CLINICAL PATHOLOGY OF LUNGS

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CLINICAL PATHOLOGY OF LUNGS

• Bakalets
• Olena Valeriivna

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Respiratory system

• The lungs are amazing machines that give a body
  all the oxygen it needs to live.
• The respiratory system are made up of many parts,
  and they are all very important.
• 1. Airways (nose, trachea, bronchi and
  bronchiole).
• 2. Respiratory zone (alveoli )

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http//www.youtube.com/watch?NR1featureendscree
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The main function of the respiratory system

• is gas exchange, oxygen uptake from the
  environment, and removing carbon dioxide from the
  body.
• External respiration
• consists of three processes
• 1. Alveolar ventilation
• 2. Diffusion
• 3. Perfusion

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http//wn.com/alveolar_gas_exchange
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Respiratory insufficiency is such pathological
state, when
the tension ?2 in arterial blood is reduced
(arterial hypoxemia)
the tension ??2 exceeds 50 mm Hg (hypercapnia)
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• Many specialists consider what respiratory
  insufficiency else such state, when the
  respiratory parameters of blood are within the
  physiological limits.
• Hypoxia and hypercapnia are missing.
• But the result of overexertion of the apparatus
  of external respiration.

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Forms of respiratory insufficiency
Acute respiratory insufficiency
Chronic respiratory insufficiency
Chronic bronchitis, emphysema, bronchiectasis etc.
?sphyxia
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Acute respiratory insufficiency

• is a condition in which symptoms develop
  quickly, within minutes, hours or days. They
  quickly progressed.

Arterial hypoxemia
Death
Manifestations
Coma
Hypercapnia
Disorders of the central nervous system
Respiratory acidosis
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Chronic respiratory insufficiency

• is characterized by
• Slow growth of hypoxia
• Slow growth of hypercapnia
• Smaller level of hypoxemia and hypercapnia
• Enabling of compensatory mechanisms
• 1) erythrocytosis
• 2) increase in hemoglobin

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?sphyxia

• is a typical example of
• acute respiratory insufficiency
• This state when
• 1) oxygen doesn't get into the blood
• 2) carbonic gas is not removed from blood
• Duration acute asphyxia in the human
• 3-4 mines

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Reasons of asphyxia

• sharp contraction of respiratory ways
• complete closing of respiratory ways
• external compression of respiratory ways
• presence in them of foreign bodies
• narrowing larynx (allergic edema)
• presence in respiratory ways and alveolars of
  liquid (sink, aspiration of vomit mass)
• swelling of lung
• double-side pneumothorax
• strong oppression of respiratory centre
• disturbance of transfer of impulses in
  neuro-muscular synapses (on respiratory muscles)
• massive traumas of thorax

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Periods of asphyxia

• The first period
• Excitation of respiratory center
• Frequent and deep breathing
• Tachycardia
• Increasing of arterial blood pressure
• Inspiratory dyspnea (initially)
• Expiratory dyspnea (at the end of the first
  period )

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Mechanisms of hypertension during asphyxia

• CO2 reflexly stimulates of vascular motors center
• Adrenal glands secrete norepinephrine and
  epinephrine
• Veins are reduced
• Volume of circulating fluid is increased
• Cardiac output is increased

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Second period of asphyxia

• Rare breathing
• Expiratory dyspnea
• Expressed hypoxemia
• Brain Hypoxia
• Bradycardia
• Arterial hypotension

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Third period of asphyxia

• Decrease of frequency and depth of breathing
• Preterminal pause
• Terminal-breath (Gasping-breath)
• Stop of breathing

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Processes that provide external respiration are

• Alveolar
  Diffusion
  ?2 and ??2
• ventilation
• through the
• alveolar wall
• 
  Perfusion
• of blood through
• the capillaries
• of the lungs
• 1. Ventilation 2.
  Alveolar-respiratory
• The forms of respiratory insufficiency

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Alveolar ventilation

• is update air in the lungs during inspiration

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Diffusion

• Diffusion is the exchange of gases through the
  alveolar wall and capillary membrane.

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Perfusion

• is a passing of blood
• through
• pulmonary
• capillaries

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Processes that provide external respiration are

• Alveolar
  Diffusion
  ?2 and ??2
• ventilation
• through the
• alveolar wall
• 
  Perfusion
• of blood through
• the capillaries
• of the lungs
• 1. Ventilation 2.
  Alveolar-respiratory
• The forms of respiratory insufficiency

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The ventilation respiratory insufficiency

• Essence lies in the fact in the alveoli per unit
  time comes less air than normal (alveolar
  hypoventilation).
• The reasons of ventilation failure
• connected to the apparatus of breath (lung
  reasons)
• not connected to apparatus of breath (outlung
  reasons)

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The outlung reasons are

• Disturbance of respiratory centre function
• Disorder of the motoneurons function of spinal
  cord, which innervating respiratory muscles
• Disorder of the function nervous-muscular device
  of breath
• Limitation of thorax mobility
• Disorder of thorax integrity and pleural cavity

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The disturbance of respiratory centre function

• is a result of
• effects of medical drugs
• cerebral-brain traumas with epidural or subdural
  hematoma
• malignant tumours of brain
• absceses of brain
• meningitis
• disorder brain circulation blood

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Disorder of the motoneurons function of spinal
cord, which innervating respiratory muscles

• is a result of
• tumour of spinal cord
• syringomyelia
• poliomyelitis

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Disorder of the function nervous-muscular device
of breath

• is a result of
• lesion of nerves
• avitaminosis
• inflammation
• trauma
• blockade of impulses transfer in nervous
  muscular synapses
• myasthenia
• action of myorelaxants
• lesion of respiratory muscles
• myositis
• dystrophia
• peripheral paralysis
• hypokaliemiya
• hypophosphatemia

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Limitation of thorax mobility

• is a result of
• congenital or acquired deformitions of ribs and
  vertebral
• ossification of ribs cartilage
• ascites
• flatulence
• obesity
• pain during neuralgia of intercostals nerves

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The pleural pathology

• are
• obliteration of the pleural cavity
• pneumothorax
• hydrothorax
• hemathorax
• pleurisy

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The forms of ventilation respiratory
insufficiency

• Depending on pathogenesis are
• Obstructive
• Restrictive
• Dysregulative
• (disorder of breath due to disorders central
  regulation).

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The obstructive form of respiratory
insufficiency

• Obstruction of respiratory ways is resulting
  narrowing the lumen and increase of resistance to
  movement of air.
• The damage can be located in upper respiratory
  ways (with diameter of 2 mm and more) and in
  lower respiratory ways (diameter up to 2 mm)

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The reasons of obstruction of upper respiratory
tract are

• Internal trauma most frequently it arises as
  complication of tracheal intubation, less often
  after operation on larynx.
• Externals mechanical trauma (fractures of lower
  jaw, cervical vertebrae, larynx cartilages,
  epiglottis, trachea, damage of basis of tongue,
  mouth, neck).
• Burns and inhalation of poisonous gases
• Bleeding into the airways
• Ludwig's angina
• Angioedema

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The reasons of obstruction of lower respiratory
tract are

• aspiration of the liquid environments of vomit
  mass, of blood, of water
• allergic response mainly on medical preparations
• chronic unspecific diseases lung chronic
  bronchitis, emphysema, bronchiectasis, bronchial
  astma
• It develops immediately, during 30 mines and
  expressed laryngo- and bronchospasm.

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Restrictive insufficiency

• This form of respiratory insufficiency arises,
  when the extensibility of lung is reduced (they
  can not capable easily to be straightened).
• To carry out a breath, it is necessary to
  increase transpulmonary pressure, and it can be
  made at the expense increase of action of
  respiratory muscles

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The reasons of restrictive insufficiency are

• Pulmonary fibrosis
• Pneumonia
•  Pulmonary edema
•  Pneumothorax
• Violation of surfactant systems
•   Atelectasis
•   The chest deflection
•   Paralysis of respiratory muscles

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Pathogenesis of respiratory distress syndrome
(RSD) in the infant.
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Alveolar-respiratory insufficiency.

• when gas exchange between alveolar air and blood
  is reduced.
• Two variants of such insufficiency are possible
• 1) due to inadequacy of ventilation and perfusion
  of lung
• 2) owing to difficulty diffusion of gases through
  alveolar wall.

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The causes of decrease diffusion lung are

• Reduction of alveolar surface (resection of the
  lung, abscess, atelectasis, emphysema)
• Thickening of alveolar membranes (fibrosis,
  sarcoidosis, pneumoconiosis, emphysema,
  scleroderma, pneumonia, pulmonary edema)
• Infectious diseases (interstitial pneumonia,
  influenza, measles, tuberculosis, fungal disease)

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The causes of decrease diffusion lung are

• The chemical agents that cause pneumonia
  (chlorine, phosgene, nitrous oxide, flour dust)
• The chronic diseases (uremia, systemic lupus
  erythematosus, sarcoidosis, scleroderma)
• Professional lung lesion (asbestosis,
  anthracosis, silicosis)

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The causes of decrease perfusion lung

• Myocardial infarction
• Cardiosclerosis
• Myocarditis
• Pericardial effusion
• Stenosis of pulmonary artery
• Stenosis of right atrioventricular opening
• Vascular insufficiency - shock
• Thromboembolism of pulmonary artery

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Thank you!
Be healthy!