Tuesday 14 June 2016

Compression of the Trachea-Tracheitis or Bronchitis-Inhaled Foreign Bodies-Bronchoscopy

Compression of the Trachea
The trachea is a membranous tube kept patent under normal conditions by U-shaped bars of cartilage. In the neck, a unilateral or bilateral enlargement of the thyroid gland can cause gross displacement or compression of the trachea. A dilatation of the aortic arch (aneurysm) can compress the trachea. With each cardiac systole, the pulsating aneurysm may tug at the trachea and left bronchus, a clinical sign that can be felt by palpating the trachea in the suprasternal notch

Tracheitis or Bronchitis
The mucosa lining the trachea is innervated by the recurrent laryngeal nerve and, in the region of its bifurcation, by the pulmonary plexus. A tracheitis or bronchitis gives rise to a raw, burning sensation felt deep to the sternum instead of actual pain. Many thoracic and abdominal viscera, when diseased, give rise to discomfort that is felt in the midline  .It seems that organs possessing a sensory innervation that is not under normal conditions directly relayed to consciousness display this phenomenon. The afferent fibers from these organs traveling to the central nervous system accompany autonomic nerves




Inhaled Foreign Bodies
Inhalation of foreign bodies into the lower respiratory tract is common, especially in children. Pins, screws, nuts, bolts, peanuts, and parts of chicken bones and toys have all found their way into the bronchi. Parts of teeth may be inhaled while a patient is under anesthesia during a difficult dental extraction. Because the right bronchus is the wider and more direct continuation of the trachea , foreign bodies tend to enter the right instead of the left bronchus. From there, they usually pass into the middle or lower lobe bronchi
Bronchoscopy
Bronchoscopy enables a physician to examine the interior of the trachea; its bifurcation, called the carina; and the main bronchi. With experience, it is possible to examine the interior of the lobar bronchi and the beginning of the first segmental bronchi. By means of this procedure, it is also possible to obtain biopsy specimens of mucous membrane and to remove inhaled foreign bodies (even an open safety pin). Lodgment of a foreign body in the larynx or edema of the mucous membrane of the larynx secondary to infection or trauma may require immediate relief to prevent asphyxiation. A method commonly used to relieve complete obstruction is tracheostomy.

 

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