Emphysema

Introduction to emphysema Emphysema refers to the airway elasticity of the distal bronchioles (breathing bronchioles, alveolar duct, alveolar sac and alveoli), excessive expansion, inflation and increased lung volume or accompanied by pathological changes of the airway wall. . According to the cause of the disease, emphysema has the following types: senile emphysema, compensatory emphysema, interstitial emphysema, focal emphysema, paraventricular emphysema, obstructive pulmonary qi swollen. basic knowledge The proportion of illness: 0.001% Susceptible people: environmental pollution, long-term exposure to organic or inorganic dust, exposure to harmful gases, smokers. Mode of infection: non-infectious Complications: respiratory failure, gastric ulcer, pulmonary hypertension

Cause of emphysema

Environmental factors (35%):

Various factors that cause chronic bronchitis, such as infection, smoking, air pollution, long-term inhalation of occupational dust and harmful gases, allergies, etc., can cause obstructive emphysema.

Body factor (30%):

The theory of the imbalance of elastase and its inhibitors.

Studies of the relationship between 1-antitrypsin deficiency and emphysema suggest that emphysema is caused by an imbalance of protease and anti-protease content in the lungs, which disrupts alveolar septum, and an animal model of massive emphysema supports this hypothesis, humans Emphysema studies have shown that the concentration of elastin is increased in patients with emphysema, smoking can increase elastin activity, inhibit lung fibroblast infiltration, resulting in increased tissue sensitivity to elastase, inhibiting resistance The activity of elastase, which is found to support smoking, breaks the balance between elastase and anti-elastase, causing damage to the fine structure of the lungs and causing emphysema.

Pathogenesis

1. Pathological changes of emphysema: emphysema is an abnormal enlargement of alveolar and alveolar duct caused by various causes and destruction of alveolar wall, which increases the amount of residual gas in the lung. According to the extent of the affected alveoli, it is divided into small leaf central lung gas. Swollen (often located at the tip of the lung), total lobular emphysema (often at the base of the lung) and distal lobular emphysema, total lobular and lobular central emphysema associated with smoking, both types Emphysema often exists in the upper lobe or lower lobe of the lung. When the emphysema is severe, tracheal obstruction also develops. The recurrent bronchial inflammation causes tracheal obstruction, pulmonary interstitial destruction, causing trachea. Loss of mechanical support, causing it to collapse and obstruction of the trachea, resulting in increased gas in the lungs, forming an air cavity.

2, emphysema pathophysiology: the function of respiratory muscles in the emphysema patients have significant changes, other respiratory assisted muscles, intercostal muscles can not work on the normal length-tension curve, the degree of swelling of the diaphragm muscles, so that When the contraction is performed, sufficient intrathoracic negative pressure cannot be formed. When the diaphragm is flattened, the lower thorax is pulled downward during contraction, and the lungs are squeezed, which has a reverse effect on the respiratory effect, causing the diaphragm to become larger when the diaphragm is contracted. The function is converted to exhalation, the destruction of the alveolar wall structure reduces the capillary bed of the lung, the destruction of the pulmonary microcirculation increases the pulmonary vascular resistance, and the pulmonary blood flow resistance of the emphysema patient is inversely related to the CO diffusion capacity of the lung. Therefore, before pulmonary hypertension occurs in patients with emphysema, there must be serious damage to the gas exchange function.

Emphysema prevention

1. The first is to quit smoking.

2, pay attention to keep warm, avoid cold, prevent colds.

3. Improve environmental sanitation, do personal labor protection, eliminate and avoid the effects of smoke, dust and irritating gases on the respiratory tract.

Emphysema complications Complications, respiratory failure, gastric ulcer, pulmonary hypertension

Respiratory failure, gastric ulcer, pulmonary hypertension.

Pulmonary emphysema symptoms Common symptoms Barrel chest mediastinum dullness sound enlargement transverse sputum low flat breath sound weakened breath sound prolonged small bronchial mucosa edema thick or purulent sputum with... Chest tightness lung voice after labor impatience

1, slow onset, many chronic cough, history of cough, early symptoms are not obvious, or feel tired when tired, with the development of the disease, breathing difficulties gradually increase, so that it is difficult to do the original work, slow support in concurrent obstructive In the case of emphysema, on the basis of the original cough, cough and other symptoms, there is a gradual increase in breathing difficulties. When secondary infection occurs, chest tightness, shortness of breath, cyanosis, headache, lethargy, delirium and other respiratory failure symptoms, lungs When the swelling is aggravated, the barrel chest is appeared, the breathing movement is weakened, the exhalation is prolonged, the speech vibrato is weakened or disappeared, the percussion is silenced, the heart sounds are narrowed or disappeared, the liver dullness is decreased, the heart sound is far away, the breath sound is weakened, and the lungs are wet. Voice, some patients have complications: spontaneous pneumothorax, acute lung infection, chronic pulmonary heart disease.

2. There were no abnormalities in mild emphysema. When the emphysema was aggravated, the anteroposterior diameter of the thoracic cavity increased. The appearance was barrel-shaped, the kyphosis, the shoulder and the clavicle were lifted up, the intercostal space was full, the rib and clavicle activity was weakened, and the tremor was weakened. Weakened, percussion was unvoiced, heart sounds narrowed or disappeared, liver dullness decreased, breath sounds and tremors weakened, exhalation prolonged, sometimes lungs could smell dry and wet, heart sounds far away, pulmonary heartbeat second heart sounds Patients with severe emphysema, even at rest, may have a shallow breathing, almost no breath sounds, and may have cyanosis. In the case of right heart failure with pulmonary heart disease, jugular vein engorgement, ascites, and liver may occur. Depression edema and other signs.

Emphysema examination

First, X-ray inspection:

The thoracic expansion, the intercostal space is widened, the ribs are parallel, the activity is weakened, the ankle is lowered and flattened, and the translucent brightness of the two lung fields is increased.

Second, ECG examination:

Generally no abnormality, sometimes it can be low voltage.

Third, respiratory function check:

It is important for the diagnosis of obstructive emphysema.

Fourth, blood gas analysis:

In the case of obvious hypoxic carbon dioxide retention, the arterial partial pressure of oxygen (PaO2) is lowered, the partial pressure of carbon dioxide (PaCO2) is increased, and decompensated respiratory acidosis may occur, and the pH value may decrease.

5. Blood and sputum examination:

Generally no abnormalities, secondary infections like acute episodes of acute episodes.

Diagnosis of emphysema

diagnosis

According to the medical history, physical examination, X-ray examination and lung function measurement, the diagnosis can be diagnosed. X-ray examination shows that the anterior and posterior diameter of the thoracic cavity is increased, the sternal protrusion, the posterior sternal space is widened, the transverse squat is low, the lung texture is reduced, and the lung field is transparent. Increased degree, drape type heart, pulmonary artery and main branches widened, peripheral blood vessels are small, lung function measured as residual gas, total lung volume increased, residual gas / lung total ratio increased, 1 second rate decreased significantly, diffuse function decreased, The diagnosis of emphysema, especially early diagnosis, is difficult. It should be combined with medical history, physical signs, chest X-ray and pulmonary function tests. Any diseases that cause airway obstruction such as bronchitis, chronic bronchitis, bronchial asthma, tuberculosis After a history of illness, the urgency increased gradually, and the lung function test showed an increase in residual gas and residual gas/pulmonary volume. The latter exceeded 35%, and the forced expiratory volume/forced vital capacity ratio decreased in the first second, <60%, or the maximum ventilation accounted for The estimated value is below 80%, the gas distribution is uneven, the diffusion function is reduced, and the bronchodilator treatment, the lung function is not significantly improved, can be diagnosed.

Differential diagnosis

Should pay attention to the differential diagnosis of tuberculosis, lung tumor and occupational lung disease, in addition to chronic bronchitis, bronchial asthma and obstructive emphysema are chronic obstructive pulmonary disease, and chronic bronchitis and bronchial asthma can be complicated by obstructive pulmonary qi Swollen, but the three have connections, but also different, can not be equal, chronic bronchitis in the premalignant emphysema is mainly limited to the bronchial, may have obstructive ventilatory disorders, but to a lesser extent, diffuse function is generally normal, bronchial asthma attacks The period is obstructive ventilatory disorder and pulmonary hyperinflation, the gas distribution can be severely uneven, but the above changes are more reversible, better response to inhaled bronchodilators, diffuse dysfunction is not obvious, and bronchial asthma airway responsiveness Significantly increased, lung function fluctuations are also large, which is characterized by it.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.