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Centriacinar emphysema vs panacinar emphysema

Video transcript

so the two categories that we signed to emphysema the center acinar and the pan acinar they're basically referring to geography it's like saying my city's flooded and is it contained to the central streets the main street or is it everywhere so basically it's asking where is the emphysema it's a little lacking review we have pan which means everywhere and century so Center now what on earth is an Aston are and basically that's a geographical term - and this is an acid s to orient ourselves let's draw the lungs we have the trachea here and the two big bronchi so you have your logo flung here and logo flown here the bronchi are kind of like your tree trunks and as they start to branch off like this the smaller Airways here are called bronchioles and that's basically the level we're at right here here is our bronchial and the rest of this branch that I've drawn is just the rest of the airway so here we have our alveoli cluster alveoli so there are many many countless branches of Asuna in the lungs but this is what one would look like so that tells us intra acinar versus pant acinar we're talking about where in this are we so in this normal assonance that I've drawn you can see the tightly little coiled structures here in the alveoli and along the Airways - this elastic coiled shape is possible because our protein elastin elastin is cleaved by elastase which is this protein inhibitor which is good usually because we want the tissue to turn over old ones to be eaten up and this whole system is controlled by alpha 1-antitrypsin which is a compound made in the liver and it's job is to regulate the amount of elastase so by inhibiting the elastase then hitta stay elastin the antitrypsin makes her less there be more elastin so whether we're going to have sintra acinar here or pan Aston our destruction for last and really depends on pathophysiology of why's there so much elastase why is they lasting getting destroyed so first let's take a look at sintra SNR and this is what it looks like so I've drawn the same knows that we have up there but because of the lack of elastin they're fewer of the walls to begin with and in whatever walls that are left because it's so floppy that's why it looks bigger like that it just doesn't hold that nice shape so this is what we call central acinar distribution as you can geographically it's earlier it's not everywhere this intra acinar is really related to inflammation which is the first pathophysiology of emphysema now inflammation recruits and neutrophils these white blood cells that fight inflammation everywhere in the body but when they get to the lungs the neutrophils make elastase that's the whole culprit here to have too much of last days from too much inflammation and the way we get that most commonly is from smoking so even though when you see somebody smoking and the smoke rising out of there looks like just some sort of gas it's actually made of millions of tiny little particles that enter the lungs they're all fullering they're all irritating and alone as like a filter these smoke particles are big enough to get trapped pretty early on they're not small enough to get through the filter all the way to the end of the assonance so they kind of stay in this central acinar distribution which that makes sense that central snr is related to smoking and the inflammation get from that so if we look at the lungs as a whole central acinar is early on and near the larger calibre Airways like the bronchioles now the next one pain as an are some pain SNR is usually not induced by some sort of external factor this problem arises out of the body itself here we have alpha 1-antitrypsin deficiency remember we set up there this regulates the amount of elastase namely to tone it down a little bit so without it the elastase is really unchecked just goes nuts and eats up all the elastin in the tissues everywhere see this problem knows no earlier or later in the lungs because it's inherent in all the tissues of the lungs so everywhere they license getting chewed up everywhere this elastic tissue just as a side note alpha 1-antitrypsin is made in the liver and this disease when there's deficiency that means something in the DNA in the gene encoding for it there's a mistake so all the this folded protein can't leave the liver leading to liver disease when we come to the lungs we see pan acinar emphysema