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Research methods of the trachea and bronchi

The study of the lower respiratory tract, which include the trachea and bronchi, is carried out by endoscopic and radiological methods.

With indirect laryngoscopy, you can see not only the sub-fold space of the larynx, but also the first rings of the trachea. With a deep breath, in individual patients it is possible to examine the trachea throughout the bifurcation area and even the beginning of the main bronchi. However, such a study cannot be considered sufficient, it should be considered as preliminary, after which it is necessary to resort to more complex and informative research methods - radiation, primarily x-ray and tracheobronchoscopic.

X-ray examination. Radiodiagnosis for diseases and foreign bodies of the trachea and bronchi is widely used. On radiographs, the trachea appears as a uniform strip. When narrowing it, roughness in the contours may be noticeable. Of much greater importance is the study of the trachea and especially the bronchi, using a contrast medium. It can be administered through the natural pathways with the help of a guttural syringe on inhalation, or through the nose and during bronchoscopy through a bronchoscope. The introduction of contrast medium into the tracheo-bronchial space can also be carried out through a puncture of the ring-thyroid membrane. A tracheo-bronchial tree filled with a contrast medium gives a clear picture on a normal x-ray, and in pathological cases it reveals bronchial obstruction, filling defect, etc. Branching of the bronchi in the lower lobes of the lung is best filled. By tilting the subject in one direction or another, you can direct the contrast medium in the direction of interest.

In recent years, with the use of new methods of radiation diagnostics of computerographic (CT) and magnetic resonance (MRI), diagnostic capabilities have significantly increased in the study of pathological conditions of the trachea and bronchi.

Tracheobronchoscopic examinations. Endoscopic examinations of the trachea and bronchi are performed using both rigid tracheobronchoscopes and flexible ones equipped with fiber optics. A tracheobronchoscopy performed through the natural pathway is called the upper, and produced through a previously applied tracheostomy - the lower.
The latter is technically a much simpler intervention (not counting the tracheostomy) than the upper tracheo-bronchoscopy. The choice between upper and lower tracheobronchoscopy is determined by the age of the subject and the experience of the doctor.

Lower tracheobronchoscopy must be addressed if the introduction of the instrument through the natural pathways, for one reason or another, fails, and also if the introduction of the apparatus through the natural paths poses a threat to the subsequent development of laryngeal edema, which is most likely in children under 5 years of age.

Rigid bronchoscopes in our country use bronchoesophagoscopes of the Brunings and Mezrin design, as well as a special respiratory bronchoscope of the Friedel design. The first two devices allow you to inspect the respiratory tract only under local anesthesia.

Friedel’s tracheobronchoscope is designed to conduct research under general anesthesia with controlled breathing. For this, the instrument has connections to the anesthesia apparatus, and the closedness of the respiratory circuit is ensured by closing the outer end of the endoscopic tube with a displaceable lens. If necessary, make a diagnostic or therapeutic manipulation and introduce an instrument into the lumen of the tube, the lens shifts for a short time.

Tracheobronchoscopy, performed with a rigid instrument under local anesthesia, carries the danger of developing a formidable complication - bronchospasm, especially in people predisposed to bronchospasm. The likelihood of such a complication is significantly reduced with tracheobronchoscopy using a flexible fibrobronchoscope. Investigations with this instrument are usually performed under local anesthesia with prior sedation. It allows the best way to inspect almost the entire tracheobronchial tree. The technical capabilities of the device, including the availability of optics, make it possible to conduct a detailed examination of suspicious sections of the respiratory tract, to make photo documentation and a delicate biopsy (Fig. 5.8).
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Research methods of the trachea and bronchi

  1. Physiology of the trachea and bronchi
    The main function of the trachea and bronchi is respiratory. During breathing, in connection with excursions of the chest, the trachea and bronchi make a number of movements, while the bifurcation of the trachea during inspiration moves down and anterior to 2 cm (Lepnev P.G., 1956). The volume of air in the tracheobronchial tree, the so-called "harmful space" is equal to 120 - 180 ml. Due to the presence, in the annular ligaments and
  2. Malformations of the wall of the trachea and bronchi.
    Malformations of the structural elements of the wall of the trachea, bronchi and bronchioles are morphologically associated with the absence, deficiency or disorganization of cartilage or elastic and muscle tissue. Malformations of the wall of the bronchi can be divided into limited and common. Limited defects of tracheobronchial structures usually lead to local narrowing of a particular segment
  3. Damage to the bronchi and trachea
    Fractures of the first two ribs, sternum and collarbone are the most characteristic bone injuries that cause airway injuries. Hemoptysis, atelectasis, subcutaneous emphysema, pneumomediastinum or pneumothorax, which cannot be corrected by pleural drainage, are signs of possible damage to the main respiratory tract. (The presence of bilateral pneumothorax after blunt injury
  4. Clinical anatomy of the trachea and bronchi
    The respiratory throat (trachea) is a continuation of the larynx, with which it is connected through the cricotracheal ligament (lig. Cricotracheale). Trachea - a long cylindrical tube (length 11-13 cm); it begins at the body level of Suz. and at the level of ThiV — Thv is divided into two main bronchi (bronchus principalis dexter et sinister). The beginning of the septum dividing the trachea is called the spur (carina;
  5. Clinical anatomy of the trachea and bronchi
    The respiratory throat or trachea is a direct continuation of the larynx and refers to the initial section of the lower respiratory tract. The trachea is a hollow elastic tube, somewhat compressed in the anteroposterior direction. Above, through the cricoid-tracheal ligament, it connects to the larynx, below, in the bifurcation area, it is divided into two main bronchi. Distinguish in the trachea
  6. Foreign bodies of the trachea and bronchi
    Most often, foreign bodies of the respiratory tract are found in young children. This is because children, learning the world around them, take various objects into their mouths, and their protective reflexes are not sufficiently developed. The frequency of predominant localization of foreign bodies in the respiratory tract is as follows: in the larynx - 13%, in the trachea - 22%, in the bronchi - 65% (Rokitsky M.R., 1978). Other authors
  7. Clinical physiology of the larynx, trachea and bronchi
    Resume function. The larynx is part of the airway; when inhaling, it conducts air to the lower sections - the trachea, bronchi and lungs, when exhaling, the air passes in the opposite direction. The act of breathing is provided by the respiratory muscles, and in the larynx by the contraction of the posterior cricoid muscles, which expand the glottis. When breathing, the glottis is always open,
  8. Physiology of the esophagus, trachea and bronchus
    Physiology of the Esophagus, Trachea and
  9. Clinical anatomy of the esophagus, trachea and bronchus
    Clinical anatomy of the esophagus, trachea and
  10. Injuries, foreign bodies of the esophagus, trachea and bronchus
    Injuries, foreign bodies of the esophagus, trachea and
  12. Examination of the larynx and trachea.
    Carry out external and internal studies of the larynx and trachea. Outdoor research. It consists of examination, palpation and auscultation. With an external examination, you can notice the lowering of the head, stretching of the neck and shortness of breath, sometimes swelling is established in the larynx and trachea due to inflammation and swelling of the surrounding tissues. When examining the trachea determine the change in its shape,
    Patients with diseases of the pancreas (pancreas) may complain of abdominal pain, as well as dyspeptic symptoms and general weakness. Pain is most often localized in the upper abdomen, mainly in the epigastric region or left hypochondrium, radiating to the back, left shoulder. They can be acute, intense, girdling, with radiation to the lumbar region,
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