Internal illnesses. Emphysema (most important)

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Internal illnesses. Emphysema (most important)

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36. PULMONARY EMPHYSEMA

A condition characterized by an increase in the size of the air spaces located distal to the terminal or non-respiratory bronchioles due to expansion or destruction of their walls.

Etiology. The cause of the disease can be chronic obstructive pulmonary disease, chronic pneumonia, pneumoconiosis, tuberculosis.

Pathogenesis. There is a narrowing of the lumen of the bronchi, an increase in intra-alveolar pressure, thinning of the walls of the alveoli, a violation of their trophism, elasticity, development of alveolitis, destruction of the interalveolar septa.

Classification. Emphysema has forms: interstitial, mediastinal, compensatory.

Clinically, pulmonary emphysema is classified:

1) by origin: primary (idiopathic) - hereditary insufficiency of a-1-antripsin, b-2-macroglobulin, secondary (due to the development of chronic obstruction of the bronchial lumen);

2) by the nature of development: acute (due to sudden prolonged bronchial obstruction - after an attack of bronchial asthma), chronic (due to the presence of permanent bronchial obstruction);

3) by complications.

Clinic. Primary pulmonary emphysema is manifested by shortness of breath (uncaused) of an expiratory nature, unproductive cough, and the appearance of an emphysematous (breathing) type of obstruction.

With secondary emphysema, a pink complexion, dry cough is noted, with exacerbation of chronic bronchitis with mucopurulent or purulent sputum, expiratory shortness of breath. It develops gradually and begins to bother you in the 6th-7th decade of life. There is a barrel-shaped chest, retraction of the intercostal spaces when inhaling, participation of auxiliary muscles in breathing, a short neck, swelling of the jugular veins, and acrocyanosis. A bronchotic type of obstruction appears (“cyanotic edema”), patients lose weight, and often sleep sitting. On percussion, there is a boxy tint, the lower borders of the lungs are lowered by 1-2 ribs, their mobility is limited, the apexes of the lungs bulge above the clavicles. The pulmonary heart is formed according to the right ventricular type (in the terminal stages), liver enlargement.

Diagnostic research. A general blood test is performed, where compensatory erythrocytosis, a moderate increase in ESR are noted.

A functional study of the lungs is carried out - there is a decrease in the forced expiratory rate, a decrease in the Tiffno index, a decrease in the vital capacity of the lungs with an increase in the total and residual capacity, a decrease in the diffuse capacity of the lungs.

Inhalation tests with bronchodilators are negative.

The ECG shows right atrial hypertrophy (increased P and right ventricle (S)).

X-ray examination - increased transparency of the lung fields, low standing of the diaphragm, dilated intercostal spaces.

Treatment. If there is a bronchopulmonary infection, antibiotics are prescribed. Bronchodilators (M-anticholinergics, b2-agonists, methylxanthines), mucolytics, oxygen therapy, physiotherapeutic procedures, therapeutic exercises, spa treatment (in the absence of severe pulmonary heart failure) are indicated.

Flow. Chronic, progressive.

Forecast. Adverse.

Author: Myshkina A.K.

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