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Emphysema
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What is Emphysema?
Permanent abnormal enlargement of the acini(acinius, Latin for “berry”) (MedicineNet, 1999)
Destruction of alveolar walls without obvious fibrosis(McCance & Huether, 2006)
Specifically, two things combined:
Image from www.nucleusinc.com
(as opposed to something like Asbestosis: http://en.wikipedia.org/wiki/Asbestosis)
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Two kinds of emphysema
Primary emphysema1-2% of casesInherited lack of alpha-1 antitrypsin, a
protective protein (inhibits neutrophil elastase)
Secondary emphysemaAlso caused by inability to inhibit
proteolytic enzymes in the lungsFrom inhaled toxins (e.g., cigarette smoke)20% of smokers at risk (McCance & Huether, 2006)
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Secondary Emphysema: Pathophysiology
Toxins (smoke) cause inflammationInfiltration of neutrophils, macrophages
and lymphocytesInflammatory cytokines increase
protease activity, inhibiting normal antiprotease activity (antitrypsin)
Alveoli are destroyed because elastin is being broken down by proteases(McCance & Huether, 2006)
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Acinius Normal vs. Emphysema
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Emphysema & Normal Alveoli
• Loss of septa
• Loss of capillary beds
• Hyperinflation
• Loss of elastic recoil & collapse of alveoli
• Increased residual volume
• Decreased diffusion (lower SA/Volume )
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Bullous Emphesyma
“Bullae are large dilated airspaces that bulge out from beneath the pleura.”
[Image and quote from http://medlib.med.utah.edu/WebPath/LUNGHTML/LUNG056.html]
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Centriacinar (centrilobar) Emphysema
Respiratory bronchioles in proximal portion of acinus are lost
Alveoli distal to terminal bronchiole intact
Occurs in smokers with chronic bronchitis
Usually in upper lobes
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Emphysema: Clinical Manifestations
•Dyspnea•Wheezing is minimal•Barrel chest, often thin•Tachpynea with prolonged expiration•Pursed lip breathing•Tripod stance•Hypoxemia &/or hypercapnia•Chronic hypoventilation (later stage)•Not much coughing with little sputum
(Productive cough with infection)
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COPD: Chronic Bronchitis & Emphysema
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Barrel Chest: Increased Anterior/Posterior Diameter
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Radiograph: Emphysema, Pulmonary hypertension, Cardiomegaly
•Flattened diaphragm
•Hyperinflation
•Translucency of lung
•Hypertrophy of heart
(Hypoxia/ hypercapnea & damage = pulmonary vasoconstriction & hypertension. Later cor pulmonale)
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Clubbing of the Nails
A sign of chronic hypoxia
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Normal Spirograph
Emphysema Spirograph
FEV1/VC normally greater than 75%(per Walters presentation)
Decreased FEV1/VC
Total Lung Capacity normal or increased
RV increased