The human lungs are the most important organ of the respiratory system. Their features are considered to be a pair structure, the ability to change their size, narrow and expand many times during the day. The shape of this organ resembles a tree and has numerous branches.
Where are the human lungs located?
The lungs are allocated a large, central part of the internal space of the chest. From the back, this organ occupies an area at the level of the shoulder blades and 3-11 pairs of ribs. The chest cavity containing them is a closed space in which there is no communication with the external environment.
The base of the paired respiratory organ is adjacent to the diaphragm, which separates the peritoneum and sternum. The neighboring insides are represented by the trachea, large main vessels, and the esophagus. Close to the paired respiratory structure is the heart. Both organs fit quite tightly to each other.
The shape of the lungs is comparable to truncated cone, directed upwards. This section of the respiratory system is located next to the collarbones and protrudes slightly beyond them.
Both lungs have various sizes– located on the right dominates its “neighbor” by 8-10%. Their shape is also different. mostly wide and short, while the second is often longer and narrower. This is due to its location and close proximity to the heart muscle.
The shape of the lungs is largely determined by the characteristics of the human constitution. With a thin physique, they become longer and narrower than with excess weight.
What are the lungs made of?
The human lungs are structured in a peculiar way - they completely lack muscle fibers, and a section reveals a spongy structure. The tissue of this organ consists of pyramid-shaped lobules, with their bases facing the surface.
The structure of the human lungs is quite complex, and is represented by three main components:
- Bronchi.
- Bronchioles.
- Acini.
This organ is saturated with 2 types of blood - venous and arterial. The leading artery is the pulmonary artery, which gradually divides into smaller vessels.
In a human embryo, pulmonary structures begin to form at the 3rd week of pregnancy. After the fetus reaches 5 months, the process of formation of bronchioles and alveoli is completed.
By the time of birth, the lung tissue is fully formed, and the organ itself contains the required number of segments. After birth, the formation of alveoli continues until a person reaches 25 years of age.
“Skeleton” of the lungs – bronchi
The bronchi (translated from Greek as “breathing tubes”) are represented by hollow tubular branches of the trachea, connected directly to the lung tissue. Their main purpose is to conduct air - the bronchi are respiratory tracts through which oxygen-saturated air enters the lungs, and waste air flows saturated with carbon dioxide (CO2) are discharged back.
In area 4 thoracic vertebra in men (5 in women), the trachea is divided into left and right bronchi, directed to the corresponding lungs. They have special system branches, resembling the structure of a tree crown in appearance. That is why the bronchi are often called the “bronchial tree”.
The primary bronchi do not exceed 2 cm in diameter. Their walls consist of cartilaginous rings and are smooth muscle fibers. This structural feature serves to support the respiratory organs and ensures the necessary expansion of the bronchial lumen. The bronchial walls are actively supplied with blood and penetrated by lymph nodes, which allows them to receive lymph from the lungs and participate in the purification of inhaled air.
Each bronchus is equipped with several membranes:
- external (connective tissue);
- fibromuscular;
- internal (covered with mucus).
A progressive reduction in the diameter of the bronchi leads to the disappearance cartilage tissue and mucous membrane, their replacement thin layer cubic epithelium.
Bronchial structures protect the body from the penetration of various microorganisms and keep the lung tissue in an intact state. When protective mechanisms are violated, they lose the ability to fully resist the effects of harmful factors, which leads to the occurrence of pathological processes (bronchitis).
Bronchioles
After penetration into the lung tissue of the main bronchus, it divides into bronchioles (the terminal branches of the “bronchial tree”). These branches are distinguished by the absence of cartilage and have a diameter of no more than 1 mm.
The walls of the bronchioles are based on ciliated epithelial cells and alveolocytes that do not contain smooth muscle cells, and the main purpose of these structures is to distribute air flow, maintaining resistance to it. They also provide sanitation respiratory tract, remove rhinobronchial secretions.
From the trachea, air goes directly into the alveoli of the lungs - small bubbles located at the ends of the bronchioles. The diameter of these “balls” ranges from 200 to 500 microns. The alveolar structure looks much like grape bunches.
The pulmonary alveoli are equipped with very thin walls, lined from the inside with surfactant (a substance that prevents adhesion). These formations make up the respiratory surface of the lungs. The area of the latter is prone to constant fluctuations.
Acini
The acini are the smallest pulmonary unit. There are about 300,000 of them in total. The acini are the final point of division of the bronchial tree, and form lobules from which segments and lobes of the entire lung are formed.
Lung lobes and bronchopulmonary segments
Each lung consists of several lobes separated by special grooves (fissures). The right one contains 3 lobes (upper, middle and lower), the left – 2 (the middle one is missing due to its smaller size).
Each lobe is divided into bronchopulmonary segments, separated from adjacent areas by connective tissue septa. These structures are shaped like irregular cones or pyramids. Bronchopulmonary segments are functional and morphological units within which pathological processes can be localized. Removal of this part of the organ is often performed instead of resection of lobes of the lung or the entire organ.
In accordance with generally accepted norms of anatomy, there are 10 segments in both lungs. Each of them has its own name and a specific location.
The protective lining of the lungs is the pleura.
The lungs are covered on the outside with a thin, smooth membrane - the pleura. It also lines the inner surface of the chest and serves as a protective film for the mediastinum and diaphragm.
The pulmonary pleura is divided into 2 types:
- visceral;
- parietal.
The visceral film is tightly connected to the lung tissue and is located in the cracks between the lobes of the lung. In the root part of the organ, this pleura gradually becomes parietal. The latter serves to protect the inside of the chest.
How the lungs work
The main purpose of this organ is to carry out gas exchange, during which the blood is saturated with oxygen. The excretory functions of the human lungs involve removing carbon dioxide and water from the exhaled air. Such processes serve the full course of metabolism in various organs and tissues.
Principle of pulmonary gas exchange:
- When a person inhales, air travels through the bronchial tree into the alveoli. Also, streams of blood containing large amounts of carbon dioxide rush here.
- After the gas exchange process is completed, CO₂ is released into the external environment through exhalation.
- Oxygenated blood enters the systemic circulation and serves to nourish various organs and systems.
The respiratory act in humans occurs reflexively (in an involuntary manner). This process is controlled by a special structure located in the brain (breathing center).
The participation of the lungs in the act of breathing is considered passive and consists of expansion and contraction caused by movements of the chest. Inhalation and exhalation are ensured by the muscle tissue of the diaphragm and chest, due to which there are 2 types of breathing - abdominal (diaphragmatic) and thoracic (costal).
During inhalation, the volume of the inner part of the sternum increases. Then a reduced pressure arises in it, allowing air to fill the lungs without obstacles. When you exhale, the process reverses, and after relaxation of the respiratory muscles and lowering of the ribs, the volume of the thoracic cavity decreases.
Interesting to know. Standard lung capacity is 3-6 liters. The amount of air inhaled at a time is on average 1/2 liter. 16-18 are completed in 1 minute breathing movements, and during the day up to 13,000 liters of air are processed.
Non-respiratory functions
The functioning of the human lungs is closely related to various organs and systems. The healthy state of this paired organ contributes to the smooth, full functioning of the entire body.
In addition to the main function, the human lungs provide other important processes:
- participate in maintaining acid-base balance, coagulation (blood clotting);
- promote the removal of toxins, alcohol vapors, essential oils;
- retain and dissolve fatty microemboli, fibrin clots;
- affect the maintenance of normal water balance (normally, at least 0.5 liters of water per day evaporates through them, and in the event of extreme situations, the volume of fluid removed can increase several times).
Another non-gas exchange function of this organ is phagocytic activity, which consists of protecting the body from the penetration of pathogens and supporting the immune system. This organ also acts as a kind of “shock absorber” for the heart, protecting it from shock and negative external influences.
How to keep your lungs healthy
The lungs are considered a fairly vulnerable organ of the respiratory system, which means constant care for them. The following will help prevent the development of pathological processes:
- Quitting smoking.
- Prevention of severe hypothermia.
- Timely treatment of bronchitis and colds.
- Normalized cardio loads that occur when running, swimming, cycling.
- Maintaining normal weight.
- Moderate consumption of salt, sugar, cocoa, and spicy seasonings.
The presence of creamy, olive oil, beets, seafood, natural honey, citrus fruits, fermented milk products, cereals, walnuts. Vegetables and fruits should occupy at least 60% of the entire menu.
Among liquids, you should give preference to green and rosehip tea. Regular consumption of pineapples, which contain a special enzyme - bromelain, which helps destroy the tuberculosis bacillus, is considered beneficial.
The human lungs are located in the chest paired organ, responsible for supplying oxygen to the entire body.
Brief description of the structure of the lungs
A person has two lungs. The right lung has a larger volume compared to the left, greater width and a little shorter. This is explained by the location of the diaphragm and heart. The heart is located in the middle of the chest and is shifted more to the left by its lower part. The right side of the diaphragm, in turn, rises upward.
Both lungs have the appearance of an irregular cone. The left lung consists of two lobes, the right - of three. The basis, or skeleton, of the lungs is the bronchi. They look like wood. At the ends of each branch there are alveoli, in which the accumulation of air and all gas exchange actually occur.
Lung functions
The main function of the lungs is to accumulate oxygen and supply it to the entire body, as well as to remove carbon dioxide from the body. Gas exchange occurs due to the movements of the diaphragm, chest and lungs themselves. Motor activity The lungs are expressed in their expansion when air enters through the nasal passages and in their contraction to their original size.
In addition to the main function, the lungs also perform additional functions. They support what is needed acid-base balance due to the fact that they take part in regulating the required amount (concentration) of ions in the body. The lungs also remove other gases (aromatic substances), ethers and other volatile substances.
Maintaining the body's water balance also occurs with the participation of the lungs. From their surface, from half a liter of water to ten (in special extreme cases) evaporates per day. Average healthy levels are 0.3 - 0.8 liters per day.
Breathing of the lungs and the whole body
Just like everything else the body's lungs they need to breathe, that is, they also need oxygen. Their ventilation occurs as a result of the difference in pressure between inhalation and exhalation. When you exhale, pulmonary pressure exceeds atmospheric pressure, and when you inhale, it decreases noticeably.
How does the body breathe? There are two types of breathing: abdominal and thoracic.
Abdominal breathing is carried out through the diaphragm. Inhalation occurs, as was written above, due to a decrease in pressure in the lungs. When the diaphragm muscles contract, the volume free space in the chest increases. The lungs expand and inhalation occurs. Exhalation occurs as a result of relaxation of the diaphragm muscles and its return to its original size.
Inhale at thoracic breathing, or costal breathing, is carried out by contracting and relaxing external intercostal muscles, one end of which is attached to the rib, and the other to the vertebra. When exhaling, as a rule, no muscles are used. Exhalation during costal breathing is passive. However, in case of any serious disorders of the respiratory system, the internal intercostal muscles take part in the breathing process, which exhale.
The control center for breathing and the respiratory system is located in the medulla oblongata. Regulation of breathing, as such, occurs through certain receptors that are located in the blood vessels, in the bronchi, and in the area of the carotid arteries.
Treatment of diseases of the bronchopulmonary system
Pneumonia is one of the most severe illness lungs. Like other diseases, it is easier to prevent. For the purpose of prevention, especially if there is an existing predisposition, it is good to use peptide preparations for the lungs and bronchi. For example, a peptide bioregulator for the respiratory system, to normalize the bronchial mucosa and regulate lung functions, in a solution for the bronchi and lungs. Also great help complex application various drugs for the respiratory system. As part of traditional treatment, they speed up recovery and enhance the effect of medications.
The lungs are paired respiratory organs located in a hermetically sealed chest cavity. Their airways represented by the nasopharynx, larynx, trachea. The trachea in the chest cavity is divided into two bronchi - right and left, each of which, branching repeatedly, forms the so-called bronchial tree. The smallest bronchi - bronchioles at the ends expand into blind vesicles - pulmonary alveoli. The totality of the alveoli forms the tissue of the lungs.
Rice. 1 . Diagram of the airways. 1 - larynx; 2 - trachea;
3 - bronchi; 4 - bronchial tree; 5 - light.
Rice. 2. Scheme of the structure of the lung lobe,
the left lobe is covered with a network of capillaries.
The mucous membrane of the trachea and bronchi is covered with stratified ciliated epithelium, the cilia of which oscillate towards the oral cavity. In addition, the mucous membrane contains numerous glands that secrete mucus. Mucus humidifies the inhaled air. Thanks to the presence of the nasal concha and a dense network of capillaries in the mucous membrane, as well as the ciliated epithelium, the air entering the respiratory tract, before reaching the lungs, is warmed, moistened and largely cleared of mechanical impurities (dust particles).
Gas exchange does not occur in the respiratory tract, and the composition of the air does not change. The space enclosed in these respiratory tracts is called dead, or harmful. At calm breathing air volume in dead space is 1.4-10 -4 -1.5-10 -4 m 3 (140-150 ml).
The structure of the lungs ensures that they perform the respiratory function. The thin wall of the alveoli consists of a single-layer epithelium, easily permeable to gases. The presence of elastic elements and smooth muscle fibers ensures quick and easy stretching of the alveoli, so that they can accommodate large amounts of air. Each alveolus is covered with a dense network of capillaries into which the pulmonary artery branches (Fig. 2). Both lungs contain 300-400 million microscopic alveoli, the diameter of which in an adult is 0.2 mm. Due to the large number of alveoli, a huge respiratory surface is formed. In a person weighing 70 kg, during inhalation the respiratory surface of the lungs is 80-100 m 2, when exhaling - 40-50 m 2.
In addition to the respiratory function, the lungs regulate water metabolism, participate in thermoregulation processes, and act as a blood depot. Platelets and some blood clotting factors are destroyed in the lungs.
Each lung is covered on the outside serosa- pleura, consisting of two layers: parietal and pulmonary (visceral). Between the layers of the pleura there is a narrow gap filled serous fluid- pleural cavity. Normally there is no cavity, but it can occur if the pleural layers are pushed apart by exudate formed during some pathological conditions, or air, for example, in case of chest injury.
The expansion and collapse of the pulmonary alveoli, as well as the movement of air along the airways, is accompanied by the appearance of respiratory sounds, which can be examined by auscultation.
Emphysema – chronic disease lungs, characterized by expansion of small bronchioles (final branches of the bronchi) and destruction of the partitions between the alveoli. The name of the disease comes from the Greek emphysao - to swell. Air-filled voids form in the lung tissue, and the organ itself swells and increases significantly in volume.
Manifestations of emphysema– shortness of breath, difficulty breathing, cough with slight mucous sputum, signs respiratory failure. Over time, the chest expands and takes on a characteristic barrel shape.
Reasons for the development of emphysema divided into two groups:
- Factors that impair the elasticity and strength of lung tissue are inhalation of polluted air, smoking, congenital deficiency of alpha-1-antitrypsin (a substance that stops the destruction of the walls of the alveoli).
- Factors that increase air pressure in the bronchi and alveoli are chronic obstructive bronchitis, blockage of the bronchus by a foreign body.
Risk of developing the disease some categories are higher than other people:
- Congenital forms of pulmonary emphysema associated with whey protein deficiency are more often detected in residents of Northern Europe.
- Men get sick more often. Emphysema is detected at autopsy in 60% of men and 30% of women.
- People who smoke have a 15 times higher risk of developing emphysema. Passive smoking also dangerous.
Anatomy of the lungs
Lungs- paired respiratory organs located in the chest. The lungs are separated from each other by the mediastinum. It consists of large vessels, nerves, trachea, and esophagus.Each lung is surrounded by a two-layer membrane, the pleura. One of its layers fuses with the lung, and the other with the chest. Between the sheets of pleura there remains a space - the pleural cavity, in which there is a certain amount of pleural fluid. This structure helps the lungs stretch during inhalation.
Due to anatomical features, the right lung is 10% larger than the left. The right lung consists of three lobes, and the left lung has two. The lobes are divided into segments, which in turn are divided into secondary lobules. The latter consist of 10-15 acini.
The hilum of the lung is located on the inner surface. This is the place where the bronchi, artery, and veins enter the lung. Together they form the root of the lung.
Lung functions:
- ensure blood saturation with oxygen and removal of carbon dioxide
- participate in heat exchange due to liquid evaporation
- secrete immunoglobulin A and other substances to protect against infections
- participate in the transformation of the hormone angiotensin, which causes vasoconstriction
- bronchi, through which air enters the lungs;
- alveoli, where gas exchange occurs;
- blood vessels that carry blood from the heart to the lungs and back to the heart;
- Trachea and bronchi- called the respiratory tract.
The trachea at the level of 4-5 vertebrae is divided into 2 bronchi - right and left. Each of the bronchi enters the lung and forms a bronchial tree there. The right and left are the bronchi of the 1st order; at the place of their branching, the bronchi of the 2nd order are formed. The smallest are bronchi of the 15th order.
Small bronchi branch, forming 16-18 thin respiratory bronchioles. Alveolar ducts depart from each of them, ending in thin-walled vesicles - alveoli.
Bronchial function– ensure the passage of air from the trachea to the alveoli and back.
Structure of the bronchi.
- Cartilaginous base of the bronchi
- large bronchi outside the lung consist of cartilaginous rings
- large bronchi inside the lung - cartilaginous connections appear between the cartilaginous half-rings. Thus, the lattice structure of the bronchi is ensured.
- small bronchi - cartilage looks like plates, the smaller the bronchus, the thinner the plates
- the terminal small bronchi do not have cartilage. Their walls contain only elastic fibers and smooth muscles
- Muscular layer of the bronchi– smooth muscles are arranged circularly. They provide narrowing and expansion of the lumen of the bronchi. At the site of the branching of the bronchi there are special bundles of muscles that can completely block the entrance to the bronchus and cause its obstruction.
- ciliated epithelium, lining the lumen of the bronchi, performs protective function– protects against airborne infections by drip. Small villi remove bacteria and small dust particles from distant bronchi into larger bronchi. From there they are removed when coughing.
- Lung glands
- single-celled glands that secrete mucus
- small lymph nodes connected to larger lymph nodes in the mediastinum and trachea.
- Cartilaginous base of the bronchi
- Alveolus – bubble, in the lungs, entwined with a network blood capillaries. The lungs contain more than 700 million alveoli. This structure allows you to increase the surface area in which gas exchange occurs. Atmospheric air enters the bubble through the bronchi. Through the thinnest wall, oxygen is absorbed into the blood, and carbon dioxide is released into the alveoli during exhalation.
The area around the bronchiole is called the acinus. It resembles a bunch of grapes and consists of branches of the bronchioles, alveolar ducts and the alveoli themselves
- Blood vessels. Blood enters the lungs from the right ventricle. It contains little oxygen and a lot of carbon dioxide. In the capillaries of the alveoli, the blood is enriched with oxygen and releases carbon dioxide. After this, it collects in the veins and enters the left atrium.
Causes of emphysema
The causes of emphysema are usually divided into two groups.
- Impaired elasticity and strength of lung tissue:
- Congenital deficiencyα-1 antitrypsin. In people with this abnormality, proteolytic enzymes (whose function is to destroy bacteria) destroy the walls of the alveoli. While normally α-1 antitrypsin neutralizes these enzymes within a few tenths of a second after their release.
- Birth defects lung tissue structure. Due to their structural features, the bronchioles collapse and the pressure in the alveoli increases.
- Inhalation of polluted air: smog, tobacco smoke, coal dust, toxic substances. The most dangerous in this regard are cadmium, nitrogen and sulfur oxides emitted by thermal power plants and transport. Their smallest particles penetrate the bronchioles and are deposited on their walls. They damage the ciliated epithelium and vessels feeding the alveoli and also activate special cells, alveolar macrophages.
They help increase the level of neutrophil elastase, a proteolytic enzyme that destroys the walls of the alveoli.
- Violation hormonal balance . An imbalance between androgens and estrogens impairs the ability of bronchiole smooth muscles to contract. This leads to stretching of the bronchioles and the formation of cavities without destruction of the alveoli.
- Respiratory tract infections: chronic bronchitis, pneumonia . Immune cells, macrophages and lymphocytes, exhibit proteolytic activity: they produce enzymes that dissolve bacteria and the protein that makes up the walls of the alveoli.
In addition, clots of sputum in the bronchi allow air into the alveoli, but do not release it in the opposite direction.
This leads to overfilling and overstretching of the alveolar sacs.
- Age-related changes associated with poor circulation. In addition, older people are more sensitive to toxic substances in the air. With bronchitis and pneumonia, lung tissue recovers worse.
- Increased pressure in the lungs.
- Chronic obstructive bronchitis. The patency of the small bronchi is impaired. When you exhale, air remains in them. With a new breath, a new portion of air enters, which leads to overstretching of the bronchioles and alveoli. Over time, disturbances occur in their walls, leading to the formation of cavities.
- Occupational hazards. Glassblowers, wind players. A feature of these professions is an increase in air pressure in the lungs. The smooth muscles in the bronchi gradually weaken, and blood circulation in their walls is disrupted. When you exhale, all the air is not expelled; a new portion is added to it. A vicious circle develops, leading to the appearance of cavities.
- Blockage of the lumen of the bronchus a foreign body leads to the fact that the air remaining in the segment of the lung cannot escape out. Developing acute form emphysema.
Mechanism of lung damage in emphysema- Stretching of bronchioles and alveoli - their size doubles.
- Smooth muscles are stretched, and the walls of blood vessels become thinner. The capillaries become empty and the nutrition in the acinus is disrupted.
- Elastic fibers degenerate. In this case, the walls between the alveoli are destroyed and cavities are formed.
- The area in which gas exchange occurs between air and blood decreases. The body experiences oxygen deficiency.
- The enlarged areas compress healthy lung tissue, further impairing the ventilation function of the lungs. Shortness of breath and other symptoms of emphysema appear.
- To compensate and improve respiratory function lungs, the respiratory muscles are actively activated.
- The load on the pulmonary circulation increases - the vessels of the lungs become overfilled with blood. This causes disturbances in the functioning of the right side of the heart.
Types of emphysema
There are several classifications of pulmonary emphysema.According to the nature of the flow:
- Acute. Develops during an attack of bronchial asthma, entering the bronchi foreign object, sharp physical activity. Accompanied by overstretching of the alveoli and swelling of the lung. This condition is reversible but requires urgent medical attention.
- Chronic. Develops gradually. On early stage the changes are reversible. But without treatment, the disease progresses and can lead to disability.
By origin:- Primary emphysema. Independent disease, which develops in connection with congenital features body. It can even be diagnosed in infants. It progresses quickly and is more difficult to treat.
- Secondary emphysema. The disease occurs against the background of chronic obstructive pulmonary diseases. The onset often goes unnoticed, and symptoms intensify gradually, leading to decreased ability to work. Without treatment, large cavities appear that can occupy an entire lobe of the lung.
By prevalence:
- Diffuse form. The lung tissue is uniformly affected. Alveoli are destroyed throughout the lung tissue. At severe forms A lung transplant may be required.
- Focal form. Changes occur around tuberculosis foci, scars, in places where a blocked bronchus approaches. Manifestations of the disease are less pronounced.
- Panacinar emphysema(vesicular, hypertrophic). All acini in the lung lobe or the whole lung are damaged and swollen. There is no healthy tissue between them. The connective tissue in the lung does not grow. In most cases there are no signs of inflammation, but there are manifestations of respiratory failure. Formed in patients with severe emphysema.
- Centrilobular emphysema. Damage to individual alveoli in the central part of the acinus. The lumen of the bronchioles and alveoli expands, this is accompanied by inflammation and mucus secretion. Fibrous tissue develops on the walls of damaged acini. Between the changed areas, the parenchyma (tissue) of the lungs remains intact and performs its function.
- Periacinar(distal, perilobular, paraseptal) - damage to the extreme parts of the acinus near the pleura. This form develops with tuberculosis and can lead to pneumothorax - rupture of the affected area of the lung.
- Okolorubtsovaya– develops around scars and areas of fibrosis in the lungs. Symptoms of the disease are usually mild.
- Bullous(bubble) shape. In place of the destroyed alveoli, bubbles form, ranging in size from 0.5 to 20 cm or more. They can be located near the pleura or throughout the lung tissue, mainly in the upper lobes. Bullae can become infected, compress surrounding tissue, or rupture.
- Interstitial(subcutaneous) - characterized by the appearance of air bubbles under the skin. The alveoli rupture, and air bubbles rise through the lymphatic and tissue gaps under the skin of the neck and head. Bubbles may remain in the lungs, and when they rupture, spontaneous pneumothorax occurs.
- Compensatory– develops after removal of one lobe of the lung. When healthy areas swell, trying to take up the vacant space. Enlarged alveoli are surrounded by healthy capillaries, and there is no inflammation in the bronchi. The respiratory function of the lungs does not improve.
- Senile– called age-related changes in the vessels of the lungs and the destruction of elastic fibers in the wall of the alveoli.
- Lobarnaya– occurs in newborns, more often boys. Its appearance is associated with obstruction of one of the bronchi.
Symptoms of emphysema
Diagnosis of emphysema
Examination by a doctor
If symptoms of pulmonary emphysema appear, consult a therapist or pulmonologist.
Instrumental methods for diagnosing pulmonary emphysema
- Radiography- study of the condition of the lungs using x-rays, as a result of which an image is obtained on film (paper) internal organs. A general X-ray of the chest is taken in a direct projection. This means that the patient faces the device during the shooting. An overview image allows you to identify pathological changes in the respiratory organs and the extent of their spread. If the image shows signs of illness, then a additional research: MRI, CT, spirometry, peak flowmetry.
Indications:
- Once a year within preventive examination
- prolonged cough
- dyspnea
- wheezing, pleural friction noise
- weakening of breathing
- pneumothorax
- suspected emphysema, chronic bronchitis, pneumonia, pulmonary tuberculosis
- breastfeeding period
- the lungs are enlarged, they compress the mediastinum and overlap each other
- affected areas of the lung appear excessively transparent
- expansion of intercostal spaces with active work muscles
- the lower edge of the lungs is drooping
- low aperture
- reduction in the number of blood vessels
- bullae and areas of tissue airing
- Magnetic resonance imaging (MRI) of the lungs- a study of the lungs based on the resonant absorption of radio waves by hydrogen atoms in cells, and sensitive equipment records these changes. MRI of the lungs provides information about the condition of the large bronchi vessels, lymphoid tissue, presence of liquid and focal formations in the lungs. Allows you to obtain sections 10 mm thick and view them from different positions. To study upper parts lungs and areas around the spine are injected intravenously contrast agent- gadolinium drug.
Disadvantage: air prevents accurate visualization of small bronchi and alveoli, especially at the periphery of the lungs. Therefore, the cellular structure of the alveoli and the degree of destruction of the walls are not clearly visible.
The procedure lasts 30-40 minutes. During this time, the patient must lie motionless in the magnetic tomograph tunnel. MRI does not involve radiation, so the study is permitted for pregnant and breastfeeding women.
Indications:
- there are symptoms of the disease, but x-ray changes cannot be detected
- tumors, cysts
- suspicion of tuberculosis, sarcoidosis, in which small focal changes are formed
- enlarged intrathoracic lymph nodes
- abnormal development of the bronchi, lungs and their vessels
- presence of a pacemaker
- metal implants, staples, fragments
- mental illnesses that do not allow lying for a long time without moving
- patient weight over 150 kg
- damage to the alveolar capillaries at the site of destruction of lung tissue
- circulatory disorders in small pulmonary vessels
- signs of compression of healthy tissue by expanded areas of the lung
- increase in pleural fluid volume
- increase in the size of the affected lungs
- cavities-bulls of different sizes
- low aperture
- Computed tomography (CT) of the lungs allow you to obtain a layer-by-layer image of the structure of the lungs. CT is based on the absorption and reflection of X-rays by tissues. Based on the data received, the computer creates a layer-by-layer image with a thickness of 1mm-1cm. The study is informative on early stages diseases. When a contrast agent is administered, CT provides more complete information about the state of the pulmonary vessels.
During a CT scan of the lungs, the X-ray emitter rotates around the patient lying motionless. The scan lasts about 30 seconds. The doctor will ask you to hold your breath several times. The whole procedure takes no more than 20 minutes. Using computer processing, X-ray images taken from different points are summarized into a layer-by-layer image.
Flaw– significant radiation exposure.
Indications:
- if symptoms are present, no changes are detected on the x-ray or they need to be clarified
- diseases with the formation of foci or diffuse damage to the lung parenchyma
- chronic bronchitis, emphysema
- before bronchoscopy and lung biopsy
- decision on the operation
- allergy to contrast agent
- extremely serious condition patient
- severe diabetes mellitus
- renal failure
- pregnancy
- patient weight exceeding the capabilities of the device
- an increase in the optical density of the lung to -860-940 HU – these are airy areas of the lung
- expansion of the roots of the lungs - large vessels entering the lung
- dilated cells are noticeable - areas of alveolar fusion
- reveals the size and location of bullae
Lung scintigraphy – injection of labeled radioactive isotopes into the lungs, followed by a series of images taken with a rotating gamma camera. Preparations of technetium - 99 M are administered intravenously or in the form of an aerosol. The patient is placed on a table around which the sensor rotates.
Indications:
- early diagnosis vascular changes in emphysema
- monitoring the effectiveness of treatment
- assessment of lung condition before surgery
- suspicion of oncological diseases lungs
- pregnancy
- compression of lung tissue
- disturbance of blood flow in small capillaries
- Spirometry – functional examination of the lungs, volume study external respiration. The procedure is carried out using a spirometer device, which records the amount of air inhaled and exhaled.
The patient puts into his mouth a mouthpiece connected to a breathing tube with a sensor. A clamp is placed on the nose to block nasal breathing. The specialist explains what breath tests must be completed. A electronic device converts sensor readings into digital data.
Indications:
- breathing disorder
- chronic cough
- occupational hazards (coal dust, paint, asbestos)
- smoking experience over 25 years
- lung diseases (bronchial asthma, pneumosclerosis, chronic obstructive disease lungs)
- tuberculosis
- pneumothorax
- hemoptysis
- recent heart attack, stroke, abdominal or chest surgery
- increase in total lung capacity
- increase in residual volume
- decreased vital capacity of the lungs
- reduction in maximum ventilation
- increased resistance in the airways during exhalation
- reduction in speed indicators
- decreased compliance of lung tissue
Peak flowmetry - measurement maximum speed exhalation to determine bronchial obstruction.Determined using a device - a peak flow meter. The patient needs to tightly clasp the mouthpiece with his lips and exhale as quickly and forcefully as possible through his mouth. The procedure is repeated 3 times with an interval of 1-2 minutes.
It is advisable to carry out peak flowmetry in the morning and evening at the same time before taking medications.
Disadvantage: the study cannot confirm the diagnosis of pulmonary emphysema. The rate of expiration decreases not only with emphysema, but also with bronchial asthma, preasthma, chronic obstructive pulmonary disease.
Indications:
- any diseases accompanied by bronchial obstruction
- evaluation of treatment results
Symptoms of emphysema:
- reduction in expiratory flow by 20%
- Determination of blood gas composition – study arterial blood during which the pressure in the blood of oxygen and carbon dioxide and their percentage, the acid-base balance of the blood are determined. The results show how effectively the blood in the lungs is cleared of carbon dioxide and enriched with oxygen. For research, a puncture is usually done ulnar artery. A blood sample is taken from a heparin syringe, placed on ice, and sent to the laboratory.
Indications:
- cyanosis and other signs of oxygen starvation
- breathing disorders due to asthma, chronic obstructive pulmonary disease, emphysema
- oxygen tension in arterial blood is below 60-80 mmHg. st
- blood oxygen percentage less than 15%
- increase in carbon dioxide tension in arterial blood over 50 mm Hg. st
- General blood test - a study that includes counting blood cells and studying their characteristics. For analysis, blood is taken from a finger or from a vein.
Indications- any diseases.
Contraindications does not exist.
Deviations for emphysema:
- increased amount red blood cells over 5 10 12 /l
- increased hemoglobin level over 175 g/l
- increase in hematocrit over 47%
- decreased erythrocyte sedimentation rate 0 mm/hour
- increased blood viscosity: in men over 5 cP, in women over 5.5 cP
Treatment of emphysema
Treatment of pulmonary emphysema has several directions:- improving the quality of life of patients - eliminating shortness of breath and weakness
- prevention of the development of heart and respiratory failure
- slowing the progression of the disease
- complete cessation of smoking
- exercise to improve ventilation
- taking medications to improve the condition of the respiratory tract
- treatment of the pathology that caused the development of emphysema
Treatment of emphysema with medications
| Group of drugs | Representatives | Mechanism of therapeutic action | Directions for use |
| α1-antitrypsin inhibitors | Prolastin | The introduction of this protein reduces the level of enzymes that destroy the connective fibers of lung tissue. | Intravenous injection at the rate of 60 mg/kg body weight. 1 time per week. |
| Mucolytic drugs | Acetylcysteine (ACC) | Improves the removal of mucus from the bronchi, has antioxidant properties - reduces the production of free radicals. Protects the lungs from bacterial infection. | Take 200-300 mg orally 2 times a day. |
| Lazolvan | Liquefies mucus. Improves its removal from the bronchi. Reduces cough. | Used orally or inhaled. Orally during meals, 30 mg 2-3 times a day. In the form of inhalations using a nebulizer, 15-22.5 mg, 1-2 times a day. |
|
| Antioxidants | Vitamin E | Improves metabolism and nutrition in lung tissues. Slows down the process of destruction of the walls of the alveoli. Regulates the synthesis of proteins and elastic fibers. | Take 1 capsule per day orally. Take courses for 2-4 weeks. |
| Bronchodilators (bronchodilators) Phosphodiesterase inhibitors Anticholinergics | Teopek | Relaxes the smooth muscles of the bronchi, helps to expand their lumen. Reduces swelling of the bronchial mucosa. | The first two days take half a tablet 1-2 times a day. Subsequently, the dose is increased - 1 tablet (0.3 g) 2 times a day every 12 hours. Take after meals. The course is 2-3 months. |
| Atrovent | Blocks acetylcholine receptors in the bronchial muscles and prevents their spasm. Improves external respiration indicators. | In the form of inhalations, 1-2 ml 3 times a day. For inhalation in a nebulizer, the drug is mixed with saline solution. | |
| Theophyllines | Long-acting theophylline | Has a bronchodilator effect, reducing systemic pulmonary hypertension. Increases diuresis. Reduces fatigue of the respiratory muscles. | The initial dose is 400 mg/day. Every 3 days it can be increased by 100 mg until the required therapeutic effect appears. The maximum dose is 900 mg/day. |
| Glucocorticosteroids | Prednisolone | Has a strong anti-inflammatory effect on the lungs. Promotes the expansion of bronchi. | Used when bronchodilator therapy is ineffective. At a dose of 15–20 mg per day. Course 3-4 days. |
Therapeutic measures for emphysema
- Transcutaneous electrical stimulation diaphragm and intercostal muscles. Electrical stimulation with pulsed currents with a frequency of 5 to 150 Hz is aimed at facilitating exhalation. At the same time, the energy supply to the muscles, blood and lymph circulation improves. In this way, fatigue of the respiratory muscles, followed by respiratory failure, is avoided. During the procedure, painless muscle contractions occur. The current strength is dosed individually. The number of procedures is 10-15 per course.
- Oxygen inhalation. Inhalation is carried out for a long time, 18 hours a day. In this case, oxygen is supplied to the mask at a rate of 2–5 liters per minute. In case of severe respiratory failure, helium-oxygen mixtures are used for inhalation.
- Breathing exercises- training of the respiratory muscles, aimed at strengthening and coordinating the muscles during breathing. All exercises are repeated 4 times a day for 15 minutes.
- Exhale with resistance. Exhale slowly through a cocktail straw into a glass filled with water. Repeat 15-20 times.
- Diaphragmatic breathing. On the count of 1-2-3, take a strong, deep breath, drawing in your stomach. On the count of 4, exhale - inflating your stomach. Then tense your abdominal muscles and cough loudly. This exercise helps to expel mucus.
- Lying push-up. Lying on your back, bend your legs and clasp your knees with your hands. As you inhale, draw in lungs full of air. As you exhale, stick your stomach out (diaphragmatic exhalation). Straighten your legs. Tighten your abs and cough.
When is surgery needed for emphysema?
Surgical treatment for emphysema is not often required. It is necessary when the lesions are significant and drug treatment does not reduce the symptoms of the disease. Indications for surgery for emphysema:
- shortness of breath leading to disability
- bullae occupying more than 1/3 of the chest
- complications of emphysema - hemoptysis, cancer, infection, pneumothorax
- multiple bullae
- permanent hospitalizations
- diagnosis of emphysema mild severe degrees"
- inflammatory process – bronchitis, pneumonia
- asthma
- exhaustion
- severe deformation of the chest
- age over 70 years
Types of operations for emphysema
- Lung transplant and its variants: lung transplantation together with a heart; transplantation of a lung lobe. Transplantation is performed in case of large diffuse lesions or multiple large bullae. The goal is to replace the diseased lung with a healthy donor organ. However, the waiting list for transplantation is usually too long and problems with organ rejection may arise. Therefore, such operations are resorted to only as a last resort.
- Reduced lung volume. The surgeon removes the most damaged areas, approximately 20-25% of the lung. At the same time, the function of the remaining part of the lung and respiratory muscles improves. The lung is not compressed, its ventilation is restored. The operation is performed in one of three ways.
- Minimally invasive technique (thoracoscopy) under the control of video equipment. 3 small incisions are made between the ribs. A mini-video camera is inserted into one, and surgical instruments are inserted into the others. The affected area is removed through these incisions.
- Bronchoscopic surgery. A bronchoscope with surgical equipment is inserted through the mouth. The damaged area is removed through the lumen of the bronchus. Such an operation is possible only if the affected area is located near large bronchi.
Opening the chest. The doctor removes the affected lobe and places stitches to seal the lung. Then a suture is placed on the chest.
Is hospitalization necessary to treat emphysema?
In most cases, patients with emphysema are treated at home. It is enough to take medications according to the schedule, adhere to a diet and follow the doctor’s recommendations.Indications for hospitalization:
- sharp increase in symptoms (shortness of breath at rest, severe weakness)
- the appearance of new signs of illness (cyanosis, hemoptysis)
- ineffectiveness of the prescribed treatment (symptoms do not decrease, peak flow readings worsen)
- heavy concomitant diseases
- newly developed arrhythmias
- difficulties in establishing a diagnosis;
Nutrition for emphysema (diet).
Therapeutic nutrition for pulmonary emphysema is aimed at combating intoxication, strengthening the immune system and replenishing the patient’s high energy costs. Diets No. 11 and No. 15 are recommended. Basic principles of diet for emphysema
- Increasing calorie content to 3500 kcal. Meals 4-6 times a day in small portions.
- Proteins up to 120 g per day. More than half of them must be of animal origin: animal and poultry meat, liver, sausages, fish of any kind and seafood, eggs, dairy products. Meat in any culinary processing, excluding excessive frying. All complications of pulmonary emphysema are life-threatening. Therefore, if any new symptoms appear, you should immediately seek medical help.
- Pneumothorax. Rupture of the pleura surrounding the lung. In this case, air escapes into the pleural cavity. The lung collapses and becomes unable to expand. Fluid accumulates around it in the pleural cavity, which needs to be removed. There is severe pain in the chest, which gets worse when you inhale, panic fear, rapid heartbeat, the patient takes a forced position. Treatment must be started immediately. If the lung does not expand within 4-5 days, surgery will be required.
- Infectious complications. Decreased local immunity increases the sensitivity of the lungs to bacterial infections. Severe bronchitis and pneumonia often develop, which progress to chronic form. Symptoms: cough with purulent sputum, fever, weakness.
- Right ventricular heart failure. The disappearance of small capillaries leads to an increase in blood pressure in the vessels of the lungs – pulmonary hypertension. The load on the right parts of the heart increases, which become overstretched and wear out. Heart failure is the leading cause of death in patients with emphysema. Therefore, at the first signs of its development (swelling of the neck veins, pain in the heart and liver, swelling), it is necessary to call an ambulance.
The prognosis for pulmonary emphysema is favorable under a number of conditions:- complete cessation of smoking
- prevention frequent infections
- clean air, no smog
- good nutrition
- good sensitivity to drug treatment with bronchodilators.
The chest is a part of the body that contains vital organs. To protect them from external influences, the ribs, spine, muscles and sternum are used. Breathing is provided by special ones.
Lungs are main body, which is involved in the human breathing process. They fill 90% of the chest cavity; the quality of oxygen saturation of the rest of the body depends on how well the activity of this organ is carried out.
Location of the lungs in humans
The lungs in the human body are distinguished by such an arrangement that allows all important vessels, airways, blood vessels, nerve cells and, which relate to the lymphatic system.
If we consider the lungs from an anatomical point of view, then appearance This organ has a lot of features. The shape of each lung resembles a cone that has been dissected vertically, so that two concave surfaces and one convex tissue can be clearly seen.
The convex area is called the costal area, since it is as close to the ribs as possible. One concave surface is diaphragmatic, it is in close proximity to the diaphragm. The second concave surface is medial, that is, located in the middle part of the body. Each of the mentioned planes is also divided into interlobar surfaces.
The diaphragm is the area that allows the right side of the lung structure to be separated from the liver. Left side separated by the diaphragm from organs such as the spleen, stomach and parts of the intestines. The middle part of the pulmonary space anatomically borders the heart and large vessels.
Anatomically, it has been noted that the location of the lungs affects their shape. If a person has a long chest, then the lungs will have an elongated shape. Short and wide lungs are observed in people with a rectangular chest.
The structure of the lungs includes the so-called base, which is located on the diaphragmatic dome, that is, on the surface of the diaphragm itself. The other base is located in the cervical region, it rises above the level of the collarbone by 4-5 centimeters.
Lung composition
The pulmonary structure anatomically includes the following elements:
- pulmonary type alveoli;
- bronchioles.
The bronchi have a branched structure that serves as the pulmonary frame. A large number of small lobules, which are structural units, make up the lung. If you consider each lobe separately, its shape resembles a small pyramid, medium size they are 15x25 mm.
The apex of each structural unit of the lung contains a bronchus, which is called a small bronchiole. One bronchus includes up to 20 small bronchioles. Each bronchiole has little education, which is called the acini. Each acinius, in turn, consists of several dozen alveolar branches, at the ends of which there are a large number of alveoli.
The pulmonary alveoli are small in size, which has thin tissue walls with a large number of blood vessels (capillaries). Despite the fact that the alveoli are the smallest parts of the pulmonary structure, they are one of the important parts of the lung.
The oxygen exchange of the body and the removal of carbon dioxide from the blood depend on their activity. It is the alveoli that are necessary for the uninterrupted supply of oxygen to the blood vessels of the body and for the implementation of the gas exchange process.
Gas exchange is a process during which oxygen and carbon dioxide penetrate into the alveoli, where, in the blood vessels, they “meet” red blood cells. Due to great content alveoli, the area of which does not exceed 0.3 square mm, the total area for the gas exchange process increases by almost 80 square meters.
What is the bronchial system?
Before air penetrates the alveoli, it must pass through the bronchial system. The trachea is a kind of “funnel” for air. The trachea is a breathing type tube, the beginning of which is located below the larynx area.
The main structure of the trachea is cartilaginous rings. They provide the proper level of stability of the tube, which must maintain a certain lumen for the air mass to enter the body. Cartilaginous rings prevent the trachea from being compressed, even with mechanical impact from the outside.
Components of the trachea and bronchi:
- laryngeal protrusion, or the usual name of the Adam's apple;
- thyroid cartilage;
- thyroid ligament;
- tracheal;
- arcuate-type cartilages, which are the base of the trachea;
- ring-type ligaments, which relate to the trachea;
- esophagus;
- main bronchi (on the right and left sides);
- aorta
The surface inside the tracheal region is the mucous membrane, on which there is a huge number of microscopic villi. These villi belong to the ciliated epithelium. The main task of this fabric is to carry out high-quality filtration of air masses coming from outside, since no debris, dust or foreign bodies should enter the bronchi.
The ciliary epithelium is an anatomical filter that should protect the human lungs from harmful elements. In people who smoke for a long time, this tissue ceases to perform its main functions, and the eyelashes simply die off after a while. All this leads to harmful substances entering and settling inside the lungs, which in the future can cause serious pulmonary tumors, including cancer.
The trachea divides into two bronchi at the posterior part of the sternum. Each bronchi enters the left and right lung. Anatomically, there is a “gate” through which the bronchus enters the lung; they are located in the internal part of each organ. Each large bronchus branches into small segments.
In its anatomical structure, the bronchial system resembles a tree with wide branches. It penetrates through the entire pulmonary region, thereby ensuring a continuous process of gas exchange and oxygen saturation of the blood. Cartilaginous rings are necessary only to strengthen the large bronchi and trachea.
Small in size, segmental bronchi can only be further strengthened with cartilaginous plates. The bronchi are ring-type and do not contain cartilage cells at all.
The anatomical structure of the lungs is the key to a unified structure that supplies other organs and systems of the body 24 hours a day required quantity oxygen and also releases carbon dioxide from the body.
Segmental structure of the human lungs
The structure of the right lung involves the formation of three lobes, left lung Only 2 lobes are formed. Each share includes a certain number of segments. The segments are separated from each other by a special connective tissue, in which many vessels of the intersegmental type are located.
The upper lobe, which is located in right lung, includes elements such as:
- apical,
- rear,
- front elements.
Average share:
- interior,
- outer element.
Posterior lobe:
- basal,
- medial superior;
- lateral;
- anterior and posterior basal elements.
The left lung is distinguished by a basal element that is not constant. The posterior and apical elements have a common bronchus. Each element of the bronchial system is not only a structural, but also an anatomical and clinical unit that determines the development of any pathological processes in the pulmonary system.
Circulation
The pulmonary circulation is formed by veins and arteries, which are the constituent elements circulatory system the entire human body.
The lesser circle originates near the pulmonary trunk, which starts from the right cardiac ventricle, and enters the lungs through it venous blood saturated with carbon dioxide. The alveoli provide the process of gas exchange, as a result of which, through the right atrium, clean and oxygenated blood enters the large ones, which are located in the lungs.
Blood supply to the entire system of the lungs and bronchi is ensured due to the fact that the system great circle The circulatory system includes veins and arteries passing through the bronchial region. The outflow of lymph from the pulmonary area occurs through lymphatic vessels, which also have several nodes, in particular, most of them are concentrated in the trachea and.
Due to the fact that in the lung area it is located nervous system sympathetic and parasympathetic in nature, the process of innervation of the bronchopulmonary apparatus is carried out.
Functions of the respiratory system
The main function of the lungs, which is determined by their anatomical structure, is to provide external respiration. The process itself involves the entry of air masses into the lung area, air filtration and gas diffusion. At everyone's expense component element. A single pulmonary system is formed with blood vessels, all of whose activities are aimed at supporting the metabolic process and saturating each individual organ with the necessary amount of oxygen.
In addition to the respiratory function, the activity of the lungs also performs a number of other functions:
If a person healthy lungs, then these shells must be in constant interaction with each other. They should create slight friction when breathing. Between the shells there is a small space in which a small amount accumulates to soften the friction of the shells.
At different pulmonary diseases, this space increases and is filled with more liquid. The pleura is a membrane that is distinguished by the presence of nerve endings. Therefore, the first signs of a disease such as pleurisy are pain.
By watching the video you can learn about pneumonia.
Anatomically, the lungs have complex structure and a large number of elements, which as a whole are a single pulmonary system. This is an important organ, on whose work the activities of other organs depend. Lung health is the key to health.
