SEMIO CH23 TRIGGER

RAPPEL : LOW VOLUME + NORMAL TIFFENEAU INDEX =

RESTRICTIVE DISEASE PATTERN

FEV1 / VC PATTERN RESTRICTIVE DISEASE

FEV1 AND VC DECREASE IN THE SAME PROPORTION

→ FEV1/VC RATIO IS ALMOST NORMAL

5 MAIN TYPES OF RESTRICTIVE LUNGS DISEASE

COLLAPSE

CONSOLIDATION

INTERSTITIAL LUNG DISEASE

PLEURAL EFFUSION

PNEUMOTHORAX

RAPPEL = SHUNT EFFECT →

BAD ALVEOLI VENTILATION AND NORMAL ALVEOLI PERFUSION

V/Q RATIO BELOW 1

COLLAPSE DEF

ALVEOLI ARE COLLAPSED AND HAS NO AIR INSIDE THEM

IF THE COLLAPSE AFFECTS 1 LUNG →

LUNG ATELECTASIS

IF THE COLLAPSE AFFECTS 1 LOBE →

LOBAR ATELECTASIS

IF THE COLLAPSE AFFECTS 1 SEGMENT →

SEGMENTARY ATELECTASIS

3 MECHANISMS THAT CAUSES COLLAPSE

BRONCHIAL OBSTRUCTION

LACK OF PULMONARY SURFACTANT

ALVEOLI COMPRESSION

TRIGGER BRONCHIAL OBSTRUCTION CAUSED BY MUCUS / FOREIGN BODY

INTRALUMINAL PROBLEM

TRIGGER BRONCHIAL OBSTRUCTION CAUSED BY BRONCHIAL WALL DISEASE

BRONCHIAL NEOPLASM / LUNG CANCER

TRIGGER BRONCHIAL OBSTRUCTION CAUSED BY EXTRINSIC PROBLEM

MEDIASTINAL ADENOPATHIES

SOUND ON PERCUSSION W/ COLLAPSE

DULLNESS → SON SOURD DUE AU MANQUE D’AIR

SOUND ON AUSCULTATION W/ COLLAPSE

BREATH SOUND ABSENT

LUNG CONSOLIDATION

ALVEOLI FILLED W/ NON GASEOUS MATERIAL

→ FILLED W/ LIQUID OR SOLID MATERIAL

LUNG CONSOLIDATION CAUSES WHAT ?

CAUSES SHUNT EFFECT / HYPOXIA

WHY LUNG CONSOLIDATION CAUSES SHUNT EFFECT / HYPOXIA?

BECAUSE ALVEOLI ARE FILLED WITH LIQUID / SOLID MATERIAL → BLOOD PERFUSION CAN BE DONE BUT AIR CANNOT REACH THE ALVEOLIS

TRIGGER → ALVEOLI FILLED W/ EXUDATE

PNEUMONIA / INFLAMMATION / INFECTION

TRIGGER → ALVEOLI FILLED W/ TRANSUDATE ?

PULMONARY EDEMA / LEFT SIDED HEART FAILURE

TRIGGER → ALVEOLI FILLED W/ BLOOD ?

ALVEOLAR / BRONCHIAL BLEEDING

TRIGGER → ALVEOLI FILLED W/ NEOPLASTIC CELLS ?

LUNG CANCER

TRIGGER → ALVEOLI FILLED W/ ACCIDENTAL ASPIRATION PRODUCT ?

MATERIAL FROM ORO / NASOPHARYNX ENTERS THE ALVEOLI

INTERSTITIAL LUNG DISEASE AFFECTS WHAT ?

AFFECTS THE PARENCHYMA OF THE LUNG

(the alveoli, the alveolar epithelium, the capillary endothelium,

and the spaces between those structures)

5 MAIN CAUSES OF INTERSTITIAL LUNG DISEASE ?

INORGANIC DUST INHALATION

ORGANIC DUST INHALATION

IONIZING RADIATION

DRUGS

CHEMOTHERAPY DRUGS

TRIGGER DISEASE CAUSED BY INORGANIC DUST INHALATION

PNEUMOCONIOSIS

2 MAIN MECHANISM THAT CAUSES PULMONARY HYPERTENSION ?

INCREASE IN PULMONARY ARTERY RESISTANCE

INCREASE IN LEFT ATRIA PRESSURE

2 CAUSES OF PULMONARY ARTERY VASOCONSTRICTION

SECONDARY TO HYPOXEMIA (PO2 BELOW 60)

IDIOPATHIC ( = PRIMARY)

PULMONARY EMBOLISM CAUSES → THAT CAUSES →

CAUSES VASCULAR OBSTRUCTION → PULMONARY RESISTANCE ↑

DECREASE IN PULMONARY VESSELS REPLACED BY FIBROUS TISSUE → CAUSES →

PULMONARY FIBROSIS ↑ → PULMONARY RESISTANCE ↑

WHY : INCREASE IN LEFT ATRIAL PRESSURE CAUSES PULMONARY HYPERTENSION ?

LEFT ATRIAL PRESSURE ↑ → PULMONARY VENOUS PRESSURE ↑ → PULMONARY HYPERTENSION

PLEURAL EFFUSION =

INCREASE OF PLEURAL FLUID IN THE PLEURAL SPACE

THIS EFFUSION CAN BE OF 3 NATURES :

EXUDATE / TRANSUDATE / BLOOD

TRANSUDATE PLEURAL EFFUSION APPEARS BECAUSE OF →

INCREASE OF HYDROSTATIC PRESSURE / DECREASE OF ONCOTIC PRESSURE

EXUDATE PLEURAL EFFUSION APPEARS BECAUSE OF →

AN INFLAMMATORY DISEASE AFFECTS THE PLEURA → PNEUMONIA / PLEURITIS

BLOOD PLEURAL EFFUSION APPEARS BECAUSE OF →

HEMOTORAX

PNEUMOTHORAX =

LUNGS COLLAPSED DUE TO AIR ACCUMULATION IN THE PLEURAL SPACE

OPEN PNEUMOTHORAX =

PENETRATING CHEST INJURY

CLOSED / SPONTANEOUS PNEUMOTHORAX =

EMPHYSEMATOUS BULLAE RUPTURE

CLINICAL FEATURES PNEUMOTHORAX

SUDDEN SHARP PLEURITIC PAIN + DYSPNEA

PERCUSSION SOUND W/ PNEUMOTHORAX PATIENT ?

HYPERRESONNANCE