EMPHYSEMA DEFINITION

 Emphysema is a condition of the lung characterized

by abnormal, permanent enlargement of the airspaces distal to

the terminal bronchiole, accompanied by destruction of their walls.

Fat embolism triad

 Hypoxemia

Neurological abnormalities

Petechiae

COPD -GOLD Definition

COPD is a common preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation, due to airway/alveolar abnormalities, usually caused by significant exposure to noxious particles or gases and influenced by host factors like abnormal lung development.

Medium pitched breath sounds

 Bronchovesicular breath sounds are medium pitched.

Both inspiration and expiration heard.

No pause in between.

Often heard over upper third of anterior chest wall.

Spinoscapular distance

 Measurement of distance between the inferior angle of scapula and the closest horizontal spinous process of the thoracic spine.

Skodaic resonance

Skodaic resonance is a high pitched sound elicited by percussion over a cavity just above the level of pleural effusion.

Causes of Localised bulging on chest wall

 A.Chest wall

    -Boils, Lipoma, Fibroma

B.Ribs and Cartilage

    -Osteomyelitis, Costochondritis

C.Pleura

    -Encysted pleural effusion, Epyema necessitans

D.CVS

    -Enlargement of cardiac chamber, Aortic aneurysm

E.Lungs

    -Actinomycosis of lung and chest wall

F.Swelling in pectoral area

    -Subpectoral abcess, Pectoral major tendon rupture, Post pectoral implant procedure, Post pacemaker implantation, Pectoral muscle rupture with hematoma

G.Others

    -Bony prominence, Surgical emphysema 

Post tussive - crackles

 

These crackles are not present normally on auscultation but can appear after a bout of cough. Crackles appear as the cough dislodges the thick secretions. It is present in early pneumonia, early tuberculosis, and lung abscess

Bronchophony

 Bronchophony, is the abnormal transmission of sounds from the lungs or bronchii. It is a general sign, detected by auscultation. The patient is requested to repeat a word several times  while the physician auscultes symmetrical areas of each lung. Normally, the sound of the patient's voice becomes less distinct as the auscultation moves peripherally; bronchophony is the phenomenon of the patient's voice remaining loud at the periphery of the lungs or sounding louder than usual over a disctinct area of consolidation...seen in conditions like consolidation, cavity communicating with a bronchus,above the level of pleural effusion

TERMINAL RESPIRATORY UNIT

                                                     TERMINAL RESPIRATORY UNIT 

It consists of all alveolar ducts and all of the accompanying alveoli that stem from the proximal respiratory bronchiole.

In human, one unit contains approximately 100 alveolar ducts and 2000 alveoli. It measures about 5mm diameter and 0.02ml volume at FRC. An acinus contains 10-12 Terminal Respiratory Unit(TRU). 

The gas exchange amongst the structures in TRU occurs more rapidly. All parts of the TRU participate in volume changes in respiration.

Alveoli is a complex structure with flat walls and sharp curvature at the junctions between the walls. The wall of the alveoli are predominately made of pulmonary capillaries.

 The inner lining of the alveoli are made up of cuboidal type II cells and flattened type I cells. The type I cells occupy all surface area of the lung though their number is less than Type II cells.

 Ref : Murray