Introduction & investigations to respiratory diseases

introduction and investigations to respiratory system

1. INTRODUCTION & INVESTIGATIONS TO RESPIRATORY DISEASES Dr. Firoz A Hakkim . MBBS , MD Dept. Of Pulmonary Medicine K S Hegde Medical Academy

2. Human respiratory system-- That organ of body which participate in respiration known as respiratory organ and that system which participate known as respiratory system. The human respiratory system can be divided into two group stracturally.As -- * The upper respiratory tract – Nose, nasal cavity,sinuses,pharynx. * The lower respiratory tract- - Larynx, trachea, bronchial tree,lungs.

3. . And the organs of the respiratory tract can be divided into two groups functionally. * The conducting portion-- system of interconnecting cavities and tubes that conduct air into the lungs . nose, pharynx, trachea, bronchi. * The respiratory portion— system where the exchange of respiratory gasses occurs. respiratory bronchioles,alveolary duct,alveoli.

4. .

5. Summary of function- Nose/nesal cavity– warms,moistens and fiters air it is inhaled.

6. Pharynx(Throat)- Passage way for air,leads to trachea.

7. Larynx- The voice box,where vocal chords are located.

8. Trachea(windpipe)- Tube from pharynx to bronchi rings of cartilage provide stracture,keep the windpipe open . trachea lined with fine hairs called cilia which filter air before it reaches the lungs.

9. Bronchi- Two branches at the end of the trachea,each lead to a lungs .

10. Bronchioles- A network of smaller branches leading from the bronchi into the lungs tissue and ultimetly to lungs sacs

11. alveoli The functional respiratory units in the lungs where gases(o2 and co2) are exchanged(enter and exit the blood stream)

12. The Bronchopulmonary segments are the anatomic structural and functional unit of lung parenchyma, each ventilated by a segmental/tertiary bronchus Bronchopulmonary segments

13. RIGHT LUNG BRONCHOPULMONARY SEGMENTS Upper lobe Apical anterior posterior Middle lobe medial lateral Lower lobe superior Medial basal Anterior basal Lateral basal Posterior basal

14. LEFT LUNG BRONCHOPULMONARY SEGMENTS Upper lobe apical anterior posterior Superior lingular Inferior lingular Lower lobe superior Medial basal Anterior basal Lateral basal Posterior basal

15. Gaseous exchange-- a) In between blood vessels and lungs.

16. . b) In between blood vessels and body tissue –

17. Gaseous transport- Main function of blood is to transport the gases in diffirent form. Transport of o2 - Most o2 is transported by Hb(red pigment protein in erythrocytes),(97%) o2 combine with hemoglobin to form oxyhemoglobin.As— Hb + o2 Hbo2 A small amount of o2 is transported in solution in the blood plasma(3%) and other body fluid.

18. Transport of co 2 -- Most co2 is transported as bicarbonate ions. First co2 bind with water to form carbonic acid. As- CO2 + H2O H2CO3 Then carbolic acid dissosiates to form hydrogen and bicarbonate ions. As-- H2CO3 H + + H C O 3 − A small amount of co2 is transported by the hemoglobin molecules in the form of carbaminohemoglobin(HbCO3). Co2 +Hb HbCO3 (23%)

19. .

20. Removal of inhaled foreign particles and infectious organisms Olfaction (sensation of smell) Warming and humidification of air (losing excessive heat) Phonation Filtration of blood at the pulmonary capillaries Acting as a volume reservoir of blood Metabolic functions of the pulmonary tissue NON RESPIRATORY FUNCTIONS OF LUNG

21. Investigations of Respiratory System

22. A- Imaging Plain CXR A PA film provides information on the lung fields , heart , mediastinum , vascular structures and the thorathic cage. additional information can be obtained from a lateral film .

23. CT scan It is superior to CXR in determining the position and size of a pulmonary lesion and whether calcification or cavitations is present. It is now routinely used in the assessment of patients with suspected lung cancer and facilitate guided percutaneous needle biopsy. HRCT (high resolution), that uses thin section to provide a detail assessment of pulmonary parenchymal diseases ( interstitial lung disease , bronchiectasis )

24. Ultra sound of chest cavity; is sensitive to detect plural effusion , may also be used to improve the diagnostic field of plural biopsy.

25. Ventilation – perfusion scan; the main value of this technique is to detect pulmonary thrombi or embolism, a filling defect in the perfusion scan accompanied by preserved ventilation is highly suggestive of recent PE.

26. Positron Emission Tomography PET scan; In new technology to investigate pulmonary nodules , staging of mediastinal lymph nodes and distal metastasis.

27. CT- pulmonary angiography Is widely available and gold standard to diagnose PE.

28. B- Endoscopic Examinations; Laryngoscopy ; larynx may be inspected directly with a mirror or indirectly with a laryngoscope.

29. Bronchoscopy ; The trachea , large bronchi and lung segments can all be inspected by either flexible or rigid bronchoscope. Diagnostic indication of flexible bronchoscopy ; Suspected cases of Lung ca, slowly resolving pneumonia, pneumonia in the immunocompramised patients, interstitial lung disease, and collecting lavage for AFB and culture in suspected cases of TB , with – ve sputum.

30. Mediastinoscopy ; Through a small incision at the supra sternal notch under GA, to get an access to the mediastinum .

31. - Other investigations Plural aspiration and biopsy. Sputum examination , for microbiological ( AFB, Culture, Gram stain ) and cytological examinations Pulse oximetry Allow a non invasive assessment of peripheral O2 saturation, it provides a useful tool for monitoring those who are acutely ill or at risk of deterioration.

32. Peak expiratory flow rate (PEF). Is measured by a maximum forced expiration through a peak flow meter , it should be monitored regularly in asthmatic patients monitor response to therapy and disease control.

33. Arterial blood gas analysis It is heparinized blood taken from , the radial , brachial and femoral arteries to check, PH, PaO2, PaCO2 and HCO3. Type I respiratory failure; PaO2 < 8Kpa , PaCO2 either Normal or reduced.( hypoxia only), PH is normal. Type II respiratory failure ; PaO2 < 8Kpa , PaCO2 >6Kpa ( hypoxia and hypercapnia ), PH could be normal , high or low.

34. Pulmonary Function Tests. Are used to aid diagnosis, assess functional impairments and monitor treatment or progression of diseases. Abbreviations used in RFT FEV1 forced expiratory volume in 1 second FVC forced vital capacity VC vital capacity TLC total lung capacity FRC function residual capacity RV residual volume TLco Gas transfer factor for carbon monoxide Kco Gas transfer per unit lung volume.

35. FEV1 is disproportionately reduced in obstructive lung disease ( asthma, COPD, bronchial obstruction) and the ratio of FEV1/ VC will be <70%. When there is an airflow obstruction the test should be repeated following administration of inhaled or nebulised B2 agonist ( salbutamol) to see the reversibility to normal or >15% that would give the diagnosis of asthma . FEV1 and VC will both reduce in restrictive lung disease (Pulmonary Fibrosis) that will make the FEV1/VC ratio , >80%.

36. Interesting facts about respiratory system- - About half a liter of water /day is lost through breathing. Yawning bring more O 2 to the lungs . Our right lungs is larger then left lungs. We breathe 13 pints of air every minute. People under 30 take in double the amount of O 2 in comparison to someone who’s 80 years old.