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Published byJuliet Richard Modified over 9 years ago
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THE LUNG
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The Lung Embryology 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 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 Failure of medical RX Giant abscess ( >6cm) Haemorrhage Inability to R/O carcinoma Rupture with resulting empyema Type of Resection ‒ Lobectomy
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B.Bronchiectasis Def Bronchial dilatation Cause 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 cyst Cause Echinococcus granulosus Diagnosis Treatment
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Tumor Benign Malignant Primary Secondary
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A.Primary lung carcinoma Incidence Risk Factor Smoking Others Pathology Adenocarcinoma Squamous cell carcinoma Large cell carcinoma Small cell carcinoma NSCLC vs. SCLC
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Clinical Features Asymptomatic Symptomatic Lung Surrounding structures Rec. L. nerve Oesophagus C 8, T 1 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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Management Depends on: Stage Cell Type Patient Physical fitness NSCLC Surgical Radiotherapy Chemotherapy SCLC Chemotherapy Radiotherapy
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B.Secondary Lung Carcinoma Solitary Lung Nodule Primary Carcinoma Tuberculous Ganuloma Mixed tumor °2 Carcinoma Miscellaneous Benign Vs. Malignant Hamartoma-Carcinoid Age Sex X-ray ‒ Size ‒ Time ‒ Calcification
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THE MEDIASTINUM Anatomy Boundaries Divisions Traditional Clinical Access: Mediastenoscopy, mediastenotomy Mediastinal mass lesions Anterior mediatinum(5 T’s) Middle Mediastinum(Cyst) 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
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