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Showing posts with label Emphysema. Show all posts
Showing posts with label Emphysema. Show all posts

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.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
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

Emphysema

Emphysema Lung Is the permanent widening of the structure of pulmonary gas exchange that is distal to the terminal bronchioles, accompanied by destruction of alveolar walls.

Etiology
  1. Main factors: smokers either active smoking or passive smoking depending on the length, number, how to smoke.
  2. Air pollution, in the form: Particles, These chemicals, Toxic Gas
  3. Infections: viral and bacterial
  4. Genetics:
a. Talent arise emphysema
b. The balance of destructive enzymes (protease) & protective enzymes (alpha-1-antitrypsin).

Google Image
Pathogenesis
Inhalation of cigarette smoke or pollutants stimulate cells in the lung macrophages and neutrophils produce elastase and collagenase is an enzyme that damages the fibers of elastin and collagen, and which is the framework of the alveoli and acini in order not to collapse. Smoking also inhibit the action of alpha-1-antitrypsin, an enzyme that protects elastin fibers against proteases.
In the lung there is a balance between destroying enzyme (protease) and protective enzymes (alpha-1-antitrypsin). Due to destruction of fibers of the lung elastin & collagen loss of elastic recoil.

Complaints and Clinical Symtomps
Progressive shortness of breath, tired easily when moving.
Pure emphysema without coughing, shortness, of breath sounds, sputum.
Breathing by means of "purse lips" aims to breathe more easily because of the onset of back pressure in the bronchioles so easy expiration and prevent "water trapping".

On physical examination found:
Chest barrel shaped chest, the space between the ribs widen.
Lung hyperinflation, the percussion sounds hipersonor, reduced chest expansion, difficulties inspiration, decreased breath sounds, rhonchi could be heard when there is phlegm.

Diagnosis
Based on anamnesa, complaints and symptoms, supplemented by investigation as follows:
  • PA chest X-ray photo:
Lung looks hyperaereted.
Reduced vascular picture and not look at the third peripheral lung field, it appears the bulla, where the diaphragm is low, little heart shape in the form of water droplets.
  • Tests pulmonary physiology:
Showed abnormalities obstruction.
FEV1 <80% pred. and restrictive decreased FVC <70%, RV> pred. in accordance with lung hyperinflasi
  • Examination of enzymatic:
Levels of alpha-1-antitrypsin is low.
  • Analysis of blood gases:

There hipercapnea hypoxemia and the alveoli as a result of capillary damage and interference ratio of ventilation / perfusion.

Differential Diagnosis

Management of Emphysema
  • Prevention: stop smoking, reduce exposure to air pollution.
  • There is no effective treatment and satisfactory.
  • Treatment with a new bronchodilator reversibility is given when there is obstruction.
  • Antibiotics are given if there are signs of respiratory tract infection.
  • Oxygen increases when crowded.
  • Rehabilitation of relaxation with breathing exercises, postural drainage, exercise improves breathing capacity.
  • Treatment of the complications.

Complications
  • Pneumothorax: outbreak caused superficial bulla
  • Respiratory failure: due to bad ratio of ventilation / perfusion
  • Cor pulmonale: arise due to pulmonary hypertension due to hypoxemia and pulmonary vasospasm
  • Weight loss until emasiasi.

Prognosis
In emphysema caused by deficiency of alpha-1-antitrypsin bad prognosis.
Prognosis is determined by:
  • The rate of progression of the emphysema
  • The degree of bronchial obstruction and reversibilitasnya
  • The presence of complications
  • The accuracy of the management of emphysema.
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