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Atelectasis

Atelectasis is a common acute restrictive disease occurs, include the collapse of lung tissue or lung functional unit. Atelectasis is a common problem post-surgery clients.
Atelectasis is incomplete lung expansion at birth (neonatorum atelectasis) or collapse before fully developed alveoli, which are usually found in adults that is atelectasis acquired.
atelectasis causes, atelectasis causes, atelectasis symptoms, define atelectasis, what is atelectasis, pulmonary atelectasis, atelectasis pathofisiology
Atelectasis is shriveling, some or all of the lung caused by blockage of the airways (bronchi and bronchioles) or by very shallow breathing.
Pulmonary Atelectasis is a state or part of the lung who have developed resistance to perfect that developing lung aeration or completely filled with air.
As a basic picture of atelectasis is radiologically in the lung volume reduction both lobaris, segmental or whole lung, with the consequent lack of aeration, thus giving more gloomy shadow (high density) with the withdrawal of the mediastinum towards the atelectasis, whereas the diaphragm is pulled up and broke ribs narrowed.

Types of Atelectasis
Based on the Factors Causing 
1.  Atelectasis Neonatorum
Many occur in premature infants, in which the respiratory center in the brain is not mature and respiratory movement is still limited. Precipitating factors including childbirth complications that cause hypoxia intrauteri.
At autopsy, the lungs appear collapsed, bluish red, non-crepitant, tender and alastis. The typical lung is not able to expand in the water. Histologically, lung alveoli have a baby, with a small alveolar spaces of uniform, covered with thick septa dindingin that looks shriveled. Epithelial cabbage prominem melaposi cavity and the alveoli often contained granular edapan protein mixed with amniotic debris and air cavity. Neonatorum atelectasis on the system, respiratory distress, have been previous discussion
2. Acquired atelectasis or Learned
Atelectasis in adults, including intrathoracic disorders that cause collapse of the air space, which previously has been developed. So divided into absorption atelectasis, compression, contractions and spotting. This term involves a lot of the basic mechanisms that lead to lung collapse or on the distribution of these changes.
  • Altelectasis absorption occurs if the respiratory tract completely blocked so that air can not enter the distal parenchyma. The air that has been available is gradually entering the blood stream, accompanied by the collapse of the alveoli. Depending on the level of airway obstruction, the entire lung, a lobe of a complete, or spotting segments can be involved. The most common cause of the collapse of absorption is bronchial obstruction by a mucus blockage. This often occurs after surgery. Bronchial asthma, bronchiectasis and chronic bronchitis and acute, can also cause acute and chronic obstruction. Can also cause acute and chronic obstruction, can also cause obstruction due to blockage mukopurulen materials. Sometimes the obstruction caused by foreign body aspiration or blood clots, especially in children or during oral surgery or anesthesia. Airways may also be too stoppers by tumors, especially bronchogenic carcinoma with enlarged lymph nodes (as in tuberculosis, for example) and by vascular aneurysms.
  • Compression atelectasis most often associated with fluid accumulation of blood or air in the pleural cavity, which mechanically causes lung collapse beside him. This is a frequent occurrence in the pleural effusion from any cause, but perhaps most often associated with heart trouble hidrotoraks on congestion. Pneumothorax may also cause compression atelectasis in patients with bed rest and the patient with ascites, atelectasis basal position of the diaphragm causes a higher rate.
  • Contraction atelectasis occurs when changes in pulmonary and pleural fibrosis which inhibits ekspensi and enhance resilience to expiration.
  • Atelectasis spots shall mean the existence of small elapsed from lung collapse, as occurs in multiple obstruction of bronchioles due to secretion or exudate respiratory distress syndrome in both adults and infants. In a few cases, atelectasis occurs because certain that accompanies pathogenesis clear to the chest wall.
Atelectasis acquired (acquired) may be acute or chronic. Usually arise because of the relatively acute blockage of mucus, which becomes manifest as sudden shortness of breath occur. Indeed, events of acute breathlessness in 48 hours after a surgical procedure, it is almost always diagnosed as atelectasis. The important thing is atelectasis can be diagnosed early and appropriate happens reekspensi of the affected lung, due to the collapse parenchyma forbid the menunggagi susceptible to infection. Persistent atelectasis lung segments may be an important part to the occurrence of bronchogenic carcinoma who quietly.
Based on the extent of atelectasis
  1. Massive atelectasis, on one lung
  2. One lobe, branching main bronchus
Based on the location of atelectasis
  1. Atelectasis lobaris down: if there is dilobaris down the left lung, it will be hidden behind the shadow of the heart and the PA chest x-ray only diaphragm showed a high position.
  2. Atelectasis lobaris center-right (right middle lobe). Often caused by inflammation or suppression of the bronchi by the enlarged lymph nodes.
  3. Atelectasis lobaris top (upper lobe): provide high-density shadow fissure interlobaris withdrawal sign up and trachea toward atelectasis.
  4. Segmental atelectasis: sometimes hard to recognize in the photo thoraj PA, it is necessary to shoot with other positions such as lateral, oblique (obligue), which shows the money is disguised as a withdrawal interlobularis fissure.
  5. Lobularis atelectasis (plate like / local atelectasis). If a blockage occurs in the small bronchi for some segments of the lung, there will be a shadow of a thin horizontal, usually lower lung field that is often difficult to distinguish from the process of fibrosis. Because only a small portion of lung is affected, then there is usually no complaints.
  6. Atelectasis in the right lung upper lobe. These include the collapse of the anterior, superior and medial. On PA chest x-ray indescribable with minor fissure and the superior part of the shift dial. On the lateral image, the major fissure moves forward, while the minor fissure can also experiencing a shift towards a superior.

Etiology
Etiology of atelectasis is the most that is two intrinsic and extrinsic.
1. Atelectasis intrinsic etiology is as follows:

  • BBronchi are blocked, the blockage can be derived in the bronchi such as bronchial tumors, foreign bodies, fluid secretion is massive. And bronchial obstruction due to suppression of tumor outside the bronchus such as around the bronchi, the enlarged gland.
  • Intraluminar airway inflammation that causes the buildup of mucus secretions.
  • Extra pulmonary pressure, usually caused by pneumothorax, pleural fluid, elevation of the diaphragm, abdominal herniation tool into thoracic cavity, thoracic tumors such as tumors of the mediastinum.
  • Paralysis or paresis of respiratory motion, will cause the development of the lungs are not perfect, for example in cases of poliomyelitis and other neurological disorders. Impaired breathing motion will affect the smooth bronchial secretions and this expenditure will lead to blockage of the bronchus that ended with the situation worsens atelectasis.
  • Barriers to respiratory motion by pleural abnormalities or trauma to the thoracic pain, state expenditures will also inhibit bronchial secretions that can aggravate the occurrence of atelectasis

2. Etiology extrinsic atelectasis:
  • Pneumothorax
  • Tumors
  • Enlarged lymph nodes.
  • Anesthesia  / Surgery
  • Bed rest the long run without change of position
  • Shallow Breathing
  • Lung disease

Symptoms
Atelectasis can occur slowly and cause only a mild shortness of breath. Patients with medial lobe syndrome may have no symptoms at all, although many who suffer from short cough.
Symptoms can include:
• Respiratory problems
• Chest pain
• Cough
If accompanied by an infection, may develop a fever and increased heart rate, sometimes to shock (very low blood pressure).
Clinical symptoms vary widely, depending on the cause and extent of atelectasis. In general, atelectasis that occurs in tuberculosis, lymphoma, neoplasm, asthma and diseases caused by infection such as bronchitis, bronchopneumonia, and other pain-rarely cause obvious clinical symptoms, unless there is obstruction in the main bronchus. If the area of atelectsis was large and occurred very rapidly going to happen dipsneu with a pattern of rapid and shallow breathing, tachycardia and frequent cyanosis, high temperatures, and if continued will lead to loss of consciousness or shock. On percussion dim and perhaps also normal compensation in case of emphysema. In an extensive atelectasis, atelectasis involving more than one lobe, noisy breathing will weaken or no sound, usually obtained differences thoracic wall motion, the motion between the ribs and diaphragm. On percussion of the heart and mediastinum may limit will be shifted, the position of the diaphragm may be elevated.

Pathophysiology
After the blockage occurs suddenly bronchial peripheral blood circulation will be absorbed by the air of the alveoli, which will lead to respiratory failure and withdrawal of the lung within a few minutes, this is without desebabkan an infection. The lungs will shrink in the complex. In early levels, blood perfused lungs will lack the air that causes arterial hypocsemia. If the capillary and tissue hypoxia lead to the emergence of transudates in the form of gas and fluid and pulmonary oedema. Expenditures transudates of alveoli and cells is a complete prevention of collapse of lung atelectasis. However in case of diaphragm collapse extensive experience exaltation, chest wall pain, and this will affect the change of location of the heart and mediastinum.
Congested due to a variation of the central stimulus change respiration and cerebral cortex. The stimulus comes from the chemoreceptors in areas where there are extensive atelectasis causing less pressure or O2 from the lungs and respiratory muscles, lungs where oxygen deficiency is not met and the additional work of breathing. May the blood flow in areas of atelectasis is reduced. CO2 pressure is usually normal or should be down slightly from the rest of the lung parenchyma hyperventilation are normal.

Diagnosis
Diagnosis based on clinical symptoms and results of physical examination. Chest X-rays will show the existence of air-free areas in the lungs. To determine the cause of the blockage may be necessary CT - scan or fiber-optic bronchoscopy.
Collapse can be diagnosed by the presence of:

Increased density and pulmonary blood vessels are clustered
Change the location of the hilum or fissure (upwards or downwards). In normal circumstances where the lower right hilum of the left hilum
Shift of the trachea, mediastinum or fissures interlobaris toward the collapsed lung
The remaining lung can be highly developed (over-expanded) and thus become hipertranslusen.

Radiological Picture
Lung atelectasis can be said to have when all / most of the lung to deflate, there will be a homogeneous shadow on the sides of it, to heart and went to the department's trachea and the diaphragm lifted. When only one lobe of the atelaktasis caused by bronchial obstruction, may appear two characteristic abnormalities. The first abnormality is a shadow of a homogeneous than the deflated lobe itself, which will occupy a smaller space than when it develops at all.
A right upper lobe collapse would appear as an opaque area at the top, with a limit that is strictly concave beneath the clavicle near the fissures caused by the raised horizontalis.
The left upper lobe usually includes Lingula when deflated, and the resulting image is less firm without the firm lower limit. But in the lateral projection would seem a tongue-shaped shadow with a peak near the diaphragm; anteriorly, it may be up to the sternum, or may be separated by a translucent area of ​​the lungs caused by a slip right next to them and the sternum posterior shadow It has a clear boundary with concave boundary caused by large fissures are pushed to the front.
A middle lobe will cause a shadow that is not firmly on the anterior projection, but may blur the line than the right heart, in the lateral projection it will appear as a ribbon-shaped shadow extending from the hilum to the angle of the sterno-diafragmatikus. Strict upper limits established by the nearest horizontalis fissures, whereas the concave rear boundary by a major fissure is pushed forward.
Lower lobe is deflated causing a triangular-shaped shadow, with the lateral border of the firm that ran downward and outward from the hilum to the diaphragm. Therefore it is usually located behind the heart shadow, he can only be seen when the radiograph is good. On the lateral projection image may be blurred at all, but its presence usually gives three images; thoracic vertebrae at the bottom will look more gray than black than the vertebrae next to the middle; the posterior than the shadow of the left diaphragm will not be seen; and finally, vertebrae in the back area below the heart shadow will be less black than the translucent area behind the sternum.
The symptoms of the other characteristics are the consequence rather than vascular shadows have become blurred in the general opacity than lobes that do not contain air, while the shadows of blood vessels in the other lobe is more dispersed because it fills a larger volume. Hilar blood vessels on the affected side will show a disease and not a lateral convexity concafitas as in the normal state at the place where the group rather than the upper lobe artery basal met in addition, the hilum will be smaller than on the other side, while blood vessels of the lungs will be more dispersed, so per unit area will look much less than on the other side (normal). Only there will be little or no relative translucency, because of capillary flow increases, whereas the tracheal pressure or elevation of the diaphragm and heart are usually a little switch only slightly in the direction of the deflated lobe of the collapse than the lower lobe, or more often as not at all on the upper lobe collapse rather than.
Prevention & Treatment of Atelectasis

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