseudo-allergy” due to excess leukotriene synthesis (use clopidogrel instead)

![](https://i.imgur.com/6PDfuOV.jpg)

* ASA umpire grabbing Coach Cox: inhibition of COX shifts the AA metabolism to the LOX leukotriene pathway (exaggerated in aspirin-induced asthma)

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Pulmonary/asthma%20symptoms,%20inspiration,%20expiration/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/bVIqk2e.jpg)

* normal I/E: 1 to 2
* asthma: expiratory phase prolonged, longer for air to get out. 1/4 or 1/5
* reduced peak flow (image). Highest velocity of air flow
* status asthmaticus: severe, hypoxia

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Pulmonary/asthma%20diagnosis,%20sputum%20findings,%20cardiac%20findings/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/Qk2udSe.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/r8BEslv.jpg)

* in mucous plugs in sputum: epithelial cells that shed and form whirls
* eosinophils and eosinophil membrane proteins making crystals

![](https://f001.backblazeb2.com/file/wikiFiles/AgG0UGT.jpg)

* drop in systolic blood pressure with inspiration, usually by pericardial effusion and tamponade

## Bronchiectasis

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Pulmonary/bronchiectasis%20is,%20pathogenesis/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/uLjuQHF.jpg)

* chronic inflammation causing permanently dilated airways
* obstruction: small airways thickened

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Pulmonary/bronchiectasis%20gross%20and%20CT/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/Q36hDLJ.jpg)

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Pulmonary/bronchiectasis%20symptoms%20and%20complications/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/8Waemls.jpg)

* infection both cause and consequence
* rare cause of amyloidosis: anything causes chronic inflammation can lead to secondary amyloidosis

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Pulmonary/bronchiectasis%20causes/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/2ALgRGQ.jpg)

* tumor: can't clear mucous, backs up
* smoking: either direct or by infection
* CF: recurrent infection

![](https://f001.backblazeb2.com/file/wikiFiles/C1O2nTE.jpg)

### Ciliary Dyskinesia

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Pulmonary/primary%20ciliary%20dyskinesia%20cause,%20symptoms,%20classic%20case/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/OBKkeML.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/ZvqsZ1c.jpg)

* either dynein absent or abnormal

![](https://f001.backblazeb2.com/file/wikiFiles/kHmwoPY.jpg)

* chronic sinusitis: poor ciliary function
* infertility: abnormal sperm ciliary

![](https://f001.backblazeb2.com/file/wikiFiles/Y9vggW2.jpg)

![](https://f001.backblazeb2.com/file/wikiFiles/C1O2nTE.jpg)

### ABPA

[\_](https://github.com/thisispiggy/my-wiki/tree/601ff771dc2fac1318ae8b59435ac8485628fd81/01%20Step%201/Pulmonary/ABPA%20cause,%20pathogenesis,%20demographics,%20diagnosis,%20treatment/README.md)..

![](https://f001.backblazeb2.com/file/wikiFiles/R20MEIF.jpg)

* only immunocompromised (asthma, CF)
* eosinophilia: important

![](https://f001.backblazeb2.com/file/wikiFiles/CkoockT.jpg)

* important: symptoms + blood IgE and eosinophils
* steroids: treat inflammation/allergic reaction

![](https://f001.backblazeb2.com/file/wikiFiles/cuL69ah.jpg)

* plane with letters. Farmer running/migrating, sweating, inhaler in hand: ABPA (allergic bronchopulmonary aspergillosis) is a **type I HSR** that causes wheezing, fever and migratory pulmonary infiltrates. Also association with **CF** patients
* IgE on inhaler: ABPA is associated with asthma and may show increased IgE levels in the serum

![](https://f001.backblazeb2.com/file/wikiFiles/C1O2nTE.jpg)