the lung. the lung embryology bronchial system alveolar system anatomy lobes fissures ...
TRANSCRIPT
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THE LUNG
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The LungEmbryology
Bronchial system Alveolar system
Anatomy Lobes Fissures Segments Blood supply
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DISEASES OF THE LUNG Congenital
Agenesis Hypoplasia Cystic adenomatoid
malformation Pulmonary sequestration Lobar emphysema Bronchogenic cyst
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Infectious
A.Lung Abscess Causes Clinical Features
‒ Copious production of foul smelling sputum
Investigation‒ C X R
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Treatment Abx Drainage
‒ Internal‒ External
Pulmonary resection Indications
1. Failure of medical RX2. Giant abscess ( >6cm)3. Haemorrhage4. Inability to R/O carcinoma5. Rupture with resulting empyema
Type of Resection‒ Lobectomy
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B. BronchiectasisDefBronchial dilatationCause
Congenital Infection Obstruction
Clinical Features Cough Dyspnea Haemoptysis (50%) Clubbing
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Investigation Bronchogram CT Bronchoscopy
Treatment Medical
‒ Resolve most cases
Surgical‒ Failure of medical Rx‒ Patient with localized disease
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C. Tuberculosis* 30,000 new cases occur
annually in U.S.A Cause
‒ Pulmonary‒ Extra-pulmonary
Investigation‒ C X R
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Treatment‒ Medical‒ Surgical
Failure of medical Rx Destroyed lobe or lung Pulmonary haemorrhage Persistent open cavity with + ve
sputum Persistent broncho pulmonary fistula
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D. Aspergillosis Cause
‒ Aspergillus fumigatus, A. niger Mode of Transmission Forms
‒ Allergic‒ Saprophytic‒ Invasive
Saprophytic form C-F
‒ Aspergilloma ‒ Chronic productive cough‒ Haemoptysis (patient with
preexisting Disease).
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Investigations‒ Skin test‒ Sputum‒ Biopsy (Invasive)‒ C X R
Treatment‒ Medical‒ Surgical
Indications‒ A significant aspergilloma‒ Haemoptysis
Type of resection‒ Segmentectomy‒ Lobectomy‒ Pneumonectomy
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E. Hydatid cystCause
Echinococcus granulosus
DiagnosisTreatment
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TumorBenign Malignant
Primary Secondary
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A. Primary lung carcinomaIncidenceRisk Factor
Smoking Others
Pathology
1. Adenocarcinoma2. Squamous cell carcinoma3. Large cell carcinoma4. Small cell carcinoma
NSCLC vs. SCLC
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Clinical Features Asymptomatic Symptomatic
Lung Surrounding structures Rec. L. nerve Oesophagus C8, T1 nerve Sympathetic Pleure SVC
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distal (para-neoplastic syndrome) PTH ADH ACTH Hypertrophic pulmonary
osteoathropathy
Investigations C X R Bronchoscopy Trans-thoracic needle aspiration CT Scan MRI
Staging(see table)
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ManagementDepends on: Stage Cell Type Patient Physical fitnessNSCLC Surgical Radiotherapy ChemotherapySCLC Chemotherapy Radiotherapy
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B. Secondary Lung Carcinoma Solitary Lung Nodule Primary Carcinoma Tuberculous Ganuloma Mixed tumor °2 Carcinoma Miscellaneous
Benign Vs. MalignantHamartoma-Carcinoid Age Sex X-ray
‒ Size‒ Time‒ Calcification
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THE MEDIASTINUM Anatomy
Boundaries Divisions
Traditional Clinical
Access: Mediastenoscopy, mediastenotomy
Mediastinal mass lesionsA.Anterior mediatinum(5 T’s)B.Middle Mediastinum(Cyst)C. Posterior mediastinum(Neurogenic)
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THYMOMA Incidence
The commonest tunmor of A.M. Peak 40-60 y. M : F (1 : 1)
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Pathology Classification
‒Epithelial‒Lymphocystic‒Lymphoepithelial‒Spindle cell
Benign vs. malignant Stages
I, II, III, IV
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Clinical Features Asymptomatic Symptomatic
‒ Mass effect‒ Systemic effect
M.G. is the commonest
Investigation C X R CT Scan Biopsy Bronchoscopy } Esophagoscopy } Selected
cases Angiogram }
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Treatment Benign complete excision
Malignant complete excision if possibal
If non-resectable } post-op
Or } Radiotherapy
Resection incomplete }
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Trauma RTA Fracture Ribs Simple –
Complicated Haemothorax Pneumothorax Flail chest Lung Contusion and ARDS
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Chest Wall Deformity:
‒ Pectus excavatum‒ Pectus Carniatum
Infection Chest wall tur Thoracic outlet Syndrome.
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Pleura Spontaneous preumothorax Pleural effusion Empyema Mesothelioma .
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Air-way: Tracheal Cougenital anomalies Tracheal Stenosis Tracheostomy
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Lung Transplantation: Indication Procedure Outcome
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Surgery: Thoracotomy Thoracoscopy Sternotomy Analgesia