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03-18-2009, 10:18 AM
Emphysema


The word emphysema means hyperinflation or abnormal distention with air.
Types of Emphysema
1- Mediastinal emphysema or pneumo-mediastinum caused by rupture esophagus.
2- Subcutaneous emphysema due to injury of chest
3- Pulmonary Emphysema.

(i.e.) air spaces are distended distal to terminal bronchioles with destruction of the alveolar septa.

Causes: of (pulmonary emphysema)
1- Chronic Bronchitis (obstructive. Emphysema)
2- Senile (atrophic emphysema)
3- Compensatory Bronchiectasis emphysema upper
lung zone.
Unilateral lung disease contralatral
compensatory emphysema
4- Congenital: Presented at middle age = al antitrypsin deficiency
Normally there are proteases which tend to digest the lung parenchyma (alveoli), So there are antiproteases the most important of them is a 1 antitrypsin.

Pathology: in some cases generalized destruction of alveolar walls panacinar emphysema as in a l antitrypsin decrease.
In chronic bronchitis it is centriacinar affecting those alveoli closely related to respiratory bronchioles.


N.B: Smoking ­­ proteases due to chronic irritation
secreted by neutrophil



Emphysema

C/P Symptoms:
* Dyspnea * little cough
* Symptoms of chronic bronchitis if present.
O/E
General Examination:
Neck veins. (expiratory filling)
Pulses paradoxicus (insevere cases)
Core pulmonale.
Local examination. Inspection movement or A- P
diameter, symmetrical chest
Palpation Rt. V++, TVf or
equal on both sides
Percussion Hyper resonance
& encroachment on

The bare area hepatic dullness
Auscultation Harsh vesicular
breathing
Investigations
1- X-ray bronchovascular marking .
Copulae of diaphragm are depressed.
2- EGG : Rt. V. ++
3- Blood gases Respiratory Failure. Type I if pure emphysema.
Type II in emphysema with chronic bronchitis.
4- Assessment of the level of a1 antitrypsin in serum.
Treatment:
1. No definite treatment.
2. treatment of the cause.
3. Symptomatic
4. In a1 antitrypsin deficiency we can give a1 antitrypsin injection.
Q (Blue bloater, pink puffer) !?

Blue bloater (bloater - blue)

Edema cyanosis
Patient With chronic. bronchitis. + emphysema
With dominate chronic bronchitis.

Severe O2 Rt. V++ early Rt. Ventricular Failure.
P ++
cyanosis edema
Pink Puffer
This patient Has dominant emphysema with mild O2 + dyspnea no cyanosis
puffer the patient try to keep the intra bronchial pressure high so the patient expire the breathe with pursed lips.


Clinical abnormalities found in pts with advanced Air flow obstruction (signs of severity of GOAD)

A reduction in the length of the trachea palpable above the sternal notch
Tracheal descent during inspiration
Contraction of the sternomastoid and scalene muscles on inspiration
Excavation of the suprasternal and supraclavicular fossae during inspiration.
Jugular venous filling during expiration.
Indrawing of the intercostal spaces during Inspiration (Littin sign).
An increase in the A-P diameter of the chest.

Source: Internal Medicine Book of Dr.Osama Mahmoud (Ain Shams University)