Emphysema Overview

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EMPHYSEMA

Definition: It is a condition of the lung characterized by increase beyond the normal in the size of air spaces distal to the terminal bronchioles either from dilatation or from destruction of their walls.

Types (1) bilateral hypertrophic type (2) Atrophic type (3) obstructive type 4) Complementary emphysema

Mostly male middle and late years of life (1) after pneumonectomy (2) Aviation of mediastinum (3) Tuberculosis (4) Bronchiectasis (5) Atelectasis (6) Pneumoconiosis (1) Persistent coughing (8) Old age (9) Heredity (10) Destructive Bronchiectasis.

Pathology: The lung is large and spongy with enlarged air spaces. Projecting on the surface, vesicles may be seen these are termed ‘blebs’ when they res1t from rupture a alveoli into the pleura with separation of the layers to form air ac and also formed by fusion of air spaces and are termed bull’. The functional fault in emphysema consist of a mechanical difficulty in ventilating the a1veali a disturbance in the normal relationship between alveolar gas and capillary blood and ultimately a failure of the pulmonary circulation (chronic cor pulmonale).

Clinical Features: Symptoms (1) Dyspnea on exertion. (2) Cough and expectoration. (3) Wheezing sound. (4) Gradual weakness and loss of weight.

Signs – (1) Cyanosis, central in type. (2) Hurried respiration and accessory muscles prominent. (3) Decubitus propped up or stooping forward position. (4) On examination (a) Inspection — Barrel shaped chest, diminished movement, the ribs more horizontal, sub costal angle is wide, distension of the lung apices, apex beat is invisible. (b) Palpation — Vocal fremitus diminished, liver pushed down, reduced chest expansion. (C) Percussion — increased resonance, cardiac and liver dullness reduced. (d) Auscultation —. Weak breathing sound, brief inspiration, prolonged expirati0fl weak heart sounds; resonance is diminished on both sides.

Investigation: (1) X-ray of chest — costal angles shallow, Ostopenic recesses deepened, descent and rotation of the heart; prominence of pulmonary arteries, translucent areas devoid of vascular markings. (3) E.C.G,—T sharp wave, more than 3 mm. in height.

Differential Diagnosis: (1) Uncomplicated chronic bronchitis. (2) Bronchial asthma, (3) Pneumoconiosis 4) Left ventricular failure. (5) Sp0fltafle0 pneumoth0ra (6) Carcinoma of bronchus. (7) Pulmonary tuberculosis.

Complications: (1) Right side heart failure. (2) Acute respiratory failure. (3) Spontaneous pneumothorax (4) Recurrent BronchoSPasm. (5) Tuberculosis.

Prognosis: repeated attacks of bronchitis can be prevented, the prognosis is favorable.

TREATMENT (I) to avoid respiratory infection by all means like avoidance of overheated and overrowc1td places and changing of occupations exposing to dust and irritant gases, it’ necessary. (2) Chest physiotherapy — postural drainage and proper lifting exercises: esp. expiration may be done. (3) There is no specific remedy for emphysema but the patient may benefit considerably from the treatment of associated chronic bronchitis. (4) Obesity must be prevented or corrected, (5) breathing exercises. (6) Maintain good hygienic conditions. (7) Intermittent oxygen therapy (if necessary). (8)
Definition: It is a condition of the lung characterized by increase beyond the normal in the size of air spaces distal to the terminal bronchioles either from dilatation or from destruction of their walls.

Types (1) bilateral hypertrophic type (2) Atrophic type (3) obstructive type 4) Complementary emphysema

Mostly male middle and late years of life (1) after pneumonectomy (2) Aviation of mediastinum (3) Tuberculosis (4) Bronchiectasis (5) Atelectasis (6) Pneumoconiosis (1) Persistent coughing (8) Old age (9) Heredity (10) Destructive Bronchiectasis.

Pathology: The lung is large and spongy with enlarged air spaces. Projecting on the surface, vesicles may be seen these are termed ‘blebs’ when they res1t from rupture a alveoli into the pleura with separation of the layers to form air ac and also formed by fusion of air spaces and are termed bull’. The functional fault in emphysema consist of a mechanical difficulty in ventilating the a1veali a disturbance in the normal relationship between alveolar gas and capillary blood and ultimately a failure of the pulmonary circulation (chronic cor pulmonale).

Clinical Features: Symptoms (1) Dyspnea on exertion. (2) Cough and expectoration. (3) Wheezing sound. (4) Gradual weakness and loss of weight.

Signs – (1) Cyanosis, central in type. (2) Hurried respiration and accessory muscles prominent. (3) Decubitus propped up or stooping forward position. (4) On examination (a) Inspection — Barrel shaped chest, diminished movement, the ribs more horizontal, sub costal angle is wide, distension of the lung apices, apex beat is invisible. (b) Palpation — Vocal fremitus diminished, liver pushed down, reduced chest expansion. (C) Percussion — increased resonance, cardiac and liver dullness reduced. (d) Auscultation —. Weak breathing sound, brief inspiration, prolonged expirati0fl weak heart sounds; resonance is diminished on both sides.

Investigation: (1) X-ray of chest — costal angles shallow, Ostopenic recesses deepened, descent and rotation of the heart; prominence of pulmonary arteries, translucent areas devoid of vascular markings. (3) E.C.G,—T sharp wave, more than 3 mm. in height.

Differential Diagnosis: (1) Uncomplicated chronic bronchitis. (2) Bronchial asthma, (3) Pneumoconiosis 4) Left ventricular failure. (5) Sp0fltafle0 pneumoth0ra (6) Carcinoma of bronchus. (7) Pulmonary tuberculosis.

Complications: (1) Right side heart failure. (2) Acute respiratory failure. (3) Spontaneous pneumothorax (4) Recurrent BronchoSPasm. (5) Tuberculosis.

Prognosis: repeated attacks of bronchitis can be prevented, the prognosis is favorable.

TREATMENT (I) to avoid respiratory infection by all means like avoidance of overheated and overrowc1td places and changing of occupations exposing to dust and irritant gases, it’ necessary. (2) Chest physiotherapy — postural drainage and proper lifting exercises: esp. expiration may be done. (3) There is no specific remedy for emphysema but the patient may benefit considerably from the treatment of associated chronic bronchitis. (4) Obesity must be prevented or corrected, (5) breathing exercises. (6) Maintain good hygienic conditions. (7) Intermittent oxygen therapy (if necessary).

Videos explaining Emphysema

Xray interpretation for emphysema – Video

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