Thoracic Cage Deformites, Obesity

Thoracic cage deformities

Respiratory impairment within thoracic cage deformities is due to a combination of factors

1. Elastic WOB is increased due to stiff thoracic cage

2. Diaphragm and other muscles of ventilation are at a

mechanical disadvantage from abnormal geometry

3. Lung volumes are reduced, and lung growth can be limited

in children

Manifests as: sleep disordered breathing (sleep hypoventilation) and progresses to daytime hypercapnia and pulmonary hypertension if untreated

Scoliosis

spine is curved to one side, typically appearing as an S or C
shape (lateral curvature)

Kyphosis

posterior curvature (convex) of spine occurring in the thoracic

and sacral regions (“humpback/hunchback”)

Kyphoscoliosis

Combination of both these thoracic deformities

• In severe cases, the deformity can compress the lungs &

restrict alveolar expansion → hypoventilation & atelectasis

• Impaired ability to cough & mobilize secretions

Kyphoscoliosis alteration

• Lung restriction/

compression

• Mucous accumulation

• Atelectasis

• Cor Pulmonale

CXR

Mediastinal shift in the same direction as the lateral curvature

increase density of compressed areas

Ankylosing Spondylitis (AS)

• A systemic rheumatic disease that affects the spine and thoracic cage

• Chronic joint inflammation ultimately leads to fusion of the vertebral bodies and ribs

Typically leading to severe kyphosis and a dramatic decrease in thoracic cage compliance

in severe cases of AS, complete fusion and ridgity of the spine can occur .. what is the percentage of patients develop parenchymal lung disease

10% form PLD at apical fibrocystic changes that can decrease gas exchange and

provide location for chronic infection (especially fungal)

Clinical findings of AS

Extraparenchymal Restriction → decrease chest expansion & VC

Treatment AS

• Ant-inflammatory

• Analgesics

• Exercise programs in early stages to promote range of motion

Pectus Excavatum

• Congenital chest wall deformity, producing a concave or caved-in appearance in the anterior chest wall

• Most common type of congenital chest wall abnormality

• occurs in estimated 1 in 300-400 births (M:F 3:1)

Pectus Carinatum

• spectrum of protrusion abnormalities of the anterior chest wall (Pigeon Chest)

• moderate to severe cases to the chest wall is rigid held outward position

  • respirations are inefficient and need to use accessory muscles for respirations rather than normal chest muscles during strenuous exercise Respirations

5 principle of obesity

1. it is undeniable that obesity is a complex, chronic disease

2. obesity is driven by powerful underlying biology, not by choice

3. the many health effects of excess weight can start early

4. obesity is treatable

5. weight bias, stigma and discrimination are harmful

Overweight is classified as BMI over___ and over __ is consider Obese

25, 30

BMI

ratio of weight to height (kg/m²)

• normal weight (BMIs 18.5 to 24.9)

• overweight (BMIs 25 to 29.9)

• obese (BMI 30 and over)

• Class I (30.0 – 34.9)

• Class II (35.0 – 39.9)

• Class III (≥ 40.0)

waist circumference

provides an indicator of abdominal fat.

• WC at or above 102 cm (40 in.) for men, and 88 cm (35 in.) for women, is

associated with an increased risk of developing health problems

BMI formula

weight/ height ² = kg/m²

Subcutaneous fat

• Located in the fatty tissue just beneath the skin

• Behaves like the fat elsewhere in the body

Visceral fat

• Located around the internal organs

• Cells release free fatty acids into the liver, heart, and other organs

• local immune responses in visceral adipose tissue →

chronic systemic inflammation

health-related conditions

Type 2 diabetes

HTN

Cardiovascular disease

Undernutrition

Dyslipidemia

Osteoporosis

Hypertension

Infertility

OSA

Gallbladder disease

Certain cancers ( prostate.breast, colon, endometrial)

Respiratory patho

Obesity hypoventilation Syndrome (OHS)

a combination of obesity, a body mass index greater than

or equal to 30kg/m² with awake chronic hypercapnia (PaCO₂ >45mm Hg) & sleep-disordered breathing

Chronic daytime alveolar hypoventilation

arises from a complex interaction between sleep-disordered breathing, decrease respiratory drive, and obesity-related respiratory impairment (decrease ERV & compliance)

Central chemosensitivity is lost, impairing their ventilatory response to hypoxemia and hypercapnia

is associated with significant morbidity and mortality

~ 90% of patients with OHS also have OSA

Clinical manifestation

Dyspnea

• Cyanosis

• ­­­­increase HR

• HTN (Pulmonary & Systemic)

• Pitting pedal edema (Cor Pulmonale)

• Peripheral vascular disease (emboli/stroke)

• increase surgical risk and postoperative complications