This document discusses chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema. It covers the definition, causes, pathophysiology, clinical presentation, investigations, management, and complications of COPD. Key points include that COPD is characterized by irreversible airflow limitation caused by chronic bronchitis and emphysema. Cigarette smoking is the primary risk factor. Symptoms include cough, sputum production, and shortness of breath. Pulmonary function tests can confirm the diagnosis and assess severity. Chest imaging shows hyperinflation of the lungs in emphysema. Treatment involves smoking cessation, bronchodilators, corticosteroids, oxygen therapy, and surgery in severe cases
Emphysema-medical information |management |diagnosis | tests martinshaji
HAPPY PHARMACIST DAY
Emphysema is a lung condition that causes shortness of breath. In people with emphysema, the air sacs in the lungs (alveoli) are damaged. Over time, the inner walls of the air sacs weaken and rupture — creating larger air spaces instead of many small ones
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Emphysema-medical information |management |diagnosis | tests martinshaji
HAPPY PHARMACIST DAY
Emphysema is a lung condition that causes shortness of breath. In people with emphysema, the air sacs in the lungs (alveoli) are damaged. Over time, the inner walls of the air sacs weaken and rupture — creating larger air spaces instead of many small ones
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Gas exchange between the alveoli and the pulmonary capillary blood occurs by diffusion, as will be discussed in the next chapter. Diffusion of oxygen and carbon dioxide occurs passively, according to their concentration differences across the alveolar-capillary barrier. These concentration differences must be maintained by ventilation of the alveoli and perfusion of the pulmonary capillaries.
Alveolar ventilation brings oxygen into the lung and removes carbon dioxide from it. Similarly, the mixed venous blood brings carbon dioxide into the lung and takes up alveolar oxygen. The alveolar Image not available. and Image not available. are thus determined by the relationship between alveolar ventilation and pulmonary capillary perfusion. Alterations in the ratio of ventilation to perfusion, called the Image not available., will result in changes in the alveolar Image not available. and Image not available., as well as in gas delivery to or removal from the lung.
Alveolar ventilation is normally about 4 to 6 L/min and pulmonary blood flow (which is equal to cardiac output) has a similar range, and so the Image not available. for the whole lung is in the range of 0.8 to 1.2. Image not available. However, ventilation and perfusion must be matched on the alveolar-capillary level, and the Image not available. for the whole lung is really of interest only as an approximation of the situation in all the alveolar-capillary units of the lung. For instance, suppose that all 5 L/min of the cardiac output went to the left lung and all 5 L/min of alveolar ventilation went to the right lung. The whole lung Image not available. would be 1.0, but there would be no gas exchange because there could be no gas diffusion between the ventilated alveoli and the perfused pulmonary capillaries.
Oxygen is delivered to the alveolus by alveolar ventilation, is removed from the alveolus as it diffuses into the pulmonary capillary blood, and is carried away by blood flow. Similarly, carbon dioxide is delivered to the alveolus in the mixed venous blood and diffuses into the alveolus in the pulmonary capillary. The carbon dioxide is removed from the alveolus by alveolar ventilation. As will be discussed in Chapter 6, at resting cardiac outputs the diffusion of both oxygen and carbon dioxide is normally limited by pulmonary perfusion. Thus, the alveolar partial pressures of both oxygen and carbon dioxide are determined by the Image not available. If the Image not available. in an alveolar-capillary unit increases, the delivery of oxygen relative to its removal will increase, as will the removal ...
Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term used to describe progressive lung diseases including emphysema, chronic bronchitis, and refractory (non-reversible) asthma. This disease is characterized by increasing breathlessness
Emphysema is a type of COPD involving damage to the air sacs (alveoli) in the lungs. As a result, your body does not get the oxygen it needs. Emphysema makes it hard to catch your breath. You may also have a chronic cough and have trouble breathing during exercise. The most common cause is cigarette smoking
Gas exchange between the alveoli and the pulmonary capillary blood occurs by diffusion, as will be discussed in the next chapter. Diffusion of oxygen and carbon dioxide occurs passively, according to their concentration differences across the alveolar-capillary barrier. These concentration differences must be maintained by ventilation of the alveoli and perfusion of the pulmonary capillaries.
Alveolar ventilation brings oxygen into the lung and removes carbon dioxide from it. Similarly, the mixed venous blood brings carbon dioxide into the lung and takes up alveolar oxygen. The alveolar Image not available. and Image not available. are thus determined by the relationship between alveolar ventilation and pulmonary capillary perfusion. Alterations in the ratio of ventilation to perfusion, called the Image not available., will result in changes in the alveolar Image not available. and Image not available., as well as in gas delivery to or removal from the lung.
Alveolar ventilation is normally about 4 to 6 L/min and pulmonary blood flow (which is equal to cardiac output) has a similar range, and so the Image not available. for the whole lung is in the range of 0.8 to 1.2. Image not available. However, ventilation and perfusion must be matched on the alveolar-capillary level, and the Image not available. for the whole lung is really of interest only as an approximation of the situation in all the alveolar-capillary units of the lung. For instance, suppose that all 5 L/min of the cardiac output went to the left lung and all 5 L/min of alveolar ventilation went to the right lung. The whole lung Image not available. would be 1.0, but there would be no gas exchange because there could be no gas diffusion between the ventilated alveoli and the perfused pulmonary capillaries.
Oxygen is delivered to the alveolus by alveolar ventilation, is removed from the alveolus as it diffuses into the pulmonary capillary blood, and is carried away by blood flow. Similarly, carbon dioxide is delivered to the alveolus in the mixed venous blood and diffuses into the alveolus in the pulmonary capillary. The carbon dioxide is removed from the alveolus by alveolar ventilation. As will be discussed in Chapter 6, at resting cardiac outputs the diffusion of both oxygen and carbon dioxide is normally limited by pulmonary perfusion. Thus, the alveolar partial pressures of both oxygen and carbon dioxide are determined by the Image not available. If the Image not available. in an alveolar-capillary unit increases, the delivery of oxygen relative to its removal will increase, as will the removal ...
Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term used to describe progressive lung diseases including emphysema, chronic bronchitis, and refractory (non-reversible) asthma. This disease is characterized by increasing breathlessness
Emphysema is a type of COPD involving damage to the air sacs (alveoli) in the lungs. As a result, your body does not get the oxygen it needs. Emphysema makes it hard to catch your breath. You may also have a chronic cough and have trouble breathing during exercise. The most common cause is cigarette smoking
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
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É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
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2. Chronic obstructive pulmonary
disease.
Disease state characterized by airflow
limitation that is not fully reversible.
A. Chronic bronchitis- a clinically defined
condition with chronic cough and phlegm.
B. Emphysema- an anatomically defined
condition characterized by destruction &
enlargement of lung alveoli.
3. Chronic bronchitis:-
condition associated with excessive
tracheobronchial mucus production
to cause cough with expectoration
for at least 3 month of year for
more than 2 year.
Aetiology-
cigarette smoking
air pollution
occupational hazards -
cotton mill , coal mining , rubber
industry , gold mining
familial factor
genetic factor
infection-by rhinovirus , strep
6. Clinical feature-
Cough
Sputum production
Exertional dyspnoea
Breathlessness relatively late onset
Percussion note- resonant over
lung field
Auscultation- vesicular breathing,
rhonchi, crepitation
Blue bloaters
7. Gold criteria-
GOLD
STAGE
SEVERITY SYMPTOM SPIROMETRY
0 At risk Chronic cough , sputum
production
normal
1 mild With or without chronic cough or
sputum production
FEV1/FVC<0.7
FEV1>=80%predi
cted
11 moderat
e
With or without chronic cough or
sputum production
FEV1/FVC<0.7
50%<=FEV1<80%
predicted
111 severe With or without chronic cough or
sputum production
FEV1/FVC<0.7
30%<=FEV1<50%
predicted
1V Very
severe
With or without chronic cough or
sputum production
FEV1/FVC<0.7
FEV1<=30%predi
cted
Or
9. Radiological studies-
CHEST X-RAY:-
a. Bronchial wall
thickening
b. Increase in lung
marking
c. Small,ill defined
opacity anywhere
in lung
d. Occasionally a
wide alteration in
lung marking may
be seen where the
normal vascular
pattern is partly
11. Bronchogram-
dilatation of
bronchial gland
leading to irregular
out pouching from
bronchial lumen
mostly often seen in
wall of major bronchi.
abrupt termination of
smaller branch of
bronchi with square
& truncated ending
bronchiolar spasm
increased secretion
12. Complication-
Mismatch of ventilation &
perfusion
Co2 narcosis Respiratory
failure
Hypoxaemia
hypercarbia
Pulmonary
vasoconstriction
Pulmonary
hypertension
Right ventricular
hypertrophy
Right
ventricular
failure
Increased
erythropoisis
Sec.
polycythe
mia
Desaturation
of Hb
cynaosis
13. Treatment-
1. general measure-
Smoke caessation
Regular exercise
Weight loss
2.bronchodialator-
Inhalation of b2 agonist-salbutamol 200mcg
Terbutalin 600mcg 6th
hourly
3.glucocorticoides-
improve the gas exchange to some extent
14. 4.oxygen-
Supplemental o2 by nasal catheter & through
face mask
Mainly for exertional or nocturnal hypoxaemia
6.antibiotic-
If any infection is there-
Doxycycline,co-trimoxazole,amoxycillin-
clavulanate,gatifloxacin,iv azithromycin ,
ceftriaxone,cefotaxime
5.Others
N-acetyl cysteine-mucolytic & antioxidant
15. Emphysema
Distension of air spaces
distal to terminal bronchiole
with destruction of the
alveolar septa.
Predisposing factors-
smoking
Environmental pollution
Occupational exposure-cadmium,
furnace blower
Alpha1antitrypsin deficiency
16. Type-
a. centriacinar- destruction & enlargement of
central & proximal part of respiratory
unit acinus.
Upper lobe and apices
Seen in male smokers
b.panacinar- uniform destruction & enlargement
of acinus
Mainly involve lower basal zone
Seen in alpha 1 antitrypsin def
patient
c.paraseptal- only distal acinus involve
Found near pleura
18. 1.compensatory-
Normal lung tissue undergoes compensatory
mechanism for an extensive damage to other
lung or part of the same lung.
Hyper resonant percussion note.
Increase breath sound.
2.subcutaneous-
seen in case of penetrating chest injury
Rib fracture
Intercostals tube introduction
19. 3.Mediastinal emphysema-
Vertical translucent streak , separating & outlining
the soft tissue layers & structure of mediastinum.
Air often separates the parietal pleura from the
mediastinum & pleura may then be visible as a
thin hair line running parallel to mediastinum.
Air may be seen in neck also. Due to escape of air
rapidly into mediastinum after rupture of over
distended alveoli.
On auscultation crunching sound heard.
22. SIGN..
Inspection & palpation-
Tachypnoeic
Hypertrophy of accessory muscle of
respiration
Purse lip breathing
Chest bowel shaped
AP diameter- increased
AP:TD –altered(normal-5:7)
Angle of Luis-prominent
Sub costal angle widened(normal 70’)
Apical impulse is usually invisible or
feeble.
23. Percussion-
hyper resonant over lung field area
cardiac dullness decreases
liver dullness pushed down or absent if right
side involved
Auscultation-
Breath sound –decreases
Prolong expiration
Pink puffers
24. Difference In chronic bronchitis &
emphysema.
feature chronic bronchitis emphysema
cough Before dyspnoea starts After dyspnoea starts
sputum Copious , purulent Scanty , mucoid
dyspnoea mild severe
cynosis present absent
infection common Less common
Chest x-ray Increased bronchovascular
marking , cardiomegaly
Feature of hyperinflation ,
bullae,tubular heart
Pulmonary
hypertension
Moderate to severe mild
Diffusing
capacity
normal decreased
29. Bullae-
Multiple & small-
May be localized to a lobe
or may be B/L
Upper lobe more often
affected
Giant bulla-
Rib interspaced is
widened in region of giant
bulla
Neighboring normal
tissue is compressed with
vessels crowded together
30. CT SCAN Finding:-
it permit the direct identification of destroyed lung
tissue with high precision.
It shows-
Area of decreased attenuation without visible walls
Pruning of pulmonary vessels
Distortion of pulmonary vessels
Decrease lung tissue gradient
31. Centrilobular-
lucent region initially
surrounded by normal
lung parenchyma but
become confluent
along with obliteration
of peripheral vascular
as disease progresses.
Panlobular-
Widespread area of
low attenuation usually
seen accompanied by
diffuse vascular
distortion.
32. Nuclear imaging-
Functional evaluation of the lungs can be
carried out by using xenon-133 (133 Xe) lung
ventilation scintigraphy before and after lung-
volume–reduction surgery (LVRS) in patients with
pulmonary emphysema.
Xenon-133 washout curves during lung
scintigraphy exhibit a biphasic pattern:
(1) the first component corresponds to an initial
rapid phase in washout that reflects emptying
of the large airways, and
(2) the second component, reflects a slower
phase of washout that is attributed to gas
elimination in the small airways.
34. Emphysema with chronic bronchitis-
Radiological finding--
Decrease in size & no. Of small vascular marking
specially in middle & outer 1/3rd of lung
Main pulmonary arteries are enlarged making hilar
shadow prominent
May be barrel shaped chest with increase in AP
diameter & anterior bowing of sternum
Ant mediastinal space is usually increased in depth
35. Heart shadow is often long,narrow &
cardiothoracic ratio may change to 1:3 or 1:4.
Lung fields are seen more translucent
Increased vol of lung results in flattening of
contour of diaphragm
Best seen in lateral projection & level is
lowered below the 11th rib.
38. Surgical-
A. bullectomy
B. Lung volume reduction surgery-
Not done if significant pleural disease
PASPmore than 45 mm mg
C.Lung transplantation-
Age should be less than 65 yrs
Free from liver cardiac renal disease
39. REFERENCES….
Harrison’s principles of internal medicine
Manual of practical medicine-R Alagappan
Fraser& pare’s diagnosis of diseases of chest
Roentgenlogic diagnosis bysaunder’s
CT & MRI imaging of whole body-Haaga,Tanzien,Gilkeson
Internet