Doctors Examining X-rays
The Normal Chest X-rays
The main function of the Lungs is to provide gas exchange between inspired air (supplying oxygen) and blood in the pulmonary circle.
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The lungs are each enclosed within a double membrane; visceral pleura covers the surface of the lung and is continuous at the hilum with the parietal pleura.
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The parietal pleura lines the inside of the thoracic cavity. The interpleural space between these layers normally contains only tiny amount of lubricating fluid.
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The right lung is divided into three lobes, whereas the left lung has two. The Trachea divides at the carina into right and left main Bronchi
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The Carina is the part of the Trachea lying under the junction of the Manubrium Sterni and second right costal cartillage. It divides into right and left main Bronchi.
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Within the Lungs and Bronchi branch again, forming secondary and tertiary bronchi, then smaller bronchioles and finally terminal bronchioles ending at the alveoli.
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The Airways are lined by epithelium containing ciliated columnar cells and mucous (goblets) cells- fewer of the latter in the smaller airways.
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Mucus traps macrophages, inhaled particles and bacteria and is moved by the cilia in a cephaled direction thus clearing the lungs (the mucociliary escalator).
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Gas exchange occurs in the alveolus where capillary blood flow and inspired air are separated only by thin wall composed mainly of type 1 pneumocytes and capillary endothelial cells and the capillary and alveolar basement membranes are fused as one.
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The lung has a dual supply: pulmonary (venous blood) and systemic (arterial blood). The pulmonary circulation delivers deoxygenated blood to the lungs from the right side of the heart via the pulmonary artery.
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Oxygen from inhaled air passes through the alveoli into the bloodstream and oxygenated blood is returned to the left heart via the pulmonary veins. The bronchial (systemic) system carrier arterial blood from the descending aorta to oxygenate lung.
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Carbondioxide passes from the capillaries which surrounds the alveoli into the alveolar spaces and is breathe out.
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Inspiratory ariflow is achieved by creating a sub-atmospheric pressure in the alveoli by increasing the volume of the volume of the thoracic cavity under the action of the inspiratory muscles.
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Inspiratory muscular actions are descent of the diaphragm (innervated by the phrenic nerve C3, C5) and contraction of the intercostal muscles of respiration are also recruited (sternomastoids and scalenes) during exercise or respiratory distress.
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Expiration is a passive process, relying on the elastic recoil of the lung and chest wall. During exercise, ventilation is increased and expiration becomes active, with contraction of the muscles of the abdominal wall and the internal intercostals.
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Common symptoms of respiratory diseases are cough, sputum production, chest pain, breathlessness, hemoptysis and wheeze.
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Respiratory function tests include simple outpatient investigations to assess airflow limitation and lung volumes. Normal values vary for age, sex and height,, and also between individuals.
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Routine films are taken postero-anteriorly (PA), i.e the fil is placed in front of the patient with the x-ray source behind.
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AP films are taken only in patients who are unable to stand; the cardiac outline appears bigger and the scapulae cannot be moved out of the way.
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The solitary pulmonary nodule detected on chest x-ray is a common clinical problem. Risk factors for malignancy in this situation are older age, smoker, occupational exposure to carcinogens, increasing size of lesion (80% 3cm), irregular border.
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Eccentric calcification of the lesion and increasing size are also risk factors of malignancy in such a situation.
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Cigarrette smoking has declined in recent years in the western world, but it is on the increase in many developing countries.
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Tobacco smoke contains over 40 different carcinogens and it is associated with an increase risk of cancer in the gastrointestinal tract (Oral cavity, esophagus, stomach and pancreas).
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Tobacco smoke has over 40 carcinogens that can affect the respiratory system (larynx and bronchus) and urogenital system (bladder, kidney and cervix).
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Cigarette smoking is a risk factor for ischemic heart disease and peripheral vascular disease and is the major cause of chronic obstruction pulmonary disease (COPD).
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Environmental Tobacco smoke (Passive smoking) also increases the risk of lung cancer and COPD.
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Persuading an individual to stop smoking is an essential part of the management of many respiratory diseases and has a preventive role in the 'well' person.
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Population targeted approaches such as advertising and banning smoking in public places has reduced smoking prevalence.
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Individually targeted smoking in public places has reduced smoking prevalence. Individually targeted smoking cessation strategies are best delivered by a smoking cessation clinic and are non-pharmacological.
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Non pharmacological strategies to reduce the prevalence of cigarette smoking are as follows: behavioural therapy, self-help programs and group counselling.
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A Pharmacological strategy could be: Nicotine replacement therapy as gum, lozenges, patches, tablets and nasal spray
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Another pharmacologica strategy could be Bupropion tablets: mode of action in smoking cessation is not clear.
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A final pharmacological therapy could be Varenicline tablets- partial agonist at the nicotinic acid acetylcholine receptor. The pharmacological therapies all require the smoker to commit to a target stop date.
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A normal chest x-ray showing all contours, the two lung parenchyma and pulmonary vessels with the bronchi branches
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A normal chest x-ray showing all contours, the two lung parenchyma and pulmonary vessels with the bronchi branches
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A normal chest x-ray showing all contours, the two lung parenchyma and pulmonary vessels with the bronchi branches
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A normal chest x-ray showing all contours, the two lung parenchyma and pulmonary vessels with the bronchi branches
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A normal chest x-ray showing all contours, the two lung parenchyma and pulmonary vessels with the bronchi branches
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A normal chest x-ray showing all contours, the two lung parenchyma and pulmonary vessels with the bronchi branches
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A normal chest x-ray showing all contours, the two lung parenchyma and pulmonary vessels with the bronchi branches
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A normal chest x-ray showing all contours, the two lung parenchyma and pulmonary vessels with the bronchi branches
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A normal chest x-ray showing all contours, the two lung parenchyma and pulmonary vessels with the bronchi branches
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A normal chest x-ray showing all contours, the two lung parenchyma and pulmonary vessels with the bronchi branches
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Pulmonology
© 2014 Funom Theophilus Makama
