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Respirology
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- Organs of gaseous exchange
- in pleural cavity, covered by the visceral pleura
- apex of lung extends anterior part of 1st rib and clavicle
- separated from tissues of neck by suprapleural membrane
- divided into three lobes on right and two lobes on left
- trachea bifurcates at level of body of T4 vertebra
- right main bronchus, shorter, wider and more vertical than left, hence
more often blocked by inhaled objects
- right main bronchus bifurcates before entering lung
- most commonly inhaled vomit or secretion travel to apical segment of right
lower lobe
- oblique fissure in both sides
Indentations
- right lung indented by
- trachea
- vagus
- superior vena cava
- right atrium
- subclavian artery
- left lung indented by
- oesophagus
- above arch of aorta
- below hilum
- arch of aorta
8.2.2 Pleura [Morph]
8.2.2.1 Pleural Cavities
| Pleural sac. Parietal and visceral layers of pleura.
Innervation of pleura. Costo-phrenic recess. |
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8.2.2.2 Examination of living lungs and thoracic
airway
| Percussion of chest to detect resonance of air-filled
cavity (see also 8.1.1.1: Living anatomy of the thorax) |
Auscultation with stethoscope to distinguish tracheal and
lung-field breath sounds |
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Changes in breath sounds with bronchial obstruction;
lung consolidation
Pleural effusions: clinical signs on auscultation, percussion and
radiography |
8.2.3 Lungs, Trachea and Bronchi [Morph]
| Trachea; position, level of bifurcation |
Endoscopic appearance of trachea, carina, main bronchi |
| Left and right main bronchi; major divisions. |
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| Upper and lower lobes; oblique fissure. |
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| Middle lobe and transverse fissure of right lung; |
lingula left lung |
| Pulmonary arteries and veins. Bronchial arteries.
Lymphatic drainage of the lungs and bronchi |
Pulmonary-systemic venous shunts in lungs and bronchi.
See 8.3.3. |
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| Concept of bronchopulmonary segments: especially apical
segments of upper and lower lobes, in relation to inhalation of material |
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8.4 RESPIRATORY PROBLEMS AND APPLICATIONS
8.4.1 Clinical Examination and Assessment
8.4.1.1 Examination
| Variations in shape of the chest wall in disease states:
barrel chest in chronic asthma |
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| Surface markings: the trachea in the sternal notch |
Deviation of the trachea as a sign of mediastinal shift:
tension pneumothorax |
8.4.1.2 Percussion and Auscultation of the Chest
| Principle of percussion: resonant sound for air-filled
structures, dull sound for solid and fluid-filled structures |
Surface markings of lobes: corresponding areas of
dullness in lobar pneumonias |
| Areas of dullness over the normal heart and liver |
Hyperresonance over pneumothorax |
8.4.1.3 Radiological Markers of Respiratory Disease
| Appearance of normal lung parenchyma and hila |
Pulmonary cysts |
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Enlarged nodes at hila as an indication of neoplasia |
8.4.1.4 Lung Function Tests
| Interpretation of measurements of peak flow rate and
vital capacity: differentiation between obstructive and restrictive
disease |
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8.4.1.5 Blood Gases
| Normal blood oxygen and carbon dioxide levels, normal
plasma pH: effect of hyperventilation, hypoventilation, emphysema |
Effect on blood gases of asthma: core in second year |
8.4.2 Pneumothorax [Morph; Phys]
8.4.2.1 Simple Pneumothorax
| Pleural and airways pressure gradients contributing to
collapse of lung |
Effect on pulmonary circulation and right heart |
| Radiological appearance |
Principles of action of chest drain |
8.4.2.2 Tension Pneumothorax
| Detection of mediastinal shift: trachea, apex beat |
Danger of mediastinal shift: effects on venous return and
cardiac output |
| Pressure gradients contributing to gradual rise in
pressure in pleural space |
Emergency measures to relieve pressure in pleural cavity,
not involving brandy bottles or coathangers. |
8.4.3 Acute Airways Obstruction [Morph; Phys]
8.4.3.1 Wheeze
| Turbulent flow |
Increased work resulting from decreased efficiency of
turbulent flow |
| Noise usually greatest in exhalation, because of reduced
airway diameter |
Wheeze implies moderate reduction in airflow: severe
reduction is usually silent |
8.4.3.2 Foreign Bodies
| Normal variation in airways diameter during respiratory
cycle |
Anatomy of bronchial bifurcation: favoured path followed
by inhaled foreign bodies |
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Consequences of upper airway obstruction. |
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Relief of upper airways obstruction. |
8.4.4 Loss of Diffusion Surface [Morph; Phys]
8.4.4.1 Atelectasis
| Importance of positive pressure at end of exhalation in
preventing alveolar collapse |
Potential problems in mechanical ventilation: PEEP
ventilation |
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Complications of atelectasis: infection, ventilation–perfusion
mismatch |
8.4.4.2 Destructive lesions: emphysema
| Effect on blood oxygen and carbon dioxide of loss of
diffusion surface |
Surface tension effects contributing to instability of
alveolar structure |
| Adaptation of CNS chemoreceptors to chronic respiratory
acidosis (see 8.3.5) |
Hypoxaemia as the respiratory stimulus: dangers of oxygen
therapy |
8.4.4.3 Pulmonary Fibrosis
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