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PULMO AND ALVEOLUS

A. ANATOMY
Part of pulmo
1) Pulmo Dextra:
- Lobus superior pulmo dextra
Border: Fissura horizontalis pulmo dextra
- Lobus medius pulmo dextra
Border: Fissura oblique pulmo dextra
- Lobus Inferior pulmo dextra

Image 1. Pulmo dextra


2) Pulmo Sinistra
- Lobus superior pulmo sinistra
Border: Fissura oblique pulmo sinistra
- Lobus inferior pulmo sinistra

Image 2. Pulmo sinistra

Segment of Pulmo
- Apex pulmo

Basis pulmo
Incisura cardiac
Hillum pulmonalis
Entry of radix pulmo
Radix pulmonalis
Consist of bronchus primer, artery and vein pulmonal, nodi

lymphatic plexus pulmonalis (N.Vagus), limfe.


Structure of Pulmo
- Lingula pulmonalis
- Incisura cardiaca
- Impressio cardiaca
Wrapper of Pulmo
- Pleura visceralis 4 layers which stick in pulmo
- Pleura parietalis 4 layers which stick in thorax
- Cupula pleura : pleura parietalis which cover apex pulmo

Image 3. Pulmo and pleura


PHYSIOLOGY
Alveoli are tiny sacs within our lungs that allow oxygen and carbon dioxide to
move between the lungs and bloodstream.

Image 4. Alveolus
CLINICAL APPLICATION
1. Pneumothorax
Pneumothorax is the event of air or gas in the pleural cavity. In normal
condition the pleural cavity is filled with air, so that the lungs can freely
expand in the chest cavity.
Etiology :
a. Traumatic pneumothorax.
Traumatic pneumothorax is a pneumothorax caused by a penetration into
the pleural cavity due to stab wounds or gunshot wounds or puncture.
Traumatic pneumothorax also have 2 types. Non iatrogenic traumatic
pneumothorax is pneumothorax which occurs due to an accident for
example rows of sharp chest wall open / closed. And the second is
Iatrogenic traumatic pneumothorax.
b. Pneumothorax caused by medical treatment.
Pneumothorax this type are grouped into traumatic pneumothorax
iatragenik accidental and iatrogenic traumatic pneumothorax meaning fisial
(deliberate).
Clinical symptoms:
-

Chest pain on the side

Shortness of weight can sometimes be lost up to 24 hours when

partially collapsed lung is re-inflated.


Respiratory failure and may also be accompanied by cyanosis.
The combination of complaints and clinical symptoms pneumothorax
is influenced by the lesion penumothoraks.

Treatment :
Action decompression. Pleural cavity contact with the outside world by
means of a needle through the chest wall and then entering the pleural cavity
thereby positive air pressure in the pleural space would turn into a negative
because the positive air in the pleural space would turn into a negative
because the air out through the needle. Making contact with the outside air
through a counter ventiles:
-

Can use the infusion set


Needle abbocath
Sealed water drainage pipe (WSD)

Figure 5. Pneumothorax
2. Hematothorax

Figure 6. Hematothorax
Hematothorax is the presence of blood in the pleural space. The source of
blood may be the chest wall, lung parenchyma, heart, or great vessels.
Although some authors state that a hematocrit value of at least 50% is
necessary to differentiate a hemothorax from a bloody pleural effusion, most
do not agree on any specific distinction. Hemothorax is usually a consequence
of blunt or penetrating trauma. Much less commonly, it may be a complication
of disease, may be iatrogenically induced, or may develop spontaneously.
Treatment Installation WSD (Water Sail Draignase) as high as SIC V - VI
parallel to the anterior axillary line on the affected side.

Figure 7. Water Seal Drainase


3. Pleural Effusion

Figure 8. Pleural Effusion


Pleural effusion is an abnormal collection of fluid in the pleural cavity
resulting from excess fluid production or decreased absorption or both.

Figure 9. Radiologys picture of Pleural Effusion


On the radiologys picture posterior anterior (PA) of thorax the surface of the
liquid contained in the pleural cavity will form a shadow like the curve, with
the surface of the lateral region higher than at its medial region, looked blunt of
costophrenicus angle. WSD (Water Seal Drainage) is an attempt to insert a
catheter into the pleural cavity to removing the fluid contained inside.
4. Cronic Obstructive Pulmonary Disease (COPD)
COPD or chronic obstructive pulmonary disease, is a progressive disease
that makes it hard to breathe. "Progressive" means the disease gets worse over
time. COPD can cause coughing that produces large amounts of mucus (a

slimy substance), wheezing, shortness of breath, chest tightness, and other


symptoms.

Figure 10. Radiologys picture of COPD


5. Pneumonia

Figure 11. Alveolus condition in Pneumonia

Figure 12. Radiologys picture of Pneumonia


6. Tuberculosis
Tuberculosis, commonly known as TB, is a bacterial infection that can
spread through the lymph nodes and bloodstream to any organ in your body. It
is most often found in the lungs. Most people who are exposed to TB never
develop symptoms because the bacteria can live in an inactive form in the
body. But if the immune system weakens, such as in people with HIV or
elderly adults, TB bacteria can become active. In their active state, TB bacteria
cause death of tissue in the organs they infect. Active TB disease can be fatal if
left untreated. TB bacteria most commonly grow in the lungs, and can cause
symptoms such as:
- A bad cough that lasts 3 weeks or longer
- Pain in the chest
- Coughing up blood or sputum (mucus from deep inside the lungs)
Other symptoms of TB disease may include:
-

Weakness or fatigue
Weight loss
No appetite
Chills
Fever
Sweating at night

Figure 13. Radiologys picture of TBC


7. Rib Fracture

Figure 17. Rib Fracture


Rib fracture is interruption of continuity of bone tissue or cartilage that
caused by trauma. The trauma that can occur are blunt trauma or sharp trauma.
The symptoms of rib fracture are chest pain and disruption of respiration. Rib
fracture can cause complications such as hematothorax or pneumothorax.

Figure 18. Radiologys picture of Rib Fracture


8. Carsinoma Pulmo (Lung Cancer)
Lung cancer is all malignancies in the lung, including lung malignancy
derived from itself or from extrapulmonary malignancy (tumor metastases in
the lungs).

Figure 19. Lung Cancer


Lung carcinoma growing point is located at the branching segments or
subsegmen bronchus. In the place of tumor growth appeared in the form of
small nodules then grew into a wad and extends toward the central or
centripetal and toward the pleura. Lung is the most common place for
metastatic cancer of various places. Many studies suggest that smoking is a
major cause of lung cancer. Another cause of lung cancer is air pollution,
exposure to arsenic, asbestos, radon, chloromethyl ethers, chromium, mustard

gas, nickel refining, polycyclic hydrocarbons, beryllium, cadmium, and vinyl


chloride. The incidence of lung cancer is higher also found on gas industriescoal, metal refining process. Genetic predisposition also plays a role in the
etiology of lung cancer. History will be obtained from the main complaints and
course of the disease, as well as other factors that are often very helpful
upholding diagnose. The main complaints can be:
- Cough-cough with / without sputum (phlegm white, can also purulent)
- Coughing up blood
- Hard to breathe
- Hoarseness
- Chest pain
- Difficulty / pain swallowing
- A lump in the base of the neck
- Swollen face and neck, sometimes accompanied by a swollen arm with
great pain
Not infrequently the first visible symptoms or complaints are due to
metastases outside the lung, such as abnormalities that arise because of severe
compression of the brain, liver enlargement or leg fractures. Symptoms and
complaints that are not typical like:
-

Weight loss decreases


Appetite lost
Intermittent fever
Paraneoplastic syndromes, such as "Hypertrophic pulmonary
osteoartheopathy" peripheral venous thrombosis and neuropatia.

Radiological examination results is one that is absolutely necessary


investigation to determine the location of the primary tumor and metastasis, as
well as disease staging by TNM system. Radiological examination of the
lungs that is CXR (Chest X-Ray) PA /lateral, if possible thoracic CT scan,
bone scan, bone survey, abdominal ultrasound (USG) and Brain-CT needed to
determine the location of abnormalities, tumor size and metastasis.

Figure 20. Overview CXR with lung cancer


Lung cancer treatment is combined modality therapy (multi-modaliti therapy).
In fact at the time of the selection of therapy, not only expected on histologic
type, degree and appearance of the patient but also non-medical conditions
such as facilities owned by the hospital and the patient economy is also a
factor that was crucial. Therapy in lung cancer include surgery, radiotherapy
and chemotherapy.

Thoraxs Physical Examination