ANATOMI RESPIRASI KORELASI KLINIS

Oleh Dr. Exsa Hadibrata Bagian Anatomi FK Universitas Lampung

Fracture Costae
The short, broad 1st rib, posteroinferior to the clavicle, is rarely fractured because of its protected position (it cannot be palpated). When it is broken, however, injury to the brachial plexus of nerves and subclavian vessels may occur. The middle ribs are most commonly fractured. Rib fractures usually result from blows or from crushing injuries. The weakest part of a rib is just anterior to its angle; However, direct violence may fracture a rib anywhere, and its broken end may injure internal organs such as a lung and/or the spleen. Lower rib fractures may tear the diaphragm and result in a diaphragmatic hernia. Rib fractures are painful because the broken parts move during respiration, coughing, laughing, and sneezing.

Gambar Fraktur costae :

Flail Chest
Multiple rib fractures may allow a sizable segment of the anterior and/or lateral thoracic wall to move freely. The loose segment of the wall moves paradoxically (inward on inspiration and outward on expiration). Flail chest (stove-in chest) is an extremely painful injury and impairs ventilation, thereby affecting oxygenation of the blood. During treatment, the loose segment is often fixed by hooks and/or wires so that it cannot move.

Gambar Flail Chest

Dyspnea
Dyspnea: Difficult Breathing When people with respiratory problems (e.g., asthma) or with heart failure struggle to breathe, they use their accessory respiratory muscles to assist the expansion of their thoracic cavity. They lean on their knees or on the arms of a chair to fix their pectoral girdle so these muscles are able to act on their rib attachments and expand the thorax.

Posisi tubuh saat asma

Pneumothorax, Hydrothorax, and Hemothorax

Entry of air into the pleural cavity (pneumothorax), resulting from a penetrating wound of the parietal pleura from a bullet, for example, or from rupture of a pulmonary lesion into the pleural cavity (bronchopulmonary fistula), results in collapse of the lung Fractured ribs may also tear the visceral pleura and lung, thus producing pneumothorax. The accumulation of a significant amount of fluid in the pleural cavity (hydrothorax) may result from pleural effusion (escape of fluid into the pleural cavity). With a chest wound, blood may also enter the pleural cavity (hemothorax) If both air and fluid (hemopneumothorax, if the fluid is blood) accumulate in the pleural cavity, an airfluid level or interface (sharp line, horizontal regardless of the patient's position, indicating the upper surface of the fluid) will be seen on a radiograph.

Pneumothorax

Gambar hidrothorax

Hemothorax

Thoracosintesis
Sometimes it is necessary to insert a hypodermic needle through an intercostal space into the pleural cavity (thoracentesis) to obtain a sample of fluid or to remove blood or pus To avoid damage to the intercostal nerve and vessels, the needle is inserted superior to the rib, high enough to avoid the collateral branches. The needle passes through the intercostal muscles and costal parietal pleura into the pleural cavity. When the patient is in the upright position, intrapleural fluid accumulates in the costodiaphragmatic recess. Inserting the needle into the 9th intercostal space in the midaxillary line during expiration will avoid the inferior border of the lung. The needle should be angled upward, to avoid penetrating the deep side of the recess (a thin layer of diaphragmatic parietal pleura and diaphragm overlying the liver).

Thoracosintesis

Pulmonary Emboli
Obstruction of a pulmonary artery by a blood clot (embolus) is a common cause of morbidity (sickness) and mortality (death). An embolus in a pulmonary artery forms when a blood clot, fat globule, or air bubble travels in the blood to the lungs from a leg vein, for example, after a compound fracture. The embolus passes through the right side of the heart to a lung through a pulmonary artery. It may block a pulmonary arterypulmonary embolism (PE)or one of its branches. The pulmonary arteries carry all of the blood that has been returned to the right heart via the vena caval system. Consequently, the immediate result of PE is partial or complete obstruction of blood flow to the lung. The blockage results in a lung or a sector of lung that is ventilated with air but not perfused with blood.

 When a large embolus occludes a pulmonary artery, the patient suffers acute respiratory distress because of a major decrease in the oxygenation of blood, owing to blockage of blood flow through the lung. Conversely, the right side of the heart may become acutely dilated because the volume of blood arriving from the systemic circuit cannot be pushed through the pulmonary circuit (acute cor pulmonale). In either case, death may occur in a few minutes. A medium-size embolus may block an artery supplying a bronchopulmonary segment, producing a pulmonary infarct, an area of necrotic (dead) lung tissue.

Gambar Emboli Paru

Asma Bronkial

Corpus alienum

Referensi
Anatomi Klinis Dasar. KL Moore Atlas of Human Anatomy. Netter Van De Graff of Human Anatomy. Mc Graw Hill