emphysema of lungs

Question 1

etiology

Answer 1

• smoking
• air pollution
• hyperresponsive airways
• infections
• Primary emphysema- congenital: α1 antitrypsin deficiency, Serum elastase inhibitor deficiency
• Secondary emphysema- due to other lung pathology: chronic bronchitis, obstructive bronchus, chronic pneumonia, chronic asthma, heavy exercise

Question 2

pathogenesis

Answer 2

Pathogenesis
1st stage : destruction of alveoli due to distension in bronchus 2nd stage : diffuse destruction and alveolar loss it elasticity

Question 3

classification

Answer 3

Classification
1. Acc to anatomy:
- Centrilobular
- Pan-acinar
- Distal

2. Acc to pathology:
   - Only enlargement of air spaces
   - Destroyed walls of alveolar spaces
3. According to enlargement
   - Develops due to bronchial obstruction e.g. in tumours
   - Develops due to changes in respiratory bronchioles.
4. According to mechanism
   - Involutive emphysema of lungs- doesn‘t involve reduction of vessels (normal physiological process)
   - Recurrent emphysema of the lung (compensative emphysema)- after removal of a lung or a lobe of lung, remaining pulmonary tissue becomes emphysematous.
   - Mac Cloude‘s lung- congenital emphysema of one lung
5. According to development
   - Primary- due to α1 antitrypsin deficiency, deficiency of serum elastase inhibitors
   - Secondary- caused by obstructive process in the lungs- 1st stage- dilatation of the alveoli
   2nd stage- reduction of vessels
6. type A (pink puffer/primary) and type B (blue bloater/secondary)
7. destructive form are divided into diffuse and local

Question 4

clinical symptoms

Answer 4

Subjective
- Long history of exertional dyspnoea.
- Minimal cough and very slightly productive with mucoid sputum.

Objective
1. Inspection
- asthenic,
- Patient distressed with use of accessory muscles in respiration.
- Tachypnoea, prolonged expiration pursed lips begun with grunting sound.
- chest wall moves forward on inspiration.
- Orthopnoea position.
- Neck veins dilated during expiration but quickly collapse with inspiration.
- Lower intercostal spaces retract with each inspiration.
- chest barrel form, face swell and redness of cheeks

2. Palpation
   - right ventricular impulse in the subxiphoid region.
   - ↑ chest rigidity
   - Wide ICS
   - ↓ Vocal fremitus (palpation)
   - ↓ elasticity of thorax
3. Percussion
   - hyperresonant. Band box sound
   - Cardiac dullness is absent or diminished.
   - ↑ kroenig‘s isthmus
   - Increased sound in apex, decreased motility and decreased traube‘s space
4. Auscultation
   - breathing sounds faint, high pitched ronchi, towards the end of expiration.
   - Presystolic gallop accentuated during inspiration. Weak vesicular breathing

Question 5

investigation

Answer 5

1.Chest X-ray
- presence of bullae
- overinflation of lungs (↑ lung field)
- flattened diaphragms or lowered
- ↓ diaphragm mobility
- transparent lung field increased
- more horizontal position of the ribs
- wide ICS

2.Sputum examination

3.Lung function test

4.ECG - Cor Pulmonale ( taller P wave, Right bundle branch block )

5.CT scan, bronchoscopy and radio isotope scan

6.Respiratory function tests- spirometry- total lung capacity and respiratory volume are increased, vital capacity is low, maximal expiratory flow rate is low.