doç. dr. metin akgün
DESCRIPTION
Doç. Dr. Metin Akgün. Atatürk Üniversitesi Tıp Fakültesi Göğüs Hastalıkları Anabilim Dalı. Mesleksel Solunum Hastalıkları. Rinit , larenjit. Trakeit , bronşit, bronşiolit. Astım, KOAH. Kanser. Parankimal akciğer hastalıkları. DPAH (ATS/ERS-2002). - PowerPoint PPT PresentationTRANSCRIPT
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• Rinit, larenjit• Trakeit, bronşit, bronşiolit• Astım, KOAH• Kanser• Parankimal akciğer hastalıkları
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Difüz Parankimal Akciğer Hastalıkları
Nedeni bilinen hastalıklar
KVH’lar, ilaç kulanımı, meslek
Granülomatöz hastalıklarSarkoidoz
İdiyopatik İnterstisyel Pnömoniler
DiğerleriLAM, EG
İPF İPF-DIŞI
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• Gaz• Aerosol• Buhar• Füme• Duman
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• Partikül çapı• Suda çözünürlük• Konsantrasyon• Maruziyet süresi• Havalandırma olup olmaması• Soluyan kişinin özelliği–Yaş, sigara, ek hastalık, korunma,
genetik duyarlılık
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• Partikül çapı• Suda çözünürlük
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Granülomatöz Organize pnömoni
İnterstisyel fibrozis
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• Efor dispnesi• Nonprodüktif öksürük
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• SFT’de restriktif patern• Difüzyon kapasitesinde azalma• AKG’da hipoksemi• Akciğer filminde bilateral retiküler,
nodüler veya retikülonodüler opasite artışı
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• Buzlu cam görünümü• Konsolidasyon• Nodüler• Kistik• Lineer veya retiküler • İnterlobüler septal kalınlaşma• Balpeteği akciğer (ileri olgular)
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• Hipersensitivite pnömonisi• Organik toz toksik sendromu• Astım• KOAH
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• Akut• Subakut• Kronik
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• Bilinen bir antijene maruziyet• Positif presipitan antikor varlığı• Tekrarlayan semptomlar• Fizik muayenede raller• Maruziyetten 4-8 saat sonra semptom• Kilo kaybı
Lacasse, et al. 2003.
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• İnhalasyon ateşi• Akut kimyasal pnömonitis• Subakut veya kronik pulmoner inflamasyon
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• Makül• İnterstisyel fibrozis• İmmünolojik mekanizmalar
İnert tozlar
Fibrojenik tozlar
Ağır metaller, berilyum
• Malignite
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Makül FibrozisGevenois PA, De Vuyst P. Imaging of Occupational and Environmental Disorder of
the Chest.
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METAL• Alüminyum• Antimon• Baryum (Baritozis)• Demir (Siderozis)• Kalay (Stannozis)• Kaynak dumanı
NON-METAL• Non-asbest silikatlar• Kömür• Sigara dumanı• Hava kirliliği-partikül
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Green ,1998.
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Gevenois PA, De Vuyst P. Imaging of Occupational and Environmental Disorder of the Chest.
Makül/amfizem
Pnömokonyoz
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Akut (silikoproteinoz)AkselereKronikBasit (nodüler)Komplike (masif fibrozis)Kaplan sendromu
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Ortaya çıkış süresine göre;
AKUTAKSELEREKRONİK
Haftalar-5 yıl5-10 yıl
10 yıl ve üzeri
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BASİT KOMPLİKE
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NORMAL SİLİKOZ
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MaküllerGranülomlarNodüllerProgresif masif fibrozisDifüz interstisyel fibrozisPlevral fibrozis
talk, mika, kaolin
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KYALİNAluminyum silikat
(Al2SiO5)
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ZÜMRÜT(Be3Al2(SiO3)
6)
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Neoplastik olmayan plevral hastalık
Neoplastik olmayan parankimal hastalık
Neoplastik hastalıklar
Plevral efüzyon, fibrozis, plak, round atelektazi
Asbestoz
Mezotelyoma, akciğer ca
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Gevenois PA, De Vuyst P. Imaging of Occupational and Environmental Disorder of the Chest.
Plevral fibrozis
Asbestozis
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• Asbest• Arsenik• Berilyum• Nikel• Radon• Silika
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Yandaki şekil aşağıdakilerden hangisine
benzemektedir?
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Yandaki şekil aşağıdakilerden hangisine
benzemektedir?
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standart film
standart film
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p<1,5 mm
q1,5-3 mm
r3-10 mm
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S<1,5 mm
t1,5-3 mm
u3-10 mm
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Küçük opasite
Büyük opasite
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-/0 0/0 0/1
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0/1 1/1 1/2
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2/1 2/2 2/3
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3/2 3/3 3/+
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“If you find that work seriously affects your health, it is very wise to change occupation. Money is worthless, if you loose the most valuable of all, your health.”
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Müjde Hocam!DİSPNE endikasyonu aldık.
Bronkodilatör tanıtımı yapan firma temsilcisi
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• Hafif % 6• Orta % 30• Ağır % 57
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• Küçük opasiteler (% 0-36)• Büyük opasiteler (% 11-58)
• Örnek:–q ve t; 2/3 ise % 21
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