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Vascular pathology of the lungs.
Vascular pathology of the lungs occurs in various diseases of the lungs, heart and blood vessels, liver and is described by a variety of syndromes. The most important variants of pulmonary vascular pathology are represented by the following groups of diseases: pulmonary edema; adult respiratory distress syndrome; pulmonary embolism syndrome; syndromes of primary and secondary pulmonary hypertension; pulmonary vasculitis; pulmonary hemorrhages and heart attacks. Pulmonary edema. Pulmonary edema complicates many diseases of the lungs, heart, and other organs. In the tissue of the edematous lung, more than 4-5 ml of fluid is accumulated per gram of dry matter. The mechanism of development of pulmonary edema is associated with an imbalance between three components: hydrostatic intracapillary pressure, oncotic pressure, vascular-tissue permeability, and lymphatic drainage. In this case, with the development of pulmonary edema, an increase in the performance of one or more of the first three components is noted and, on the contrary, a decrease in the work of lymphatic drainage. Pulmonary edema is most often caused by two groups of reasons: an increase in hydrostatic pressure in the venous part of the pulmonary circulation (with acute left ventricular failure, mitral stenosis, hypervolemia of the pulmonary circulation, obstruction of the pulmonary veins) or a local increase in the permeability of capillaries of the alveolar septum (with adult respiratory distress syndrome ) In addition, pulmonary edema can develop with a decrease in blood oncotic pressure with nephrotic syndrome, liver diseases, enteropathy, accompanied by hypoalbuminemia, as well as edema caused by obstruction of lymphatic drainage. The clinical picture of pulmonary edema is characterized by the development of shortness of breath, orthopnea, cough, sometimes with a pink foamy type of sputum. During auscultation, crepitus is found in the basal parts of the lung. Functional tests demonstrate a decrease in lung capacity, hypoxemia, hypercapnia. A vascular pattern with vasodilatation and fluid levels in the lungs are radiologically detected (Curly B line). The morphology of pulmonary edema consists of micro- and macroscopic manifestations. Macroscopically light red, heavy and wet. When pressed, a foamy red liquid flows from the surface of the incision. Microscopically, pulmonary edema has different manifestations depending on the stage. In the first stage, the edematous fluid accumulates in the interstitial tissue of the lung, in the second - in the lumen of the alveoli, which becomes possible only when the tight contacts between the first order pneumocytes are destroyed with a sharp increase in the pressure of the interstitial edematous fluid. With the progression of edema, red blood cells and other cellular elements of the blood go into the lumen of the alveoli. Pulmonary edema can resolve without any consequences. However, interstitial fibrosis often develops in the outcome, and with chronicity of the process, sclerosis and hemosiderosis of the lungs. Adult respiratory distress syndrome. In the literature, adult respiratory distress syndrome (RDSV) is described under different names: shock lung, diffuse damage to the alveoli, acute damage to the alveoli, traumatic wet lung. The clinical picture and morphological changes in RDSV are similar to those in newborn respiratory distress syndrome, which gave the name to this suffering. However, neonatal ECD has a different etiology and pathogenesis. RDSV (from Latin distringo - severe suffering) can complicate aspiration of gastric contents, DIC, infectious diseases of the lungs, especially pneumonia, various types of shock - septic, traumatic, posthemorrhagic, burn, as well as inhalation of toxic substances, including . excessive amounts of oxygen, paraquat, an overdose of drugs, heart surgery with extracorporeal circulation, and radiation exposure. More than 60% of patients with RDSV die, despite modern treatment methods. Mortality is especially high in the outcome of RDSV with aspiration of gastric contents (93.8%), sepsis (77.8%) and pneumonia (60%). Pathogenesis and morphogenesis. RDSV is associated with damage to the endothelium of capillaries and often first-order pneumocytes in the area of the airborne barrier with the subsequent development of respiratory failure. In the pathogenesis of early changes in RDSV, polymorphonuclear leukocytes play an important role. In experiments, it is possible to reduce damage to the lung tissue in neutropenia. The pathogenetic role of activated neutrophils is due to their generation of diverse factors: 1) proteolytic lysosomal enzymes; 2) free oxygen radicals; 3) nitric oxide; 4) derivatives of arachidonic acid (leukotrienes and prostaglandins) that activate phospholipase A; 5) platelet activation, leading to platelet aggregation and sequestration and production of platelet growth factor, which stimulates sclerosis processes.
Therefore, patients with RDSV often develop thrombocytopenia, and in the end - interstitial pulmonary fibrosis; 6) violations of the synthesis of surfactant by second-order pneumocytes, leading to the development of atelectasis. In a number of conditions in the pathogenesis of RED, the generation of proteolytic enzymes, free oxygen radicals and nitrogen oxides not only by neutrophils, but also by alveolar macrophages and endothelium of alveolar capillaries (radiation, endotoxic shock, intoxication, etc.) comes first. RDSV proceeds in three stages: 1. The preclinical stage is characterized by morphological signs of damage to the capillaries of the alveolar septa. 2. The acute stage is characterized by the development of interstitial and alveolar edema, it develops during the first week after the action of a damaging factor. At the same time, there are phenomena of intra-alveolar and interstitial edema, inflammatory changes with a large number of polymorphonuclear leukocytes and fibrin both in the intraalveolar exudate and in tissue infiltrates, hyaline membranes, atelectasis. 3. The stage of organization of exudate and proliferation of second-order pneumocytes ends with interstitial fibrosis. Organization processes begin on the 2nd – 3rd day of the disease. Clinically, RDSV is characterized by the following manifestations: refractory hypoxemia, which cannot be corrected by increasing oxygenation of the respiratory mixture; decreased lung capacity; unchanged intracapillary and oncotic pressure; radiological symptoms of pulmonary edema. With the progression of RDES, interstitial pulmonary fibrosis develops. Death occurs from pulmonary heart failure. Pulmonary hypertension. Pulmonary hypertension syndrome is characterized by increased pressure in the pulmonary circulation with the development of hypertrophy of the right ventricle, and subsequently of the pulmonary heart. Pulmonary hypertension syndrome can be primary and secondary. Syndrome of primary pulmonary hypertension is extremely rare, as a rule, in children and women aged 20-40 years and has the morphology of plexogenic pulmonary arteriopathy. The etiology of primary pulmonary hypertension has not been established. The literature describes family cases of the disease, inherited both in the dominant and recessive types. The disease also refers to polygenic pathologies, and the role of environmental factors is not excluded. The pathogenesis of primary pulmonary hypertension syndrome is most likely autoimmune, as evidenced by the frequent development of plexogenic pulmonary arteriopathy in patients with proven autoimmune diseases (scleroderma, rheumatoid polyarteritis, goiter Hashimoto, primary biliary cirrhosis of the liver, etc.), as well as characteristic stenosis. arteries. The role of hormones in the pathogenesis of plexogenic pulmonary arteriopathy is not ruled out, which is confirmed by the development of this disease in women of reproductive age, as well as during pregnancy and when taking oral contraceptives. In the 70s. in Western Europe, cases of plexogenic pulmonary arteriopathy have been reported in women who used aminorex, in a chemical formula similar to epinephrine, to reduce weight. Often, the diagnosis of primary pulmonary hypertension syndrome is made to patients with congenital malformations of the pulmonary artery and heart. Morphological changes in the syndrome of primary pulmonary hypertension are characterized by the development of: atherosclerosis of the large branches of the pulmonary artery; fibrosis and muscle hypertrophy of the branches of the pulmonary artery of medium and small caliber. Microscopic examination reveals a spectrum of changes corresponding to different stages of the progression of plexogenic pulmonary arteriopathy in the form of muscularization of the pulmonary artery, migration of dark muscle cells into intima, proliferation of intimal cells and transformation into myofibroblasts, the formation of plexogenic structures, dilatations (microaneurysms) and ruptures of microaneurysms, the development of fibrinoid . Secondary pulmonary hypertension syndrome develops in chronic lung diseases, as well as in chronic left ventricular heart failure and repeated pulmonary thromboembolism. In the lungs, pneumosclerosis develops, and with stagnation of venous blood, pulmonary vasculitis and embolism, hemosiderosis joins. In recent years, the development of pulmonary hypertension syndrome in chronic liver diseases, as well as chronic viral infections, has been of great interest.
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Vascular pathology of the lungs.
- Lung diseases. Congenital malformations. Atelectases. Vascular pathology. Infectious pathology
Lung diseases, related to the most common diseases of modern man and having high mortality rates, can be combined into the following groups: congenital anomalies; atelectasis; vascular pathology of the lungs; infectious diseases of the lungs; bronchial asthma; chronic obstructive pulmonary disease; interstitial lung diseases; lung tumors.
- Tutorial. Private pathophysiology. Pathophysiology of the cardiovascular system. Pathology of vascular tone, 2002
- CARDIOVASCULAR PATHOLOGY AND PREGNANCY
Cardiovascular diseases occupy one of the leading places in the structure of extragenital pathology. Maternal mortality in this pathology goes to 3-4 place, yielding to bleeding and gestosis. It is generally accepted that with an active rheumatic process, pregnancy is unacceptable. It is also contraindicated in severe valvular defects (mitral valve stenosis III - IV degree and
- Lung pathology
The main requirements for anesthetic management in patients with concomitant pulmonary pathology are as follows: 1) if circumstances permit, then it is necessary to examine the functional state of respiration in the preoperative period in order to determine the main physiological mechanisms of respiratory pathology; 2) we must try to increase the functional reserves of respiration in the preoperative period
- AH in combination with lung pathology.
Taking into account the high prevalence of hypertension and obstructive pulmonary diseases in the population (mainly bronchial asthma and chronic obstructive pulmonary disease) and their frequent combination in one patient, the presence of concomitant bronchial obstructive pathology in a patient should be considered when prescribing antihypertensive therapy. The focus is on combining COPD and
- Lesions of the lungs of vascular origin
Edema. Pulmonary edema can be the result of hemodynamic disorders (hydrodynamic or cardiogenic pulmonary edema) or an increase in the permeability of capillaries of the pulmonary circulation (due to damage to the microvasculature). The types and causes of pulmonary edema are as follows: Hemodynamic edema • Increased hydrostatic pressure in the pulmonary circulation system
- CARDIOVASCULAR PATHOLOGY
- Pathology of the cardiovascular system
200. Patient T., 45 years old, suffers from a combined heart defect formed on the basis of rheumatism transferred in her youth. For many years I felt satisfactory. However, after suffering a sore throat this year, the condition noticeably worsened. The patient is concerned about shortness of breath, palpitations, pain in the heart, hemoptysis, edema. Objectively: skin and visible mucous membranes
- Pulmonary edema with increased permeability of the vascular wall
In many conditions called acute RDSV, the ultrastructure of the lungs is damaged and vascular permeability increases, which leads to the redistribution of water into the lung tissue. The concentration of protein in the interstitial fluid and in the alveoli increases. One of the main signs of RDSV is a large amount of protein in the pulmonary extravascular fluid and alveoli. Diagnostics. Cardiogenic edema
- Lung lesions in vascular collagen diseases
Diffuse interstitial pulmonary fibrosis in the classic version occurs with progressive systemic sclerosis (scleroderma). In patients with systemic lupus erythematosus in the pulmonary parenchyma, focal infiltration can be observed, and severe lupus erythematosus sometimes develops. With rheumatoid arthritis, the lungs are often involved in the process, which manifests itself in one of 5 forms:
- Respiratory support for obstructive pulmonary disease
Obstructive pulmonary disorders are found in many diseases, but most often they occur in bronchial asthma and chronic obstructive pulmonary disease (COPD). Although the term COPD covers a wide range of diseases, its use is usually limited to chronic bronchitis and emphysema. Bronchial asthma is a standard of reversible obstructive diseases.
- Regulation of blood circulation in the lungs is normal and pathological
Unlike most organs and tissues, the lungs also have double blood supply. A specific function of the lungs is gas exchange through the pulmonary circulation, that is, the system of LA, capillaries and veins, while the nutrition of the lung tissue, including the wall of the LA itself, is due to the functioning of the bronchial arteries, which are part of a large circle of blood circulation. Distinctive
- 22. RESEARCH OF PERIPHERAL VESSELS. PROPERTIES OF THE ARTERIAL PULSE UNDER PATHOLOGY (CHANGE OF RHYTHM, FREQUENCY, FILLING, VOLTAGE, WAVE FORM, PROPERTIES OF THE VASCULAR WALL OF THE VESSEL).
On palpation of the common carotid, humeral, ulnar, temporal, femoral, popliteal, and rear art stops, the tasks are narrowed down to an approximate assessment of the pulsatory movements by voltage and filling. The carotid artery is palpated on the left and right in a delicate way, removing the sternoclavicular-nipple muscle outwards at the level of the thyroid cartilage, palpating the facts of the common carotid artery on the left and right.
- LUNG DISEASES. CHRONIC DIFFUSIVE ASTHMA. INTERSTITIAL LUNG DISEASES. CANCER INFLAMMATORY LUNG DISEASES. Bronchial lung
LUNG DISEASES. CHRONIC DIFFUSIVE ASTHMA. INTERSTITIAL LUNG DISEASES. CANCER INFLAMMATORY LUNG DISEASES. BRONCHIAL
- 17 BOUNDARIES OF RELATIVE AND ABSOLUTE HEART OBSTACLES. TECHNIQUE OF DEFINITION. DIAGNOSTIC VALUE. HEART DIMENSIONS. LENGTH, HEART RADIATOR, WIDTH OF VASCULAR BEAM IN NORMAL AND PATHOLOGY. DIAGNOSTIC VALUE.
The boundaries of the relative dullness of the heart. Right border. First, they find the level of standing of the diaphragm on the right in order to determine the general position of the heart in the chest. On the mid-clavicular line, deep percussion determines the blunting of percussion sound, corresponding to the height of the dome of the diaphragm. Make a mark on the edge of the finger-pessimeter, facing a clear sound. Count the rib. Further quiet
- Chronic diffuse inflammatory diseases of the lungs. Bronchial asthma. Lungs' cancer. Pneumoconiosis
1. The main types of diffuse lung lesions 1. interstitial 4. small focal 2. obstructive 5. panacinar 3. restrictive 2. Causes of death with obstructive emphysema 1. gas acidosis and coma 2. renal failure 3. left ventricular heart failure 4. right ventricular heart failure 5. collapse of the lungs with spontaneous pneumothorax 3. The most important
- Regular ventilation regimen with intermittent inflation
It is well known that monotonous tidal volume during mechanical ventilation increases uneven ventilation of the lungs and contributes to their atelectasis. Indeed, with independent breathing, a healthy person never breathes the same tidal volume, the latter is constantly changing. In addition, a healthy person periodically takes "sighs" of increased volume and duration. To overcome
- Artificial lung ventilation during operations on the lungs and mediastinal organs
One-lung ventilation. A necessary condition for lung operations - switching off the operated lung from ventilation according to absolute (wet lung, pulmonary bleeding, leaky lung) or relative indications - puts the body in non-physiological conditions of functioning, leads to impaired gas exchange and blood circulation. However, a technique widely used in thoracic surgery
- The relationship of hypoxia, angiopathy, circulatory disorders, BBB pathology and perivascular pathology
The main feature of the pathogenesis of intrauterine asphyxia is that, according to N.L. Garmasheva (1967), fetal circulation disorders are always preceded by it. В этих случаях часто создаются условия, при которых нарушается венозный отток от области мозгового ствола (в силу анатомо-физиологических особенностей), что ведет за собой вторичный персистирующий периваскулярный (перивенулярный и