Fundamental ideas in Lung illness .


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Fundamental ideas in Lung illness. SS Visser Inside Solution PAH and UP. Questions. Why do we require a respiratory framework? What does it comprise of? How is it controlled/directed? How is it influenced by illness? How is malady perceived? In what manner can sickness be avoided or treated?
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Essential ideas in Lung infection SS Visser Internal Medicine PAH and UP

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Questions Why do we require a respiratory framework? What does it comprise of? How is it controlled/managed? How is it influenced by ailment? How is ailment perceived? In what capacity can ailment be forestalled or treated? Why do you have know this?

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Contents Function of the respiratory framework Embryology Anatomic ideas Physiologic ideas Pathology Clinical : symptoms physical signs disease designs

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Functions of the lung Respiration: ventilation and gas trade: O 2 , CO 2, pH, warming and humidifying Non-respiratory capacities: combination, actuation and inactivation of vasoactive substances, hormones, neuropeptides, eicosanoids, lipoprotein edifices. Hemostatic capacities (thromboplastin, heparin) Lung safeguard: supplement actuation, leucocyte enlistment, cytokines and development variables Speech, spewing, crap, labor

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What does the respiratory framework comprise of?

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Embryology : lung advancement begins from the gut 24 days after origination; stomach shapes in cervical area at 3-4 weeks and moves continuously downwards conveying the phrenic nerves with; lung projections are identifiable at 12 weeks; bronchial tree is finished at four months and alveoli and vessels show up at 24 – 28 weeks; surfactant shows up at 35 weeks. Postnatal Alveolarization: serious initial 8-10 y (alveolar buds – hyperplastic development) and extension of all structures all through puberty and early adulthood ( hypertrophic development)

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Embryology and illness Developmental variations from the norm: tracheo-oesophageal fistula, congenital fissure, blisters, agenesis, sequestration, cilia brokenness and unusual structure, diaphragmatic hernias. Shared nerve supply (Vagus) between respiratory tract and GI tract – Gastro-oesophageal reflux can increment bronchial discharges (reflexively) and cause bronchial choking ( together with oesophageal fit). Diaphragmatic aggravation is frequently experienced as torment in the cervical locale (alluded torment) from where it advanced.

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Anatomy Surface Anatomy: borders of the pleura borders of the lung fissures lung flaps Bronchial tree, vascular and nerve supply, lymphatics. Point of Louis Histology, cilia, secretory and immunologic cells. Thoracic enclosure Diaphragm and embellishment muscles of breathing

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How is the respiratory framework controlled/directed?

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Physiology Lung mechanics and Lung capacities Airway resistance Diffusion :Gas laws ( Graham, alveoalar gas condition, Charles, Boyle, Dalton, Henry) Blood gasses: PaO 2 , PaCO 2 , pH, HCO3, O 2 sat Hemoglobin, separation bend, 2,3DPG Surfactant Control of Breathing

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Surfactant Reduces surface strain and in this way flexible force, making breathing less demanding Reduces the inclination to aspiratory oedema Equalizes weight in extensive and little alveoli

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Left move increased HB affinty for O 2 ( arrival of O 2 to tissues) Alkalosis Hypothermia 2,3 DPG COHB MetHB Right move decreased HB liking for O 2 ( arrival of O 2 to tissues) Acidosis Hyperthermia 2,3 DPG Oxyhemoglobin separation bend

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Hypoxia Anemic hypoxia-HB CO inebriation HB availabilty, shifts O 2 HB separation bend to one side Respiratory hypoxia-next slide R to L extrapulmonary shunting-ASD,VSD,PDA Circulatory hypoxiacardiac disappointment, stun Ischemic hypoxia-blood vessel check Increased O 2 necessities fever, work out, thyrotoxicosis Improper O 2 usage cyanide, diptheria poison

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Hypoxemia Hypoventilation Diffusion Ventilation/perfusion imbalance AV Shunt High elevation Hypercarbia Hypoventilation Ventilation/perfusion disparity Blood gasses: PO 2 and PCO 2

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How is the respiratory framework influenced by infection?

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Pathology Airway maladies: COPD, asthma, bronchiectasis, cystic fibrosis, obstructive rest apnoea Parenchymal illness: pneumonia, ARDS, Interstitial lung sickness, pneumoconiosis Pleural ailment: pleural emission, empyema. Vascular sickness: thrombo-embolism, essential pulmonar hypertension Neoplastic ailment: Bronchus Ca, mesothelioma, adenoma, carsinoid

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Airway maladies Causes: atopy, cigarette smoking, contamination, anomalous lung safeguard Effect: block to wind stream Mechanism: bronchospasm, irritation, aviation route renovating, decimation, falling aviation routes Consequences:  wind stream ( FEV1, PEF); work of breathing resp muscle exhaustion  respiratory disappointment; PaO 2 , PaCO 2 PHT cor pulmonale

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Parenchymal illness union - disease - run of the mill/atypical Oedema - cardiovascular versus non-heart (ARDS) interstitial lung ailment - idiopathic fibrosis, sarcoidosis, touchiness pneumonitis, pneumoconiosis Vascular – auxiliary/essential PHT, cor pulmonale, aspiratory thrombo-embolism (unexplained dyspnea); Virchow triade: stasis,  coagulability, vein variation from the norm, varicose veins, endothelial brokenness  DVT chance

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Pleural ailment Pleural radiation: alb, LDH, pleural/serum, cholesterol, glucose, ADA, pH. exudate: contamination, irritation, neoplastic, blood (  penetrability) transudate: hypoproteinemia (renal, liver -  oncotic weight ), systemic venous hypertension (  hydrostatic weight - Heart disappointment) Empyema Chylothorax, pseudo-chylothorax

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Neoplastic sickness Bronchus Ca: squamous, little cell ca, adeno ca, substantial cell ca, broncho-alveolar ca Mesothelioma Metastatic ca Rare tumors: lymphoma, malt-lymphoma Benign tumors

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Control and Mechanism of breathing Alveolar hypoventilation Sleep-related: focal and obstructive rest apnoea, Ondine\'s revile Neuro-strong maladies: polio, Guillain-Barre disorder, myasthenia gravis, resp muscle weakness, polimyositis Chest divider: kyphoscoliosis, rib cracks with thrash trunk

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Complications of Lung ailment Cor pulmonale Respiratory disappointment: ventilatory disappointment versus oxygenation disappointment – hypercapnia, acidosis and hypoxaemia Endstage lung infection Pneumothorax

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How is illness of the respiratory framework perceived?

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Clinical Manifestations Dyspnea, PND, orthopnea, trepopnea, platypnea and orthodeoxia. Hack: beneficial versus non-profitable, volume, character, blood, post-nasal release Chest torment: ischaemic, pleuritic, trunk divider, GE reflux, tearing of tissue Constitutional: fever, night sweats, weight reduction RHF: swelling, torment R hypochondrium, stomach expansion, palpitations

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Hemoptysis Upper aviation route: nasopharyngeal, GIT Tracheobronchial: neoplasm, bronchitis, bronchiectasis, injury, outside body Parenchyma: pneumonia, lung ulcer, TB, mycetoma, SLE, Wegeners, Goodpasture, lung wound Primary vascular illness: AV distortions, aspiratory embolism, pulmonary venous weight Others: Systemic coagulopathy, anticoagulants, pneumonic endometriosis

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Massive hemoptysis 100 – 250 ml blood for each day Causes: most every now and again PTB and bronchiectasis Rx: keep up oxygenation and forestall blood spilling into unaffected districts, stay away from suffocation Suppress hack Invasive administration: twofold lumen endotracheal tube or inflatable catheter to close site of dying, mechanical ventilation, laser phototherapy, embolotherapy, resection

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Respiratory framework indications of respiratory pain, hyperinflation, combination, pleural radiation, pneumothorax, sup vena cava obstacle

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Physical signs General: Cyanosis, iron deficiency, jaundice, oedema, lymphadenopathy, clubbing Respiratory examination: Observation Palpation Percussion Auscultation

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Auscultation Intensity of breath sounds: N,  or truant Character of breath sounds: N or bronchial breathing/amphoric breathing Intensity of vocal sounds: (one-one, 99)N,  (bronchophony) or  or nasal ( aegophony) Whispering pectoriloquy ( 66) Adventitious sounds: ronchi, creps, rubs, clicks.

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APPLICATION OF ADVENTITIOUS LUNG SOUNDS

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Diagnostic strategies XRC, CT check, MRI filter Lung capacities Blood gasses Sputum, cilia work Bronchoscopy, biopsy Nuclear prescription

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How can infection of the respiratory framework be dealt with or counteracted?

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Treatment/anticipation Patient instruction Immunization Medication: anti-infection agents, bronchodilators, mitigating drugs,diuretics, hostile to coagulants Ventolators Physiotherapy Surgery

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Why do you need to know this? Since so you would one be able to day say: " Trust me, I am your specialist!"

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