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(C.O.P.D) Ch.Bronchitis Emphysema

(C.O.P.D) Ch.Bronchitis Emphysema. AISHA M SIDDIQUI. C.O.P.D. Pathology Pathophysiology Types Clinical features Acute complications Chronic complications Investigations Differential diagnosis Treatment References. Ch.Bronchitis. Normal mechanism of cough.

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(C.O.P.D) Ch.Bronchitis Emphysema

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  1. (C.O.P.D) Ch.Bronchitis Emphysema AISHA M SIDDIQUI

  2. C.O.P.D • Pathology • Pathophysiology • Types • Clinical features • Acute complications • Chronic complications • Investigations • Differential diagnosis • Treatment • References

  3. Ch.Bronchitis Normal mechanism of cough. Ch.irritation>>>>ch.bronchitis Smoking, industries & pollution. Mortality ^ with infection More in winter & autumn More in low socioeconomic class.

  4. Emphysema • Pathology: Enlarged air spaces distal to terminal bronchioles with destruction to the walls. Centrilobular(U.Z)>>>>>Bullae Panacinar(L.Z)---->>>>

  5. Emphysema • Pathogenesis: Smoking,air pollution,infection,Intrinsic. - Alpha 1 Antitrypsin def: inhibits proteolytic enzymes released from macrophages and neutrophils. Increases in smokers Basal segments.

  6. Emphysema • Pathophysiology: Airway dis.(narrowing)>>>limitation of air flow>>> poorly ventillated. VENTILLATION PERFUION MISMATCH Extensive dis.>>>Resp. Failure(type 2) ELASTIC RECOIL OF THE LUNG LOST Expansion of lung >>> increase T.L.C Earlier closure of airways >>> inc. R.V (air trapping) Reduction of surface area for gas exchange>>>decrease in transfer factor.

  7. Blue bloaters Pink puffers TYPES

  8. Clinical Features • Breathlessness • Insidiuos onset • Increase gradually • Irritation of mucosa>>>mucous>>>cough>>> bronchoconstriction.

  9. Clinical Features • Physical signs: • Mild- Moderate >>> No abnormality • Tachypnea. • Prolonged expiration, pursed lips. • Xssory ms. Of resp. • Posture; mechanical advantage. • Chest:

  10. Complications • CHRONIC: Type 2 resp. failure. Polycythemia. Corpulmonale. • ACUTE: Infections. L.V.F. P.E. Pneumothorax.

  11. Differential Diagnosis • CHRONIC BRONCHITIS: B.asthma Bronchiectasis Ch.sinusitis Aspiration T.B/ Neoplasm • EMPHYSEMA: C.O.P.D/ B.asthma Obstructive/ Restrictive Large airways obstruc/ small

  12. Investigations C.X.R/C.T Bld. Gases Pulm. Function tests: FEV1/ FVC PEFR DL co Sputum ECG CBC

  13. Treatment • STOP Smoking • Domociliary O2 therapy: 15 hrs. 2L 28% • Bronchodilators: B2 agonists Anticholinergics (Ipratropium Bromide) Methylxanthines? • Corticosteroids: Acute exacerbations Stable dis.? Inhalers

  14. Treatment • Antibiotics: FEV1<50%, More strong A/B • Diuretics • Vasodilators • Chest physiotherapy • N.I.V: C.P.A.P • Venesection • Vaccinations

  15. References Scientific American Medicine 9/01 NEJM : June 26, 2003. Vol. 348(26) NEJM : June 24, 2004. Vol. 350(26) Davidson’s Principles and Practice of Medicine Uptodate 2008

  16. BRONCHIAL ASTHMA • Definition • Cardinal pathophysiological features: Airflow limitation (reversible) Airway hyperresponsiveness Airway inflammation • Types and aetiology • Clinical features • Investigations • Management

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