Pain in the lungs - the main causes and nature of the manifestation. Respiratory system Friction-reducing fluid for lung movement
Vital capacity (VC) is the volume of air that a person can exhale after the deepest breath. On average, women have a vital capacity of 2.7 liters, men - 3.5 liters. In physically developed healthy people, VC reaches 6-7.5 liters. The vital capacity of the lungs can vary, it depends on the state of human health and other factors. Determine the vital capacity of the lungs with a special device -spirometer.
Nervous regulation of breathing. Breathing is regulated by the central nervous system. The rhythmic change of inhalations and exhalations is provided by the respiratory center located in the medulla oblongata. In the aorta and large arteries are specialized cells -chemoreceptors,which are excited by an increase in the concentration of CO2 in the blood. But this excitation is transmitted to the sensitive nerves to the respiratory center, and from there along the motor neurons to the intercostal muscles and the diaphragm. When exhaling, the volume of the chest decreases. After exhalation, the center receives a signal from the nerve endings located in the alveoli, intercostal muscles and diaphragm, about the degree of their stretching and contraction.
The respiratory center alsoprotective regexes,such as coughing and sneezing. They can be caused by chemical (odors) or mechanical (dust, mucus) irritants. Excitation can occur in the receptors of the nasal cavity, larynx or bronchi. There is a sharp contraction of the muscles (intercostal and diaphragm), and as a result - a sharp exhalation through the nose (sneezing) or through the mouth (cough). If the cause of irritation is not removed, reflexes may be repeated. Respiration becomes more frequent under the influence of the sympathetic nervous system and is inhibited by the parasympathetic.
Humoral regulation of respiration. The work of the respiratory center is also affected by the chemical composition of the blood. An increase in the concentration of carbon dioxide in the blood causes excitation of the respiratory center, and breathing quickens. The higher the concentration of carbon dioxide, the faster the breath. In addition, the intake of adrenaline (adrenal hormone) and thyroxine (thyroid hormone) into the blood leads to increased breathing.
It is during the control of breathing that nervous and humoral regulation are closely interconnected. Respiratory movements are regulated by the nerve center, and the nerve center, in turn, reacts to the composition of the blood.
First aid for respiratory failure. With insufficient intake of oxygen into the tissues of our body or its absence, oxygen starvation, or hypoxia, develops. This condition occurs due to gas poisoning, electric shock, etc.
Rice. 112.First aid in case of respiratory failure
drowning people may lose consciousness and stop breathing. The work of the heart and lungs must be restored within 5-7 minutes. When breathing stops, it is necessary to immediately do artificial respiration and heart massage (Fig. 112,a).
Artificial respiration rules:
1)throw back the patient's head, put a roller under the neck;
2)unbutton the buttons and expose the chest;
3)close the mouth (or nose) of the victim with a napkin (handkerchief), inhale and exhale into it, repeat 16 times in 1 minute. Leakage of air through the nose or mouth is prevented by pinching it with your hand.
In cardiac arrest:
1)having crossed both hands, put them on the region of the heart and press rhythmically;
2)after 5 6 pressures, blow air into the mouth:
3)constantly monitor the pulse.
Put the drowning person face down on the thigh of the leg bent at the knee (so that his head touches the ground) and, rhythmically catching on his back (Fig. 112. b), clear the lungs of water and begin artificial respiration.
Diseases of the respiratory organ can be caused by various inflammations, leading to swelling of the mucous membrane, injuries, poisoning. infections, etc. One of the most serious diseasespulmonary tuberculosis.This infectious disease is caused by tuberculosis bacteria, visible only under a microscope (Fig. 113). Tuberculosis leads to a loss of sensitivity in lung tissue. They condense. Patients have weakness, sweating, decreased appetite, cough, hemoptysis. The treatment is long, sometimes for many years.
Prevention measures:exclusion of contact with patients; nutrition of high-calorie, vitamin-rich food; personal hygiene.
Rice. 113.Stages of development of tuberculosis disease:
L primary focus; B inflammation of the lymphatic vessels:
B - inflammation of the lymph nodes Fluorography is one of the methods of X-ray examination, in which the image of an object from a fluorescent screen is transferred to photographic film. This method allows you to identify latent diseases in the early stages. Any changes in the structure of the lungs are immediately reflected in the fluorograms.
Colds and flu are the most common infectious diseases weakening the entire body. They can also cause other diseases. The patient's temperature rises, coughing, sneezing appear, sensitivity to smells and taste of food is disturbed. Increased nasal discharge.
For colds, you need:
1)observe personal hygiene;
2)have individual dishes and bedding;
3)ventilate the room more often;
4)often do wet cleaning:
5)wear a gauze bandage.
In addition, you need to observe bed rest and take a plentiful warm drink.
Respiratory tract and smoking. You hear about the dangers of smoking almost from the cradle. Why is smoking dangerous? By lighting a cigarette, you steal from your body half the oxygen that is intended for it. And if half of the oxygen enters the body, the cells begin to starve. They can no longer grow as usual. In addition, smoking leads to disruption of the blood supply to the organs. Nicotine constricts blood vessels.
Nicotine is most damaging to the lungs. It affects their work, constricts blood vessels and destroys vitamin C, which is vital for health and immunity. Tobacco smoke causes inflammation
respiratory tract. The soot and tar contained in tobacco smoke clog the lumens of the small bronchi and alveoli. The lungs do not provide the body with oxygen completely, and gas exchange is disturbed. Smoking causes severe lung disease.
Vital capacity of lungs, spirometer, chemoreceptors. hypoxia, artificial respiration, pulmonary tuberculosis.
1. What is the vital capacity of the lungs? What is the name of the device that determines it?
2.How are nervous and humoral regulation of respiration interrelated?
3.What respiratory diseases do you know?
4.Name protective respiratory reflexes.
1.What does lung capacity depend on?
2.What do you know about artificial respiration?
3.Why are colds considered dangerous? How do you treat yourself when you get the flu or colds?
4.What can be an irritant when coughing?
1.How is the nervous regulation of respiration carried out?
2.How does tobacco smoke affect the body?
3.Name the preventive measures for tuberculosis.
4.What can be an irritant when sneezing?
LR10. Introduction to the respiratory system.
1.Using the tables and figures in the textbook, tell us about the structure and position of the respiratory organs.
2.Using the table and model, consider the structure of the lungs. State the difference between the left and right lungs.
3.Examine your body. Determine the frequency of your breathing at rest and during exercise (jumping).
Draw a table and record the results.
Respiratory rate (respiratory movements per 1 min) | State rest (sitting) | jumping | Squats, 15 reps (fast) | Run |
CONCLUSION
Breaththe process of gas exchange between the body and the environment. Oxygen is needed to obtain energy from nutrients. Therefore, breathing must be carried out constantly. Central organ of the respiratory system lungs. In addition to them, there are airways: nasal cavity, oral cavity, nasopharynx, pharynx, larynx, trachea and bronchi. All airways are lined from the inside with ciliated (ciliated) epithelium, which removes solid dust particles with the movements of cilia.
nasal cavityrichly supplied with blood capillaries and lined with mucous ciliated epithelium containing olfactory receptors. Therefore, the air here is cleaned of dust and microorganisms, takes on body temperature.
Oral cavity- a siding of the respiratory system if the nose is temporarily out of order (runny nose, broken nose, bleeding, etc.).
Nasopharynxthe junction of the oral and nasal cavities. She goes into throat- Communities department of the respiratory and digestive systems. At the end of the pharynx forks. One branch goes into the esophagus, and the other goes into the larynx.
Larynxformed by cartilage. The largest of them - thyroid (Adam's apple in men). Inside is the most important cartilage - epiglottis. It does not let food into the larynx, directing ce in esophagus. In addition to cartilage, the larynx contains voice apparatus. It consists of two vocal cords and between them glottis. When speaking, the glottis closes with ligaments, and the air, passing through them with force (squeezing), forms a sound. The longer the ligaments (larger larynx), the lower the voice. Therefore, men have a low voice, and women have a higher one.
The larynx goes into trachea- a tube, the front wall of which consists of cartilaginous semirings. The posterior wall adjacent to the esophagus is formed by a soft connective tissue membrane. Thanks to her, the food bolus moves freely through the esophagus, without putting pressure on the cartilages of the trachea.
The trachea branches into two bronchi. Bronchi are made up of cartilage rings. They branch out into smaller bronchioles, forming inside the lungs bronchial tree. The smallest bronchi terminate in pulmonary vesicles - alveoli. Each alveolus is surrounded by a network of blood capillaries. In them, venous blood, saturated with oxygen, becomes arterial. Hemoglobin gives carbon dioxide and add oxygen. Gas exchange occurs through the walls of the alveoli and venous capillaries. The alveoli make the lungs cellular, greatly increasing the surface area through which gas exchange takes place.
Due to the saturation of the blood with oxygen, the composition of the air that has been in the lungs changes. Atmospheric air (on inspiration) contains 21% oxygen and 0.03% carbon dioxide. After passing through the lungs (on exhalation), the air contains 16% oxygen and 4% carbon dioxide. The amount of nitrogen in the air does not change (79%).
An important indicator of lung function is VC, or vital capacity of the lungs. This is the amount of air that a person can exhale after taking the deepest breath possible. On average, it is 3.5 liters, or 3500 cm 3. Trained people have more VC (5-7 liters or more). The higher the VC, the better the lungs function.
Lungs -paired organ. The right lung is larger and is divided into three lobes. The left, pushed aside by the heart, is smaller. It is divided into two parts. Outside, the lung is covered with smooth connective tissue - pulmonary (internal) pleura. It fuses with the lung, and they cannot be separated. The chest (ribs, intercostal muscles and diaphragm) fuses with the second leaf from the inside - parietal (external) pleura. Between the two sheets of pleura there is a small space, 1-2 mm. it pleural cavity. She's filled pleural fluid, which reduces the friction of the lungs against the chest.
Due to the fact that the lungs are inextricably connected to the chest, we produce respiratory movements. When the intercostal muscles and the diaphragm contract, they increase the volume of the chest and, accordingly, the volume of the lungs. This is how inhalation happens. When the intercostal muscles and the diaphragm relax, exhalation automatically occurs, due to a decrease in the volume of the chest and lungs.
Breathing is regulated neurohumorally. Respiratory the center is in the medulla oblongata. It regulates the reflex (involuntary) change of inhalation and exhalation. The irritant for the inspiratory reflex is an increase in carbon dioxide in the blood. Chemoreceptors, located in the arteries, are excited and, through sensitive neurons, send a signal to the medulla oblongata. It sends a signal through motor neurons to the working organs: the intercostal muscles and the diaphragm. The response is their contraction, an increase in the volume of the chest cavity and lungs, and inhalation. Sympathetic non/mouse system, adrenaline and thyroxine increase the frequency and depth of breathing. Parasympathetic nervous system slows down breathing.
Protective respiratory reflexes are coughing and sneezing. Irritants for them can be odors or mechanical effects on the walls of the nasal mucosa or larynx. The response is a sharp exhalation through the nose (sneeze) or through the mouth (cough).
1.Air enters the cells of the body
7.Oxygen content in the inhaled air
8.Centerbreath is
9.Gas,necessary for oxidation
10.ContentOh inair while exhaling
11.An infectious disease that weakens the entire human body
12.A device that determines the vital capacity of the lungs
13.Inswallowing time closes the entrance to the larynx
14.ATtobaccosmokecontained
16.Inhaled microorganisms in the nasopharynx
17.Continuation of the larynx
18.Quantitylungsin humans
19.Continuationtrachea
20.Organ,generativesoundsspeeches
21.A disease that damages the lungs
22.Concentrationscarbon dioxide in exhaled air
23.thoracictype ofbreathing is characteristic
24.Abdominal type of breathing is characteristic
25.The stimulus for the inspiratory reflex is
26.Frommuscles involved in breathing
27.Atmen's larynx... thanat
28.Respiratorythe center is located
29.Protective respiratory reflexes
30.Accelerates breathing adrenal hormone 81. Oxygen starvation
32.Intrapulmonary bronchi form branched
33.The pulmonary vesicles are called
The pleural cavity is a small space in the form of a gap. It is located between the lungs and the inner surface of the chest. The walls of this cavity are lined with pleura. On the one hand, the pleura covers the lungs, and on the other, it lines the costal surface and the diaphragm. The pleural cavity plays an important role in breathing. The pleura synthesizes a certain amount of fluid (normally a few milliliters), due to which the friction of the lungs against the inner surface of the chest during breathing decreases.
- 1. Visceral is a thin film that completely covers the outside of the lungs.
- 2. Parietal (parietal) - this membrane is necessary to cover the inner surface of the chest.
- 1. Costal-diaphragmatic, which is formed in the area of transition of the costal pleura to the diaphragmatic. It runs in a semicircle along the lower outer edge of the diaphragm where it attaches to the ribs.
- 2. Diaphragmatic-mediastinal - is one of the least pronounced sinuses, located in the transition area of the mediastinal pleura to the diaphragmatic.
- 3. Rib-mediastinal - located in a person from the side of the anterior surface of the chest, where the costal pleura connects to the mediastinal. On the right it is more pronounced, on the left its depth is less due to the heart.
- 4. Vertebral-mediastinal - located at the posterior transition of the costal pleura to the mediastinal.
- 1. Open - obtained when the hole (wound) that communicates the pleural cavity with environment, gapes. With an open pneumothorax, the lung usually collapses completely (if it is not held by adhesions between the parietal and visceral pleura). During radiography, it is defined as a shapeless lump in the region of the root of the lung. If it is not straightened quickly enough, then subsequently zones are formed in the lung tissue into which air does not enter.
- 2. Closed - if a certain amount of air got into the pleural cavity and access was blocked by itself or due to the measures taken. Then only part of the lung collapses (the size depends on the amount of air that has entered). On radiographs, air appears as a bubble, usually in the upper chest. If there is not a lot of air, it resolves itself.
- 3. Valve - the most dangerous view pneumothorax. It is formed when the tissues at the site of the defect form a semblance of a valve. When inhaling, the defect opens, a certain amount of air is “sucked in”. When exhaling, the defect subsides, and the air remains inside the pleural cavity. This is repeated during all respiratory cycles. Over time, the amount of air becomes so large that it "bursts" the chest, breathing becomes difficult, and the work of the organs is disrupted. This condition is deadly.
- 1. Exudate. It is formed as a result of an inflammatory lesion of the organs of the chest cavity (pneumonia, pleurisy, tuberculosis, sometimes cancer).
- 2. Transudate. It accumulates with edema, a decrease in plasma oncotic pressure, with heart failure, cirrhosis of the liver, myxedema and some other diseases.
- 3. Pus. This is a type of exudate. It appears when the pleural cavity is infected with pyogenic bacteria. May appear with a breakthrough of pus from the lungs - with an abscess.
- 4. Blood. It accumulates in the pleural cavity when the vessels are damaged, provoked by trauma or another factor (tumor decay). Similar internal bleeding often causes massive blood loss, life-threatening.
- general analysis of blood and urine;
- blood chemistry;
- radiography and fluorography of the chest;
- study of the function of external respiration;
- ECG and ultrasound of the heart;
- testing for tuberculosis;
- puncture of the pleural cavity with the analysis of pleural effusion;
- CT and MRI and other studies if necessary.
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The structure of the pleural cavity
The pleural cavity is located in the chest. The main part of the chest is occupied by the lungs and mediastinal organs (trachea, bronchi, esophagus, heart and large vessels). When breathing, the lungs collapse and expand. And the sliding of the lungs relative to the inner surface of the chest is provided by a moistened pleura lining the organs. The pleura is a thin serous membrane. There are two main types of pleura in the human body:
The visceral pleura is immersed in the lungs in the form of folds in those places where the border of the lobes passes. It provides sliding of the lobes of the lungs relative to each other during breathing. Connecting with the connective tissue septa between the segments of the lungs, the visceral pleura is involved in the formation of the lung frame.
The parietal pleura is divided, depending on which area it lines, into costal and diaphragmatic. In the region of the sternum in front and along the spine behind the parietal pleura passes into the mediastinal. The mediastinal pleura at the roots of the lungs (the place where the bronchi and blood vessels enter the lungs) passes into the visceral. In the region of the root, the pleura sheets are interconnected, forming a small pulmonary ligament.
In general, the pleura forms, as it were, two closed bags. They are separated from each other by the organs of the mediastinum, covered with the mediastinal pleura. Outside, the walls of the pleural cavity are formed by ribs, from below - by the diaphragm. In these bags, the lungs are in a free state, their mobility is provided by the pleura. The lungs were fixed in the chest only in the region of the roots.
The main properties of the pleura and pleural cavity
The pleural cavity is normally represented by a narrow gap between the pleura. Since it is hermetically closed and contains a small amount of serous fluid, the lungs are "drawn" to the inner surface of the chest by negative pressure.
The pleura, especially parietal, contains a large number of nerve endings. The lung tissue itself has no pain receptors. Therefore, almost any pathological process in the lungs proceeds painlessly. If there is pain, this indicates the involvement of the pleura. characteristic feature pleural lesions serve as a pain response to breathing. It can increase during inhalation or exhalation and pass during a respiratory pause.
Another important property of the pleura is that it produces a fluid that serves as a lubricant between the pleura and facilitates sliding. Normally, it is 15–25 ml. The peculiarity of the structure of the pleura is such that if the pleura sheets are irritated by the pathological process, a reflex increase in fluid production occurs. A larger amount of fluid "spreads" the pleura sheets to the sides and further facilitates friction. The problem is that excess fluid can “squeeze” the lung, preventing it from expanding during inhalation.
Participation in breathing
Since the pressure in the pleural cavity is negative, when inhaling, due to the lowering of the dome of the diaphragm, the lungs straighten out, passively passing air through the airways. If you need to take a deep breath, the chest expands due to the fact that the ribs rise and diverge. An even deeper breath involves the muscles of the upper shoulder girdle.
When exhaling, the respiratory muscles relax, the lungs collapse due to their own elasticity, and the air leaves the respiratory tract. If the exhalation is forced, the muscles that lower the ribs are turned on, and the chest “compresses”, the air is actively squeezed out of it. The depth of breathing is provided by the tension of the respiratory muscles and is regulated by the respiratory center. The depth of breathing can also be adjusted arbitrarily.
Pleural sinuses
To get an idea of the topography of the sinuses, it is useful to correlate the shape of the pleural cavity with a truncated cone. The walls of the cone are the costal pleura. Inside are the organs of the chest. Right and left lungs covered with visceral pleura. In the middle is the mediastinum, covered on both sides by the visceral pleura. Below - a diaphragm in the form of a dome protruding into the interior.
Since the dome of the diaphragm has a convex shape, the transition points of the costal and mediastinal pleura to the diaphragmatic pleura also have the form of folds. These folds are called pleural sinuses.
They do not have lungs - they are filled with liquid in a small amount. Their lower border is located slightly below the lower border of the lungs. There are four types of sine:
The pleural sinuses do not fully expand even with the deepest breath. They are the lowest located parts of the pleural cavity. Therefore, it is in the sinuses that excess fluid accumulates, if it is formed. Blood is sent there if it appears in the pleural cavity. Therefore, it is the sinuses that are the subject of special attention if there is a suspicion of the presence of pathological fluid in the pleural cavity.
Participation in blood circulation
There is a negative pressure in the pleural cavity during inspiration, due to this it has a “suction” effect not only in relation to air. When inhaling, expand and large veins located in the chest, due to this, blood flow to the heart improves. When you exhale, the veins collapse and blood flow slows down.
It cannot be said that the influence of the pleura is stronger than that of the heart. But this fact must be taken into account in some cases. For example, when large veins are injured, the suction action of the pleural cavity sometimes leads to air entering the bloodstream during inspiration. Due to this effect, the pulse rate during inhalation and exhalation can also change. When registering an ECG, a respiratory arrhythmia is diagnosed, which is regarded as a variant of the norm. There are other situations where this effect must be taken into account.
If a person exhales forcefully, coughs, or makes a significant physical effort while holding the breath, then the pressure in the chest can become positive and quite high. This reduces blood flow to the heart and makes it difficult for gas exchange in the lungs themselves. Significant air pressure in the lungs can injure their delicate tissue.
Violation of the tightness of the pleural cavity
If a person receives an injury (chest injury) or internal damage to the lung with a violation of the tightness of the pleural cavity, then the negative pressure in it leads to air entering it. At the same time, the lung collapses, completely or partially, depending on how much air has entered the chest. This pathology is called pneumothorax. There are several types of pneumothorax:
The accumulation of air in the pleural cavity, in addition to the risk of infection of the wound and the threat of bleeding, is also harmful because it disrupts breathing and gas exchange in the lungs. As a result, respiratory failure may develop.
If air interferes with breathing, it must be removed. This should be done immediately with valvular pneumothorax. Air removal is carried out using special procedures - puncture, drainage or surgery. During the operation, the defect in the chest wall should be closed or the lung should be sutured to restore the tightness of the pleural cavity.
The role of fluid in the pleural cavity
As already mentioned, a certain amount of fluid in the pleural cavity is normal. It provides sliding of its leaves during breathing. In diseases of the chest organs, its composition and quantity often change. These symptoms have great importance for diagnostic search.
One of the most common and important symptoms is the accumulation of fluid in the pleural cavity - hydrothorax. This liquid has a different nature, but its very presence causes the same type of clinical picture. Patients feel shortness of breath, lack of air, heaviness in the chest. That half of the chest, which is affected, lags behind in breathing.
If the hydrothorax is small and developed as a result of pneumonia or pleurisy, then it resolves on its own with adequate treatment. The patient sometimes has adhesions and pleural overlays. This is not life-threatening, but creates difficulties in the diagnosis in the future.
Pleural effusion accumulates not only in diseases of the lungs and pleura. Some systemic diseases and lesions of other organs also lead to its accumulation. These are pneumonia, tuberculosis, cancer, pleurisy, acute pancreatitis, uremia, myxedema, heart failure, thromboembolism and other pathological conditions. Fluid in the pleural cavity chemical composition is divided into the following types:
If a lot of fluid accumulates, it “compresses” the lung, and it will subside. If the process is bilateral, suffocation develops. This condition is potentially life-threatening. Removal of fluid saves the life of the patient, but if the pathological process that led to its accumulation is not cured, the situation usually repeats. In addition, the fluid in the pleural cavity contains protein, trace elements and other substances that the body loses.
Research in pathology
Various studies are used to assess the condition of the chest and pleura. Their choice depends on what complaints the patient makes, and on what changes are revealed during the examination. General rule- moving from simple to complex. Each subsequent study is appointed after evaluating the results of the previous one, if it is necessary to clarify one or another identified change. The diagnostic search uses:
Given the fact that the pleura is very sensitive to changes in the state of the body, it reacts to a large number of diseases. Pleural effusion (the most common symptom associated with the pleura) is not a reason to despair, but an occasion for examination. It can mean the presence of a disease with a positive prognosis, and a very severe pathology. Therefore, only a doctor should determine the indications for research and the diagnostic significance of their results. And you should always remember that it is not the symptom that needs to be treated, but the disease.
The lungs located in the chest are separated from its walls of the pleural cavity- a slit-like space lined with an elastic transparent membrane (pleura). It protects the lungs, prevents air from leaking out of them into the chest cavity, and reduces friction between the lungs and the chest wall. The inner, visceral, sheet of the pleura covers the lungs, and the outer, parietal (parietal), lines the chest wall and diaphragm. The pleural cavity contains fluid secreted by the pleura. This fluid moisturizes the pleura and thereby reduces friction between its sheets during respiratory movements. The pleural cavity is impermeable to air and the pressure in it is 3-4 mm Hg. Art. lower than in the lungs. Negative pressure in the pleural space is maintained throughout inhalation, allowing the alveoli to expand and fill any extra space created by chest expansion.
Mechanism of ventilation (breathing)
Air enters the lungs and exits them due to the work of the intercostal muscles and the diaphragm; as a result of their alternate contraction and relaxation, the volume of the chest changes. Between each pair of ribs there are two groups of intercostal muscles directed at an angle to each other: the outer ones - down and forward, and the inner ones - down and back. The diaphragm is made up of circular and radial muscle fibers located around a central tendon area made of collagen.
Diagram of the location of the intercostal muscles.inhale
inhale is an active process. It proceeds as follows.
1. The external intercostal muscles contract and the internal muscles relax.
2. As a result, the ribs move forward, moving away from the spine. (This is easy to feel when you put your hand on your chest while inhaling.)
3. At the same time, the muscles of the diaphragm contract.
4. The diaphragm becomes flatter.
5. Both of these actions lead to an increase in the volume of the chest.
6. As a result, the pressure in the chest, and therefore in the lungs, becomes below atmospheric.
7. Air enters and fills the alveoli until the pressure in the lungs equals atmospheric pressure.
Schematic representation of the chest, explaining what movements are made during breathing (side view; only one rib is shown).
Exhalation
Exhalation- the process under normal conditions is mainly passive, occurring as a result of elastic contraction of the stretched lung tissue, relaxation of part of the respiratory muscles and lowering of the chest under the influence of gravity.
1. The external intercostal muscles relax, while the internal ones contract. The chest descends mainly under the influence of its own gravity.
2. At the same time, the diaphragm relaxes. The descending chest forces it to return to its original domed shape.
3. As a result, the volume of the chest decreases, and the pressure in it becomes higher than atmospheric.
4. As a result, the air is pushed out of the lungs.
During physical activity, it has place forced breathing. Additional muscles are put into action and exhalation becomes a more active process that requires energy expenditure. The internal intercostal muscles contract more vigorously and pull the ribs down more strongly. The abdominal muscles also contract vigorously, causing a more active upward movement of the diaphragm. The same thing happens with sneezing and coughing.
A disease characterized lung rupture, medically known as pneumothorax. Pneumo - air, thorax - chest. Literally, the term translates as "air in the chest."
The inside of the chest is lined with two layers of pleura. Each of its leaves is a thin, translucent formation, between which there is a sealed slit-like cavity containing several milliliters of a transparent liquid. Thanks to the pleura, the friction of the lungs during breathing decreases, a negative pressure is created, which ensures the expansion of the lung.
For reasons that will be discussed later, a rupture of the lung or a defect in the chest occurs. In the first case, the pleural cavity will communicate with the air of the lung, in the second - with the environment. The negative pressure of the pleural cavity will suck in air, the lung will subside. The collapsed lung already occupies a small volume of the chest, its main function, gas exchange, is disturbed.
The reasons
The causes of lung rupture are manifold. Primary spontaneous pneumothorax occurs in people without previous lung disease. Secondary pneumothorax occurs against the background of any disease. Most often it develops in smokers. This is explained by the accompanying and the presence of expanded - emphysematous bullae. If the bullae are located directly under the pleura, when they break, the air of the lung will rush into the pleural cavity.
The risk of developing pneumothorax increases in proportion to the number of cigarettes smoked. In smoking women, it occurs 9 times more often, in smoking men - 22 times more often when compared with non-smoking peers.
There are also traumatic causes of lung rupture. More often, as a result of injuries, an open pneumothorax occurs - if the pleural cavity communicates with the external environment. It develops as a result of penetrating injury to the chest with a sharp object. When the lung is also affected, air enters the pleural cavity in two ways.
A special, most dangerous type of traumatic pneumothorax is valvular. Its essence boils down to the fact that through a wound in the chest, air rushes into the pleural cavity on inspiration, but on exhalation, the valve closes and the air does not exit. With each subsequent respiratory movement, the pressure in the pleural cavity increases, the lung is more and more pressed to the root, and neighboring organs are shifted.
Symptoms
Symptoms of a lung rupture will differ in closed, open, and valvular pneumothorax.
With closed, as well as spontaneous pneumothorax, acute pain suddenly occurs in one or both halves of the chest, shortness of breath appears and increases. This condition has no precursors, develops at any time of the day and for no apparent reason. These symptoms may appear after physical activity. In addition to pain and shortness of breath, sometimes developing into suffocation, the patient's pulse quickens, the frequency of respiratory movements increases. The color of the skin becomes bluish. If you tap your fingers on your chest, there is a high probability of hearing a “box” sound.
Open pneumothorax occurs as a result of damage to the chest. In addition to pain within the wound and shortness of breath, the patient gives out anxiety, he tries to close the hole with his hand, as this makes breathing easier. The patient's condition is serious. Choking increases, the pulse is frequent and weak, the skin and mucous membranes are pale. Air and blood bubbles are released from the wound, accompanied by a characteristic popping sound.
Valvular pneumothorax is characterized by a very serious condition of the patient, motor excitation, an increasing respiratory disorder, characterized by frequent breathing, suffocation and blue skin. The pulse is quickened and tense. Often, air accumulates under the skin of the chest and neck; when pressed, you can hear a sound resembling the crunch of snow.
Treatment
Treatment of a ruptured lung can be divided into first aid and skilled care. As part of first aid, if a closed pneumothorax is suspected, it is necessary to call as soon as possible ambulance or take the patient to the nearest surgical hospital.
With an open pneumothorax, it is necessary to stop the ingress of air from the external environment into the pleural cavity. To do this, the wound is closed with any material that does not allow air to pass through. For this, plastic bags, oilcloth, rubberized fabric will fit. From above, the sealing fabric is firmly fixed with any improvised materials - adhesive plaster, bandage, cloth. If it is impossible to secure the bandage, you need to firmly press it with your hand until the ambulance arrives. In the case of valvular pneumothorax, the actions are similar to those described above.
Qualified assistance is provided in the surgical department of the hospital. The surgeon examines the patient, if a closed pneumothorax is suspected, the chest organs are necessarily performed. The picture shows a shriveled lung, gas in the pleural cavity. The next step of the surgeon is the drainage of the pleural cavity. A tube is inserted through the intercostal space, which is connected to an apparatus that creates negative pressure. For several days, the patient regularly presses the button that starts the pumping out of air.
In the case of open and valvular pneumothorax, surgery in the volume of primary surgical treatment. If necessary, an autopsy of the chest is performed to revise the organs.
Possible consequences
The consequences of lung rupture can be divided into early and late. The early ones include respiratory failure, pain shock, pushing back of the chest organs. If a collapsed lung is expanded too quickly, blood pressure may drop.
Late consequences of lung rupture: infection, development inflammatory process with open pneumothorax. With an open pneumothorax, blood can enter the chest, and hemopneumothorax will develop. It is possible that a repeated spontaneous closed rupture of the lung may occur, since there are other dilated alveoli that can burst.