Bronchogenic Carcinoma

Bronchogenic carcinoma is a malignant primary lung tumors, which originate from the respiratory tract.

Pathophysiology and Etiology
Etiology of bronchogenic carcinoma is not known definitely.
Factors that are considered influential:
Inhaled long-term (15-20 years) of carcinogenic substances,
such as:

• Cigarette smoke
• Exposure to industry: asbestos, nickel, "ion exchange resin", arsenic.
• Predisposing family relations / race (not clear).
• Scar tissue in the lung because of other diseases, like tuberculosis, pulmonary infarction.

Clinical Symptoms and Diagnosis
1. Symptoms intrapulmoner:

• Cough
• Coughing up blood
• Shortness of breath
• Chest pain
• Stridor unilateral

2. Symptoms intratorakal metastatic to other organs such as:

• Phrenic nerve: parese / paralise diaphragm.
• Recurrent nerve: parese / paralise vocal cords.
• Sympathetic nerves: from Horner's syndrome.
• Esophagus: disfagi.
• Superior vena cava: the superior vena cava syndrome.
• Traka & Bronchial: ateletaksis or shortness of breath.
• Cardiac: Functional impairment, effusion pericarditis.

3. Non-metastatic extrapulmonary symptoms:

• Neuromuscular: cause neuropatia carsinomatosa
• Endocrine disorders / metabolic : Cushing's syndrome, carcinoid syndrome, SIADH + hyponatremia, hyperparathyroidism hiperkalsemi + + hyperglycemia ginekomasti insulin secretion, hyperpigmentation.
• Disruption on the network: "hyperthrophy pulmonary osteoarthropathy". tissue / bone.
• Disturbances in vascular: 'thrombophlebitis migrans', anemia, purpura, and hematologic.

4. Extrapulmonary symptoms: the brain, liver, bone.
5. Systemic symptoms: anorexia.

Body weight decreased by more than 4 kg within 6 months.

Special Examination:

• X-ray photo chest, sputum cytology or biopsy material other.
• complete Bronchoscopy.
• lymph node biopsy, percutaneous lung biopsy.
• Bronchography, C.T scan and
• Surgical explorative.

Diagnosis
Based on the symptoms allegedly due to bronchogenic carcinoma and accompanied by a special examination support.

Differential Diagnosis

• The foreign objects.
• Fungi.
• Tuberculosis.
• Hamartoma.
• Metastatic tumors.
• Autoimmune Diseases.

Management Of Bronchogenic carcinoma
A. Bronchogenic carcinoma Non-Small Cell Type.

If still operabel then performed the operation.
For non operabel cases, palliative treatment.

B. Bronchogenic carcinoma Small Cell Type.

Generally not operated on, and therefore usually has spread at the time of the diagnosis.
For evaluation purposes, TMN staging was not done, but divided into:
"Limited disease": tumor limited to the hemitoraks and ipsilateral gland.
"Extensive disease": the tumor has spread beyond (1).

Prevention
Cigarettes are the leading cause of bronchogenic carcinoma.
But if people quit smoking for 3 years, the risk of bronchogenic carcinoma becomes smaller than the original. If the patient stops smoking for 10-13 years, the risk of bronchogenic carcinoma together with individuals who are not smokers.

Prognosis
5-year survival ("5 years survival rate").

• To bronchogenic carcinoma Small Cell Type = 0%.
• To bronchogenic carcinoma Non-Small Cell types depending on the stages and do surgery or not.

Phase I + operation: for epidermoid carcinoma = 54%. adenocarcinoma cell & large = 51%.
Phase II + operation: epidermoid carcinoma = 35%. adenocarcinoma cell & large = 18%.
Without surgery: survival of 5 years, less than 10%.

Tags : bronchogenic cancer, small cell carcinoma, bronchogenic carcinoma symptoms, bronchial carcinoma

Management of COPD

The goal of COPD management are:

1. Touch ups the ability of people with symptoms mengatasiu not only in the acute phase, but also the chronic phase.
2. Improving the ability of the patient in carrying out daily activities.
3. Reducing the rate of progression of disease if the disease can be detected early.

Management of COPD in the elderly are as follows:

1. Etiological factors negate / precipitation, for example immediately stop smoking, avoid air pollution.
2. Cleaning the bronchial secretions to help in various ways.
3. Eradicate the infection with antimicrobial. In the absence of antimicrobial infections need not be given. Provision of appropriate antimicrobial should be in accordance with the germs that cause infections according to the results of sensitivity testing or empirical treatment.
4. Overcome bronchospasm with bronchodilator drugs. The use of corticosteroids to resolve the inflammatory process (bronchospasm) is still controversial.
5. Symptomatic treatment.
6. Treatment of the complications that arise.
7. Oxygen treatment, for those who need. Oxygen should be administered with a slow flow of 1-2 liters / minute.
8. Rehabilitation actions which include:

• Physiotherapy, mainly aims to help the expenditure of bronchial secretions.

• Breathing exercises, to train the patient in order to make the most effective breathing.

• Exercise with weights oalh particular sport, with the aim to restore physical fitness.

• Vocational guidance, the work done against the patient can re-do their previous occupation.

• Psychosocial management, primarily intended for patient self-adjustment to her illness.

 COPD (Chronic Obstructive Pulmonary Disease)

Tags : Management of COPD, COPD treatment, The goal of COPD management,

COPD (Chronic Obstructive Pulmonary Disease)

COPD(Chronic Obstructive Pulmonary Disease) is a broad classification of disorders that includes chronic bronchitis, bronchiectasis, emphysema and asthma, which is an irreversible condition associated with dyspnea on exertion and decreased air flow in and out of the lungs.
Chronic obstructive pulmonary disease is a disease that causes airway obstruction, including therein is asthma, chronic bronchitis and emphysema Pulmonum.
Chronic obstructive pulmonary disease is a lung disorder characterized by impaired lung function in the form of prolonged expiratory period caused by the narrowing of the airways and not much changed in the period of observation for some time.
Disease chronic obstructive lung is a term used for a group of lung diseases that last long and is characterized by increased resistance to air flow as the main pathophysiological picture.

Classification
Diseases included in chronic obstructive pulmonary disease group are as follows:
1. Chronic Bronchitis
Bronchitis is a clinical definition to cough almost every day accompanied by sputum expenditure, at the lack of 3 months in a year and occurred at least 2 consecutive years.
2. Pulmonary emphysema
Pulmonary emphysema is an anatomic definition, namely a change of anatomic lung characterized by abnormal widening of the distal bronchial airways terminalis, which is accompanied by alveolar wall destruction.
3. Asthma
Asthma is a disease characterized by hypersensitivity tracheobronchial branches of various types of stimuli. This condition manifests as narrowing the channels of periodic breathing due to bronchospasm and reversible.
4. Bronchiectasis
Bronchiectasis is a chronic dilatation of bronchi and bronchioles yan may be caused by various conditions, including pulmonary infections and bronchial obstruction, foreign body aspiration, vomit, or the objects of the upper respiratory tract, and the pressure of the tumor, which dilates blood vessels and lymph node enlargement.

Etiology
The etiology of this disease is unknown. The disease is associated with the risk factors contained in people include:
1. Cigarette smoking is a long
2. Air Pollution
3. Peru recurrent infections
4. Age
5. Gender
6. Race
7. Alpha-1 antitrypsin deficiency
8. Deficiency of anti-oxidants
The effect of each risk factor for COPD is the occurrence of mutually reinforcing factors and smoking are considered the most dominant.

Pathophysiology
Lung function decline with the advent of old age are caused by elasticity of lung tissue and chest wall dwindle. In a more advanced age, the strength of respiratory muscle contraction can be reduced making it difficult to breathe.
Lung function to determine a person's oxygen consumption, ie the amount of oxygen bound by blood in the lungs to the body uses. Oxygen consumption is closely related to blood flow to the lungs. Reduced lung function is also caused by reduced function of the respiratory system such as pulmonary ventilation function.
Risk factors mentioned above will bring the process of bronchial inflammation and bronchial wall damage apda terminalis. Damage will occur as a result of the small bronchial obstruction (terminal bronchioles), which experienced early closure or obstruction of expiratory phase. The air that easily fit into the alveoli during inspiration, during expiration many trapped in the alveoli and there was a buildup of air (air trapping). This has led to complaints of shortness of breath with all its consequences. Obstruction in the early expiration will cause trouble and cause a lengthening expiratory expiratory phase. Pulmonary functions: ventilation, gas distribution, gas diffusion, and perfusion of blood will have the disorder (Brannon, et al, 1993)

Examination Support
Investigations required are as follows:
A. Radiological Examination
In chronic bronchitis radiological there are some things to note:

1. Tubular shadows or farm lines visible shadow lines are parallel, out from the hilum toward the lung apex. The shadow is the shadow of a thickened bronchus.
2. Pattern of increased lung

In pulmonary emphysema there are two forms of abnormal chest images are:

1. Picture of arterial deficiency, occurs overinflasi, pulmonary oligoemia and bullae. This situation is more often found in panlobular emphysema and pink puffer.
2. Pattern lung is increased.

B. Examination of Lung Physiology
In chronic bronchitis there is a KV VEP1 and declining, VR is growing and a normal ID card. In pulmonary emphysema there is a decrease VEP1, KV, and KAEM (arum expiratory maximum speed) or MEFR (maximal expiratory flow rate), KRF and VR increases, whereas KTP increased or normal. The situation above is more clearly at an advanced stage, being at an early stage changes only to the small airways (small Airways). In emphysema decreased diffusion capacity of the alveoli due to surface diffusion is reduced.

C. Blood Gas Analysis
In bronchitis PaCO2 increased, decreased hemoglobin saturation, arise cyanosis, pulmonary vascular vasoconstriction occurs and the addition eritropoesis. That chronic hypoxia stimulate erythropoietin formation, giving rise to polycythemia. At the age of 55-60 years polycythemia conditions causing right heart must work harder and is one of the causes of right heart trouble.

D. ECG
Abnormalities of the earliest was a clock wise rotation of the heart. If there is a cor pulmonale was found to right axis deviation and P pulmonale on delivery II, III, and aVF. Low QRS voltage ratio in V1 R / S is more than 1 and V6 ratio R / S is less than 1. There are often incomplete RBBB.

E. Cultures of sputum, to determine the cause of infection petogen.


F. Complete blood laboratory


Management of COPD


Tags : What Is COPD, COPD Symptoms, COPD treatment, COPD Stages, COPD Disease, Asthma COPD, COPD Pathophysiology, COPD Etiology, COPD Sign Symptoms, COPD Guidelines, COPD life expectancy

Asbestosis

Asbestosis is a respiratory disease caused by inhaling asbestos fibers, where the lungs extensive scar tissue is formed.

Asbestos minerals consist of silicate fibers with different chemical composition. If inhaled, asbestos fibers settle in the lungs, causing scarring.
Inhaling asbestos can also cause thickening of the pleura (the membrane lining the lungs).

Causes
Inhaling asbestos fibers can cause scarring (fibrosis) in the lungs.
Lung tissue fibrosis that forms can not inflate and deflate properly. Severity of the disease depends on the duration of exposure and the number of fibers inhaled.



Exposure to asbestos can be found in the mining and milling, construction and other industries.
Exposure to asbestos workers' families can also occur from particles brought home on the clothing of workers.

Diseases caused by asbestos include:

• Pleural plaques (calcification)
• Malignant mesothelioma
• Pleural effusion.

Mesothelioma can occur within 20-40 years after exposure.

Cigarette smoking causes increased risk of diseases caused by asbestos.
The number of events is equal to 4 among 10,000 people.

Symptoms
Asbestosis Symptoms appear gradually and emerging only after the formation of scar tissue in large quantities and the lungs lose their elasticity.

The first symptoms are shortness of breath and decreased ability to mild exercise.
About 15% of patients, will experience severe shortness of breath and respiratory failure.

Heavy smokers with chronic bronchitis and asbestosis, will suffer from coughing and wheezing.
Inhaling asbestos fibers can sometimes lead to accumulation of fluid in the space between the membranes lining the lungs. Although rare, asbestos can also cause tumors in the pleura, called mesothelioma, or the lining of the abdomen called peritoneal mesothelioma.

Mesothelioma caused by asbestos is malignant and can not be cured.
Mesothelioma generally arise stelah krokidolit exposed, one of four types of asbestos.
Amosit, other types, also cause mesothelioma.
Krisotil may not cause mesothelioma, but is sometimes tainted by tremolit that can cause mesothelioma.
Mesothelioma usually occur after exposure for 30-40 years.

Lung cancer will occur in patients with asbestosis who also smoke, especially those who smoked more than 1 (one) pack a day.

Other symptoms that may be found:
- Cough
- Tightness in chest
- Chest pain
- Nail abnormalities or clubbing fingers (fingers form that resembles a drum percussion).

Diagnosis
On physical examination using a stethoscope, you hear a voice crackles
To confirm the diagnosis, usually performed the following checks:

• Chest radiograph
• Lung function tests
• CT scan of the lung.

Treatment
Supportive treatment to overcome the symptoms is to remove mucus / phlegm from the lungs through the procedure postural drainage, chest percussion and vibration.
Given drugs to thin the mucus spray.
May need to be given oxygen, either through a facemask (mask) or through a plastic tube that is placed in the nostrils.

Sometimes performed lung transplantation.
Fatal mesothelioma, chemotherapy is not very useful and removal of the tumor does not cure cancer.

Prevention
Asbestosis can be prevented by reducing levels of asbestos fibers and dust in the working environment.
Because the industry that uses asbestos dust control has been done, now suffering from asbestosis fewer, but still mesothelioma occur in people who have been exposed 40 years ago.

To reduce the risk of lung cancer, to workers dealing with asbestos, it is recommended to quit smoking.

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How to Diagnose Occupational asthma

To make a diagnosis Occupational asthma, please note a history of atopy, exposure assessment, immunology (molecular and cellular), photograph and physiology as hipereaktivitas lung bronchus, lung function series, the specific inhalation test is the gold standard.

The diagnosis of occupational asthma in principle is to connect the clinical symptoms of asthma in the working environment is therefore a need for a good history and appropriate investigations. Thorough history of what happened in the work environment is essential, such as: when to start work somewhere this time, what the job before at work today, what is done every day, the process of what happens in the workplace, the materials used in the production process and the data material. And that is not less important is the field review by the examiner (doctor) to better understand the field situation.



In addition to the history of the workplace, which should also know is about the clinical happening. When the first occurrence of complaints, since these began to enter the place or what is known as the latent period. Latent period can be several weeks to several years, usually 1-2 year. Clinical tightness, coughing, wheezing may occur during work, after work (evening and night) or both. When the frequency of attacks more often / deteriorated during weekdays than weekends or holidays, it can be suspected asthma that arise related to the workplace.

Investigations Spirometry (FEV1 checks) before and after the shift. Said to be positive if FEV1 decreased by more than 5% between before and after work; on the normal variable is less than 3%. This examination by many experts doubt the sensitivity because one study only 20% of patients with asthma due to colophony which fell during the workshift FEV1nya; while the decline in FEV1 is also found in 10% of a group of people who are not asthmatic (control).

Another way is to measure FEV1 and FVC in workers (suspected occupational asthma) are excluded from the work environment and then measured again at work again. If the results show improvement over leaving the workplace and supported by improvements to the complaints, it can be inferred the existence of the relationship of clinical and workplace grievances.

PEFR: Examination of serial PEFR (peak expiratory flow rate) during weekdays and a few days off at home, an examination of occupational asthma is best. It said the positive response when the curve measurements during the holidays at home is better than during weekdays.

Provocation test

There are two kinds of checks:

1. Namely non-specific bronchial provocation using histamine or methacholine. This examination is only proving the existence of bronchial hiperreaktif.
2. Specific bronchial provocation with allergens is the suspected cause. This examination can be carried out when the best way of proving that the allergen is the cause of the workplace. The difficulty lies in determining the cause and reproduction when allergens are known.

Skin tests and serological tests
This examination can be done if the causative agent of its large molecular weight material as it will stimulate the immunological reactions (IgE).

Management of Occupational asthma

Tags : Occupational asthma Diagnosis, Occupational asthma Provocation test, suspected occupational asthma

Management of Occupational asthma

To prevent the occurrence of occupational asthma is a medical examination prior to employment, use of protective equipment, monitoring air pollutants in the working environment is highly recommended. If occupational asthma has occurred, then transfer to the outside of the work environment is important. If for some reason can not be moved then it must be the prevention and monitoring of lung function decline.

Periodic evaluation of lung function in workers who already suffer from occupational asthma are needed to prevent disability. Clinical asthma will persist until a few years even though the worker has been out of work environment.



Medical treatment in patients with occupational asthma such as bronchial asthma in general:

1. Theophylline, a bronchodilator and may suppress neutrophil chemotactic factor. Effectiveness of the two functions above depend on the serum levels of theophylline.
2. Beta agonists, bronchodilators are the most good for the treatment of occupational asthma in comparison with cholinergic antagonists (ipratropium bromid).
3. The combination of beta-agonists with ipratropium bromid improve lung function is better than just a beta agonist alone.
4. Corticosteroids, from various studies is known to prevent the bronchoconstriction caused by bronchial provocation with allergens. It will also improve lung function, decrease exacerbations and airway hiperesponsivitas and will ultimately improve the quality of life.

How to Diagnose Occupational asthma

Tags : Occupational asthma Management, Occupational asthma treatment,  Occupational asthma therapy

Occupational asthma

Occupational asthma is a respiratory disease characterized by attacks of shortness of breath, wheezing and coughing, which is caused by a variety of materials encountered in the workplace.

These symptoms usually occur due to spasm of the muscles lining the airways, so that the airway becomes very narrow.

Cause
Many substances (allergens, the cause of the symptoms) in the workplace that can cause asthma due to work. The most common are protein molecules (wood dust, grain dust, animal dander, mold particles) or other chemicals (especially diisocyanate).
Exact figures of the incidence of asthma because of the work is unknown, but suspected of approximately 20-20% of asthma in industrialized countries was asthma because of the work.



The workers who are at high risk for suffering from asthma because of the work is;

• Plastic workers
• Metal worker
• Firing workers
• Mill worker
• Workers grain
• Laboratory workers
• Woodworker
• Workers at the pharmaceutical
• Workers at the detergent factory.

Symptoms
Symptoms usually occur shortly after exposure to the allergen and is often reduced or disappear if the patient leaves his workplace.
Symptoms often get worse during the working day and improved on weekends or holidays.

Some patients experienced new symptoms within 12 hours after exposure to the allergen.

Symptoms include:

• Shortness of breath
• Asthma
• Cough
• Feel the tightness in the chest.

Diagnosis
In the history of the disease, patients usually experience a worsening of symptoms when exposed to certain allergens in the environment where she worked.
On examination with a stethoscope would hear a wheezing (asthma, wheezing).

Other tests are usually performed:

• Pulmonary function tests
• Measurement of peak expiratory flow rates before and after work
• Chest radiograph
• Calculate blood type
• Bronchial provocation tests (to gauge reaction to the suspected allergen)
• Blood tests to find specific antibodies.

Prevention
Industries that use substances that can cause asthma, must control dust and air, because to eliminate it is an impossible thing.

Workers with severe asthma, if possible, should change his occupation because of constant exposure will make asthma worse and are settled.

If the allergen / cause has been unknown, to prevent the occurrence of symptoms, patients should avoid the allergen.

How to Diagnose Occupational asthma
Management of Occupational asthma

Tags : Occupational asthma cause, Occupational asthma symptoms, Occupational asthma diagnose, Occupational asthma Prevention, Occupational asthma Treatment,