1. Chronic nonspecific lung diseases
Tashkent Medical academy
Chronic nonspecific lung diseases
Department of faculty and hospital surgery

2. Classification P.A.Kupriyanov, A.A. Kolesov
I. Abscesses and gangrene of lungs
1. Purulent abscess
а) acute
б) chronic
2. Gangrenous abscess:
3. gangrene of lungs
II. Pneumocirrosis after Abscesses
III. Bronchoectatic disease
IV. Purulent cysts (“cystic lung”)

3. Clinical features Cough Purulent sputum Fever Chestpain hematophthysis
Deformation of chest
Changes in blood

4. Clinical X-ray Less invasive Angiography Methods of diagnostic
Polipositional
Rentgenoscopy
rentgenography
tomography
Bronchofraphy
Less invasive CT
MRI
Angiography
angiopulmonography
Bronchial arteriography
Endoscopy
bronchoscopy
thoracoscopy
thoracoabscessoscopy
Radiopaque methods
scanning
bacteriology
bacterioscopy
Citology

5. limited purulent process during 2-3 months
Chronic abscess
limited purulent process during 2-3 months
sometimes with infiltration of connective tissue

6. 1. Multiple acute abscesses
2. Tissue sequestration
3. At lower lobe
4. D = more 5 cm

7. Lung abscess

8. Bronchography

9. Bronchoscopy

10. Treatment Lobectomy Pulmonectomy Surgical
Necessary of primary sanation

11. Transbronchial drainaging

12. Transthoracal drainaging

13. Polycystosis

14. Polycystosis of left lung

16. Definition
Bronchoectetic disease (morbus bronchoectaticus) — One of the main forms , characterised by developing of bronchoectasis (regional widespread of bronchi) with further development of purulent process.
Spread between population, 0,3—1,2%. More often in young age (5—25 years).

17. Bronchoectatic disease
Bronchoectasis
segmental bronchiectasis due to destruction and violation of the neuro-muscular tone of the walls due to inflammation, degeneration or hypoplasia of the structural elements.
Bronchoectatic disease
occurs usually in childhood or adolescence, the primary pathologic substrate of which is the regional extension of the branches of the bronchial tree, mainly localized in the lower regions of the lungs and accompanied by a chronic nonspecific suppuration in the lumen of bronchiectasis.

18. Etiology and pathogenesis
Hereditary insufficiensy
Purulent processes
Obturatory diseases
Respiratory diseases BD

19. Etiology and pathogenesis

20. Stages Superficial bronchitis Peribronchitis and panbronchitis
Deformation
bronchiectasis

24. Pathologoanatomy

25. Pathologoanatomy

26. Pathologoanatomy

27. Classification of bronchiectasis
1. By Pathogenesis:
- Primary
- Secondary
2. The shape of
- Cylindrical
- Spindle
- Saccular
- Cystiform
- Mixed
3. By amount :
single;
poly.
4. Spread of process:
unilateral
bilateral.
5. Clinic
(Zelenin G.F. et al., 1952):
Bronchitic;
Clinical changes;
complications.

28. Anamnesis
Respiratory diseases
Heredity

29. Complaints
Cough
Purulent Sputum in the great amount especially in the morning

30. Physical examination General malaise Cyanosis
Emphisematous form of chest
Change of nails and fingers

31. Physical examination
Percussion
Palpation
Auscultation

32. Preliminary diagnosis
Symptoms:
1. Chronic cough and sputum
2) hematophthysis;
3) Pneumonia;
4) Permanent rales in lungs

33. Laboratory Blood analysis
Microscopy and bacteriology - Haemophilus influenzae. Streptococcus pneumoniae, Staphylococcus aureus, et al).
Biochemical blood analysis

34. Instrumental
X-ray
Bronchography;
bronchoscopy;
CT;

35. Rentgenography

36. Rentgenography
Round shades

37. Bronchography
Gold standard

38. Bronchography

39. Bronchography

40. Bronchoscopy
Sull’s feature

41. Computed Tomography

42. Computed Tomography

43. Respiratory tests

44. Differential diagnostics
Bronchitis
Abscess
Lung tuberculosis
Cancer
Obstructive lung diseases

45. Complications bleeding; Abscess and empyem; amyloidosis.
Concomitant diseases and respiratory insufficiency.

46. Diagnosis
localisation
stage;
phase
complications.

47. treatment
1) medicamentous:
Sanation.
2) Surgical.

48. Sanation Passive: Drainage mucolitics; Gymnastic and massage. Active:
aspiration;
microdrainaging

50. Sanational bronchoscopy
Intrabronchial antibiotibs.
Dioxtdinum 10 ml 1
Furacillinum 10 ml - 1:1000,
Furaginum,
Mucollitics (ACC)

51. Prophylactics Primary – treatment of respiratory diseases in young age
Secondary – prophylactic of recurrent respiratory diseases. Sanitary state of patients
Tertiary – sanation of infectious foci,
Treatment of complications

52. Pneumocirrosis
Clinical improvement after lung abscesses with formation of scar tissue

54. Massive pulmonary hemorrhage is dangerous not so much blood loss as quickly advancing asphyxia

55. The incidence of pulmonary hemorrhage in various diseases of the lungs from 10 to 60%
Overall mortality rates for pulmonary hemorrhage to 15%.
Lethality from massive pulmonary hemorrhage 60%.

56. X-ray picture of various diseases complicated by pulmonary hemorrhage.

57. Distribution of patients according to the degree of bleeding Struchkov V.I. (1963)

58. Obturation

59. The indications for endoscopic intervention
Type of intervention
1. Bronchoscopy
Within 24 hours of admission and conduct of general clinical examination
Within 6 hours after admission and conduct of general clinical and radiographic examination
2. Combined bronchoscopy
On the sanitation of the tracheobronchial tree and the introduction of the hemostatic and vasoconstrictive drugs
With temporary obturation of the bronchus and the readjustment of the tracheobronchial tree
Statement
Stop the bleeding I degree
Continued bleeding I degree
Grade II bleeding stopped with
Grade II with continued bleeding and
Grade III bleeding
Number of
the pations 36 69 19 74

60. Bronchoscopic picture
bleeding
After obturation

62. Angiographic evidence of pulmonary hemorrhage:
Indirect:
Direct:
- Periarterial diffusion of contrast
- Extravasation of contrast
- Local gipervaskulyarisation
- Bronchial artery trunk thrombosis
- Between vascular anastomoses

63. Selective bronchial arteriography.
Under embolisation
After embolisation

64. Algorithm of diagnostic and treatment measures in pulmonary hemorrhage
I degree
III degree
II degre
Conservative treatment
against the background intensity
intensive care
against the background of resuscitation
X-ray examination general clinical
Combined bronchoscopy, aspiration of pathological content
bronchoscopy in 24 hours
administration gomostatic
and vasoconstrictive drugs
bronchoscopic bronchial obturation
upon resumption of bleeding
with inefficiency
checkup
with acute purulent destructive process
chronic process
with contraindications to perform surgery.
with inefficiency
Bronchial arteriography,
Ia with acute bronchial artery embolization
emergency surgery after training inter 6-24 hours
scheduled examination and preparation for surgery
elective surgery when indicated