Paradoxical movement of chest and abdomen

Introduction Contradictory movement of the chest and abdomen means that the chest and abdomen movements of patients with emphysema are contradictory, that is, the thoracic movement moves outward when inhaling, and the abdominal wall moves inward. The pathogenesis of obstructive emphysema is not fully understood. It is generally thought to be associated with bronchial obstruction and protease-antiprotease imbalance. Smoking, infection, and air pollution cause bronchiolitis, narrowing or obstruction of the lumen. When inhaling, the bronchioles dilate and the air enters the alveoli; when exhaling, the lumen shrinks, the air stays, and the alveolar pressure increases, causing the alveoli to over-expand or even rupture. Loss of radial traction around the bronchioles causes the bronchioles to contract, causing the lumen to narrow.

Cause

The pathogenesis of obstructive emphysema is not fully understood. It is generally thought to be associated with bronchial obstruction and protease-antiprotease imbalance. Smoking, infection, and air pollution cause bronchiolitis, narrowing or obstruction of the lumen. When inhaling, the bronchioles dilate and the air enters the alveoli; when exhaling, the lumen shrinks, the air stays, and the alveolar pressure increases, causing the alveoli to over-expand or even rupture. Loss of radial traction around the bronchioles causes the bronchioles to contract, causing the lumen to narrow. Pulmonary intima thickening, decreased blood supply to the alveolar wall, weakened alveolar elasticity, etc., contribute to the expansion of the alveolar rupture. In the case of infection, etc., the activity of protease in the body is increased, and the activity of the anti-protease system in normal humans is correspondingly increased to protect the lung tissue from damage. The 1 antitrypsin deficiency has a reduced ability to inhibit protease, so it is more prone to emphysema. Smoking also has an adverse effect on protease-antiprotease balance.

an examination

Related inspection

X-ray examination of mammogram blood test

The clinical manifestations of symptoms are based on the degree of emphysema. Early can be asymptomatic or feel short of breath only during labor and exercise, and gradually become difficult to perform the original job. As the emphysema progresses, the degree of dyspnea increases, so that it is still short of breath during a little activity or even a complete rest. In addition, you can feel fatigue, weight loss, loss of appetite, and fullness of the upper abdomen. The main cause of emphysema is chronic bronchitis, so there are symptoms such as cough and cough in addition to shortness of breath. In the early stage, only the expiratory phase is prolonged or abnormal. In typical emphysema, the anteroposterior diameter of the thoracic cavity is enlarged, the barrel chest is chest, the respiratory movement is weakened, the speech tremor is weakened, the unvoiced sound is diagnosed, the heart dullness is reduced, the liver dullness is moved down, the breath sound is reduced, and sometimes the dry and wet can be heard. Luo Yin, heart rate increased, heart sounds low, the second heart sound of the pulmonary artery.

First, X-ray examination: thoracic expansion, rib clearance widened, ribs parallel, activity weakened, sputum reduced and flattened, the transparency of the two lung fields increased.

Second, ECG examination: generally no abnormalities, sometimes can be low voltage.

Third, respiratory function check: It is important to diagnose obstructive emphysema.

Fourth, blood gas analysis: If there is obvious hypoxic carbon dioxide retention, the arterial partial pressure of oxygen (PaO2) decreases, the partial pressure of carbon dioxide (PaCO2) increases, and decompensated respiratory acidosis can occur, and the pH value decreases. .

Fifth, blood and sputum examination: generally no abnormalities, secondary infections like acute episodes of acute episodes.

Differential diagnosis

Emphysema should pay attention to the differential diagnosis of tuberculosis, lung tumors and occupational lung disease. In addition, chronic bronchitis, bronchial asthma and obstructive emphysema are chronic obstructive pulmonary disease, and both chronic bronchitis and bronchial asthma can be complicated by obstructive emphysema. But the three have connections and differences, and they are not equivalent. Chronic bronchitis in the premalignant emphysema is mainly limited to the bronchial, may have obstructive ventilatory disorders, but to a lesser extent, the diffuse function is generally normal. The bronchial asthma manifested as obstructive ventilatory disorder and hyperinflation of the lungs, and the gas distribution may be severely uneven. However, the above changes are more reversible and better respond to inhaled bronchodilators. Diffusion dysfunction is also not obvious. Moreover, the airway responsiveness of bronchial asthma is significantly increased, and the fluctuation of lung function is also large, which is characterized by it.

Diagnosis can be diagnosed based on medical history, physical examination, X-ray examination and lung function tests. X-ray examination showed an increase in anterior and posterior diameter of the thoracic cavity, sternal protrusion, widening of the posterior sternal space, lower squat level, decreased lung texture, increased lung field transmittance, overhanging heart, widening of pulmonary artery and main branches, peripheral blood vessels small. Pulmonary function was measured as residual gas, increased total lung volume, increased residual gas/lung volume ratio, markedly lower 1 second rate, and decreased diffuse function.

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