Respiratory Disease
This is an essay, evaluating the importance of histology, cytology and immunochemistry in the diagnosis and treatment of non-malignant diseases of the respiratory tract.
Our human body is composed of ten functioning systems, all of which are working interdependently with the other systems in order for us to survive with the changes within our body and adapt from pressures from the environment. One of which is our respiratory system, also known as, respiratory tract. This system is one of the vital forces essential for living, as the old saying goes, we breathe to stay alive. The tract main purpose is to serve as a piping system where air passes towards that grape-like structure inside our lungs where
Gas-exchange happens (, 2000). To better understand the works of the respiratory tract, it is essential to have a brief background of the respiratory tract’s physiology; after all, in order to understand the body as a whole, it is necessary to have a rich perspective at the tissue-level organization. Respiratory tract has two main parts: the upper respiratory tract (URT) and lower respiratory tract (LRT) (, 2000).
The upper respiratory tract starts as the air enters our nasal cavity by process of inhalation, to the pharynx (compose of nasopharynx, oropharynx and laryngopharynx), larynx (voice box) down to the trachea (windpipe). While the lower respiratory tract starts as the air enters the thoracic cavity (lungs), to the bronchi (primary, secondary and terminal), bronchioles and to the alveoli to the alveolar ducts where gas-exchange happens as stated earlier (, 2000). This organ comprises our respiratory tract, each of which has a special function aided with special groups of cells for them to work well. In order to decipher the importance of these organs in the diagnosis and management of non-malignant diseases of the respiratory tract, it is important to know what makes composes these organs, namely their histology and cytology, and how these properties do contributes to each other.
The respiratory system has three main functions: respiration, gas-exchange and acid-base balance (, 2004). In order for the respiratory tract to perform these functions, our respiratory organs are equipped with specialized cells with specialized properties in order to work effectively alongside with the demands of our body. Most of which can only be found in our respiratory system. Examples are stratified squamous cell, pseuostratified ciliated columnar, goblet cells, and type II granular pneumocyte. Nasal cavity alone is lined with stratified squamous cell, a type of cell which is the usual outer covering of other organs, its main function is to protect. It also has pseudostratified ciliated columnar cells, the cilia (meaning: hair-like) acts as an air filter that traps bacteria and foreign objects that could obstruct the airway and removes them. Pseudo-stratified ciliated columnar cells also contain ‘goblet cells’ which secretes mucus when exposed to irritation, an allergen or pollution. Our nasal cavity also has folds by bony projections called conchae which condition the air, making it warmer and moist to be more suited with our internal environment. The lungs which is the main organ of respiration is made of type II granular pneumocyte, roughly a cuboidal type of cell, which is responsible for the production and secretion of surfactant, a product that resist fiction within the lung, thus, preventing lung/alveolar collapse and facilitates a better air passage. Lastly, the alveoli, the site of gas-exchange between carbon dioxide and oxygen, it is made of exceptionally thin squamous epithelial cells to facilitate easier gas exchange. With these examples, we can easily point-out the importance of knowing the normal histology and cytology of the respiratory system as changes or abnormalities in these could bring about a cease in the normal functions of an organ. (, 2000)
Let’s take a smoker’s lung for example, considering the fact that smoking is the leading cause of one of the most common non-malignant respiratory disease- Chronic Obstructive Pulmonary Disease (COPD)- where it ranks 5th as the leading cause of death worldwide and it expected to rank 3rd by the year of 2020. (, 2006) A smoker’s lung gives a detailed view of the changes that tissues and cells undergoes one’s it become exposed to nicotine. This is the normal lining of a bronchus under a microscope.
Source 
, 2007)
Fig. 1. On the top we see the cilia, labeled (H). They are attached to columnar cells, labeled (I). The cilia sweep the mucous produced in the goblet cells, labeled (J) as well as mucous coming from deeper glands within the lungs and the particulate matter trapped in the mucous. The bottom layer of cells, labeled (L) is the basal cells. (, 2007)
This is the lung as a person starts to smoke:
Source , 2007)
Fig. 2. The columnar cells are starting to be crowded out and displaced by additional layers of basal cells. Not only are fewer cilia present but the ones that are still functioning is doing so at a much lower level of efficiency. Many chemicals in tobacco smoke are toxic to cilia, first slowing them down, soon paralyzing them all together and then destroying them.
Eventually though, the ciliated columnar cells are totally displaced. As can be seen below ominous changes have taken place. Not only is the smoker more prone to infection from the loss of the cleansing mechanism of the cilia, but these abnormal cells (O) are cancerous squamous cells. These cells will eventually break through the basement membrane wall and invade into underlying lung tissue and often spread throughout the body long before the person even knows they have the disease. (, 2007)
Cells like the columnar-shaped cell would assume a cuboidal-shaped as a compensatory mechanism against irritation in the bronchial lining. These changes in the cellular level would alter the entire normal functioning of the cell and the tissue as well. These changes are important to note as they become the basis for assessment of different non-malignant diseases of the respiratory tract. From these assessments, one could derive their diagnosis and make measures for medical management.
Human body is an organization itself. From a single unit of cell, to the group of cells that makes up a tissue, to a group of tissues that makes up an organ, to a group of organ that makes up a system and to the group of systems that makes up a fully functioning individual. It is impossible to fully appreciate how an organ works without analyzing what makes an organ works inside. It’s like when we studied chemicals in Chemistry class, it is essential for us to know the number of atoms, the presence of a proton, neutron and electron, and the molecular content that makes up a certain chemical before we could make chemical bonds. Based from what I have discussed earlier and from the examples I have given, I have derived several reasons to why it is essential for one to be knowledgeable in the histological, cytological and immunochemistry branch before considering making a diagnosis and management to any non-malignant diseases of the respiratory tract.
First because it is important to know the root/cause of everything. A good private investigator does not only look at the picture laid upon them, they look more at the details that makes up a picture rather that focusing on the picture as a whole. To make accurate diagnosis, one must not look at a certain disease as a whole, but should look at the parts that make up a whole. For example, in a lung autopsy, you just don’t look at the lung as a whole; you have to open it and dig deeper into the tissues for further observation to detect presence of a foreign body and fluid.
Second, certain bodily functions could be better understood with the help of a histological, cytological and immunochemistry perspective. (, 2006)
In cases of inflammation disorders such as tonsillitis, certain lab test is to be performed to detect the presence of a pathogen by means of culture and sensitivity, throat culture and immunoflourescence by obtaining sputum sample from the client. Diagnostic procedures like this depend greatly at microscopic observation and usage of certain chemicals for different staining procedures. Another example is laryngitis; one should take into account the normal cell-shaped of the larynx which is Pseudostratified columnar ciliated would assume a cuboidal-shaped due to the presence of irritants and mucus production. Also, other diagnostic procedures such bronchoscopy, an insertion of a rigid/flexible bronchoscope via incision or through the mouth/nose to detect any diseases involving the airway (,1996) and thoracentesis where a tissue sample is aspirated just like a procedure in biopsy (,1996). Both of these examples depend greatly on critical observation under a microscope.
Third, knowledge in histology and cytology has a great deal of relevance to almost any field in medicine (, 2006). Specific facts in these areas would provide better understanding about the course of the disease and for a more accurate diagnosis and treatment. Also, some non-malignant respiratory diseases such as benign lung tumors (bronchial adenoma, benign papilloma and parenchymal tumors) are in a tissue-level organization (, 2006).
Certain cancer cells and process of metastasis could easily be detected with an understanding about the characteristics of a cell, like most cancerous cells changes from a normal cell to what is term as anaplasia, metaplasia, dysplasia and hyperplasia (, 1999). Even though disease detection like this is usually the job of a pathologist, it wouldn’t hurt to have knowledge of this as well.
Fourth, considering the fact that medicines’ effectiveness are observed with how they react usually in a cellular level, knowledge on how certain medicines affects each cell would help you plan a more suitable treatment, you can point-out possible side effects and adverse reaction, that would be less damaging to a cell. Though, this part mostly concerns immunosuppressant/chemotherapeutic agents that are used in treating early cancer cells.
Fifth, the client may require further explanation to why you have arrived to a certain diagnosis and why this kind of medical management is necessary (, 2006). Most of the time, particularly after one undertook such test likes a sputum exam to detect presence of tuberculosis. Most clients would found themselves dumbfounded as physicians wouldn’t even try to explain the results in a more detailed way. Most physician’s are used to explaining the disease’s pathophysiology in general rather than giving the client a more detailed view of what is happening to her/his body. Clients nowadays are smarter, they want to be more involved in overcoming the disease process, and they also seek alternative way since the prevalence of eastern traditional medicine such as acupuncture and reflexology. As his/her medical practitioner, it is your duty to see to it that the client understands his/her condition to make her/him more cooperative during treatments.
Lastly, additional knowledge is always a good thing. Especially that we are in the age where people continues to seek better, faster, affordable, safer way to treat common non-malignant diseases of the respiratory tract, it will be very helpful to have a vast knowledge in these areas. After all, cytological, histological and immunochemistry is interrelated with each other, these three could serve as a fundamental tool in making diagnosis and providing medical management. Furthermore, in regards to what I’ve said earlier that disease detection with the means of histological and cytological is usually the job of a pathologist, knowledge in this area would allow you to use this as a communication vehicle, you could exchange viewpoints and learn from them, the pathologist could also participate with regards to medical management.
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