fmam2_curs investigatii respirator
DESCRIPTION
medicina internaTRANSCRIPT
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Volume si capacitati
Evaluarea ventilatiei
Probe ventilatorii (Conditii dinamice = Spirometrie)
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Probele functionale respiratorii
Boli obstructive si boli restrictive
Probe ventilatorii (Conditii dinamice = Spirometrie)
– Capacitatea vitala fortata ( CVF ) = manevra de expir fortat
in mod normal CVF = CV
– Boli obstructive CVF < CV
Metode de reprezentare
• Volumul expirat in raport cu timpul
• Debitul in raport cu volumul pulmonar
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Volum sfarsit inspir
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Volum sfarsit inspir
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Normal
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Restrictie
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Obstructie
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Obstructie
• VEMS/CVF scazut
• Volumele pulmonare crescute (VR, CRF, CPT)
(Pletismografie)
Restrictie
• CV scazuta
• VEMS/CVF normal
• Volumele pulmonare scazute
(Pletismografie)
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Investigatii paraclinice de diagnostic• Imagistica
– Radiologia clasica
– CT
– RMN
– Examenul ultrasonografic
– Scintigrama de ventilatie/perfuzie
- PET
- Angiografia (invaziva)
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CT
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RMN
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PET
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Scintigrama V/Q
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Investigatii paraclinice de diagnostic
• Bronhoscopia
– Patologie endobronsica
– Biopsie bronsica si transbronsica – Lavaj bronhoalveolar (bronsie subsegmentara)
– Terapeutica (corpi straini,aspirarea secretiilor,hemoptizia)
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Investigatii pentru diagnosticul morfologic
• Examen citologic– Sputa– Aspirat si lavaj bronsic– Lavaj bronhoalveolar
– Ex lichidului pleural
• Examen histopatologic– Biopsia bronsica sau transbronsica– Biopsia percutana cu ac fin– Biopsia prin mediastinoscopie– Biopsia pulmonara (toracotomie)– Biopsia pleurala
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Lavaj bronhoalveolar
• Modificari pulmonare interstitiale sau infiltrate nesistematizate
• Particole de pulberi in macrofage – pneumoconioze
• Fragmente de eritrocite – sd de hemoragie intraalveolara
• Infectii cu germeni oportunisti
• Cel tumorale – cancer pulmonar, limfoame
• Limfocitoza cu raport CD4/CD8, eozinofilie
• Colagenoze, limfoame