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CHRONICAL BRONCHITIS

On patency of the bronchi: obstructive and non-obstructive. According to the level of damage: proximal - up to 5-6 generation of bronchi. Purulent and catarrhal.

Obstructive bronchitis. If distal, then the main symptom is associated with an air trap (when inhaling, the air enters the alveoli, during exhalation the bronchi are shortened, take the form of a corrugated tube and the air does not pass back, the volume of residual air rises, the pressure rises. This happens until the pressure will not be enough to overcome the resistance of shortened bronchi. Ischemia and dystrophic changes develop, emphysema develops early. The main symptom is shortness of breath. Cough is not characteristic of distal bronchitis. This is 5% of all KNZL.

As an etiological factor, smoking and aerosolutants (occupational hazards).

Cough for at least 3 months in a year, at least 2 consecutive years. With the exception of other diseases in which a cough is characteristic - chronic bronchitis.

The bronchi become infected, pneumococcus, haemophilus influenzae, pneumotropic virus become a supporting factor.

Proximal bronchitis. The main symptom is coughing. In obstructive bronchitis, a paroxysmal cough is characteristic. Dyspnea. Tracheobronchial dyskinesia may develop. The number of goblet cells is increasing. Mucin is very viscous, evacuation is difficult, muccellular clearance is impaired. The load on the right chambers of the heart is gradually increasing. Blood pressure in the pulmonary artery increases to 35 - 40 mm Hg. Art. First, hypertrophy, then dilatation of the right ventricle. Epigastric pulsation, in severe cases, tricuspid insufficiency and systolic murmur over the right chambers, before that the emphasis ll tone (or splitting) over the pulmonary trunk. The outcome of chronic bronchitis is a decompensated pulmonary heart.

Pain and heaviness in the right hypochondrium (liver), edema, ascites. The pulmonary heart develops with an increased load on the right ventricle, due to vascular reduction in the pulmonary artery system, blood pressure rises to 30-40 mm Hg in it. This is already enough for hypoxia to occur. Purely distal bronchitis is a rarity. During auscultation, nothing is heard, only weakening of breathing.

At a proximal a lot of wheezing, percussion box sound. A decrease in FEV 1 primarily indicates obstruction. Also decreases MOS of inspiration and MOS of exhalation, MVL as well. Research: 2 breaths of a berotek or salbutamol, in 15 minutes. record spirogram again. If it rises by 20 - 25%, bronchospasm occurs.

Obstruction:

1. Spasm.

2.
Swelling of the bronchial mucosa.

3. The accumulation of secretions in the bronchi. This happens with inflammation.

4. Transmission into the lumen of the bronchus is less significant, for example, with pulmonary edema (heart failure), a lot of wet rales.

5. Sclerosis of the wall of the bronchus. A sign - the chest is unstable, cannot be treated yet.

In chronic bronchitis, the initial eitology is non-infectious, the infection then joins. Basically, pneumococcus, hemophilic bacillus, there may be viruses of the respiratory group - they persist, desquamation of the epithelium - opens the way for bacteria. There may also be yeast and mushrooms. Now it is a frequent occurrence.

Clinical signs of active infectious inflammation in the bronchi (exacerbation):

1. Strengthening cough.

2. The appearance or increase in the amount of sputum green or yellow.

3. Scattered rales, dry, sonorous, can be wet, small and medium caliber.

4. Evening chills.

5. Night sweat; localization - back, neck, nape - a symptom of a "wet pillow".

6. The accumulation of bacteria in a cough smear.

7. Crops: if pneumococcus grows in a dilution of 10-6-10-7 - the diagnostic value is doubtless, if only in 10-2 it is doubtful. Cytological examination of sputum, you need to know the percentage of cells of the abdomen. X-rays give almost nothing - only an increase in pulmonary pattern. Interstitial pneumonia is essentially complicated bronchitis. It is necessary to differentiate from allergic inflammation - there is no chills, sweat with it. Eosinophils predominate in allergic sputum (up to 70%), few neutrophils.

If there is an increase in cough and sputum without other signs, there are few purulent cells in the sputum - catarrhal bronchitis. The most severe chronic purulent obstructive bronchitis in the acute phase. The easiest is chronic catarrhal obstructive. An obstructive catarrhal lasts for decades without any particular consequences. In others, secondary bronchiectasis, cylindrical and spindle-shaped, may form. These are subsegmental bronchi, maybe smaller ones. Clinic: stabilization of cough. Sputum is not much, "dry bronchiectasis." Often bleed, often sputum streaked with blood. Bronchal cancer - smokers are 8 times more likely. Emphysema is also an outcome.

Secondary chronic bronchitis occurs a second time, where there is, for example, fibrotic - cavernous tuberculosis, that is, where drainage is impaired. Described in individuals after removal of lung sites, in the fields of pneumosclerosis, especially in the lower lobes. May be with lung carcinoma.
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CHRONICAL BRONCHITIS

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