Bronchoscopy Health Dictionary

An instrument constructed on the principle of the telescope, which on introduction into the mouth is passed down through the LARYNX and TRACHEA and enables the observer to see the interior of the larger bronchial tubes. The bronchoscope has largely been superseded by ?breoptic bronchoscopy. (See ENDOSCOPE.)... bronchoscope

An e?ective local anaesthetic for topical application. Rapidly absorbed from mucous membranes, it should never be applied to in?amed, traumatised or highly vascular surfaces – nor used when providing anaesthesia for bronchoscopy or cystoscopy. Amethocaine is used in ophthalmology and in skin preparations. It may sensitise the skin. (See ANAESTHESIA.)... amethocaine

A visualising technique enabling the operator to examine the internal organs with the minimum of disturbance or damage to the tissues. The procedure has transformed the management of, for example, gastrointestinal disease. In chest disease, ?breoptic bronchoscopy has now replaced the rigid wide-bore metal tube which was previously used for examination of the tracheo-bronchial tree.

The principle of ?breoptics in medicine is that a light from a cold light source passes down a bundle of quartz ?bres in the endoscope to illuminate the lumen of the gastrointestinal tract or the bronchi. The re?ected light is returned to the observer’s eye via the image bundle which may contain up to 20,000 ?bres. The tip of the instrument can be angulated in both directions, and ?ngertip controls are provided for suction, air insu?ation and for water injection to clear the lens or the mucosa. The oesophagus, stomach and duodenum can be visualised; furthermore, visualisation of the pancreatic duct and direct endoscopic cannulation is now possible, as is visualisation of the bile duct. Fibreoptic colonoscopy can visualise the entire length of the colon and it is now possible to biopsy polyps or suspected carcinomas and to perform polypectomy.

The ?exible smaller ?breoptic bronchoscope has many advantages over the rigid tube, extending the range of view to all segmental bronchi and enabling biopsy of pulmonary parenchyma. Biopsy forceps can be directed well beyond the tip of the bronchoscope itself, and the more ?exible ?breoptic instrument causes less discomfort to the patient.

Fibreoptic laparoscopy is a valuable technique that allows the direct vizualisation of the abdominal contents: for example, the female pelvic organs, in order to detect the presence of suspected lesions (and, in certain cases, e?ect their subsequent removal); check on the development and position of the fetus; and test the patency of the Fallopian tubes.

(See also ENDOSCOPE; BRONCHOSCOPE; LARYNGOSCOPE; LAPAROSCOPE; COLONOSCOPE.)... fibreoptic endoscopy

The most common form of cancer throughout the world. Five year survival: 10 per cent. Its association with cigarette smoking is now established beyond doubt. Other causes include such occupational poisons as asbestos, arsenic, chromium, diesel fumes, etc. The squamous cell carcinoma is the most common of the four types.

Diagnosis is confirmed by sputum test, chest X-ray, bronchoscopy or biopsy. Earliest symptoms are persistent cough, pain in the chest, hoarseness of voice and difficulty of breathing. Physical examination is likely to reveal sensitivity and swelling of lymph nodes under arms.

Symptoms. Tiredness, lack of energy, possible pains in bones and over liver area. Clubbing of finger-tips indicate congestion of the lungs. Swelling of arms, neck and face may be obvious. A haematologist may find calcium salts in the blood. The supportive action of alteratives, eliminatives and lymphatic agents often alleviate symptoms where the act of swallowing has not been impaired.

Broncho-dilators (Lobelia, Ephedra, etc) assist breathing. Mullein has some reputation for pain relief. To arrest bleeding from the lesion (Blood root).

According to Dr Madaus, Germany, Rupturewort is specific on lung tissue. To disperse sputum (Elecampane, Red Clover). In advanced cases there may be swollen ankles and kidney breakdown for which Parsley root, Parsley Piert or Buchu may be indicated. Cough (Sundew, Irish Moss). Soft cough with much sputum (Iceland Moss). To increase resistance (Echinacea).

Alternatives. Secondary to primary treatment. Of possible value.

Teas. Violet leaves, Mullein leaves, Yarrow leaves, Gotu Kola leaves, White Horehound leaves. Flavour with a little Liquorice if unpalatable.

Tablets/capsules. Lobelia, Iceland Moss, Echinacea, Poke root.

Formula. Equal parts: Violet, Red Clover, Garden Thyme, Yarrow, Liquorice. Dose: Powders: 750mg (three 00 capsules or half a teaspoon. Liquid Extracts: 1-2 teaspoons. Tinctures: 1-3 teaspoons. Thrice daily, and during the night if relief is sought.

Practitioner. Tinctures BHP (1983). Ephedra 4; Red Clover 4, Yellow Dock 2; Bugleweed 2; Blood root quarter; Liquorice quarter (liquid extract). Mix. Start low: 30-60 drops in water before meals and at bedtime increasing to maximum tolerance level.

Aromatherapy. Oils: Eucalyptus or Thyme on tissue to assist breathing. Inhale.

Diet. See: DIET – CANCER.

Treatment by a general medical practitioner or hospital specialist. ... cancer - bronchial carcinoma

Collapse of part or all of a lung caused by obstruction of one or more air passages in the lung. Obstruction may be caused by accumulation of mucus, by an accidentally inhaled foreign body, by a tumour in the lung, or by enlarged lymph nodes exerting pressure on the airway.

The main symptom is shortness of breath. There may also be a cough and chest pain. The condition can be diagnosed by chest X-ray. Treatment is aimed at removing the cause of the blockage and may include physiotherapy or bronchoscopy. If the obstruction can be removed, the lung should reinflate normally.... atelectasis

A rarely used X-ray procedure for examining the bronchi, the main air passages of the lungs. Once used to diagnose bronchiectasis, it has now been largely replaced by other imaging techniques, such as CT scanning, and by the use of bronchoscopy.... bronchography

Various conditions affecting the LUNGS are dealt with under the following headings: ASTHMA; BRONCHIECTASIS; CHEST, DEFORMITIES OF; CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD); COLD, COMMON; EMPHYSEMA; EXPECTORATION; HAEMOPTYSIS; HAEMORRHAGE; OCCUPATIONAL HEALTH, MEDICINE AND DISEASES; PLEURISY; PNEUMONIA; PULMONARY EMBOLISM; TUBERCULOSIS.

In?ammation of the lungs is generally known as PNEUMONIA, when it is due to infection; as ALVEOLITIS when the in?ammation is immunological; and as PNEUMONITIS when it is due to physical or chemical agents.

Abscess of the lung consists of a collection of PUS within the lung tissue. Causes include inadequate treatment of pneumonia, inhalation of vomit, obstruction of the bronchial tubes by tumours and foreign bodies, pulmonary emboli (see EMBOLISM) and septic emboli. The patient becomes generally unwell with cough and fever. BRONCHOSCOPY is frequently performed to detect any obstruction to the bronchi. Treatment is with a prolonged course of antibiotics. Rarely, surgery is necessary.

Pulmonary oedema is the accumulation of ?uid in the pulmonary tissues and air spaces. This may be caused by cardiac disease (heart failure or disease of heart valves – see below, and HEART, DISEASES OF) or by an increase in the permeability of the pulmonary capillaries allowing leakage of ?uid into the lung tissue (see ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS)).

Heart failure (left ventricular failure) can be caused by a weakness in the pumping action of the HEART leading to an increase in back pressure which forces ?uid out of the blood vessels into the lung tissue. Causes include heart attacks and HYPERTENSION (high blood pressure). Narrowed or leaking heart valves hinder the ?ow of blood through the heart; again, this produces an increase in back pressure which raises the capillary pressure in the pulmonary vessels and causes ?ooding of ?uid into the interstitial spaces and alveoli. Accumulation of ?uid in lung tissue produces breathlessness. Treatments include DIURETICS and other drugs to aid the pumping action of the heart. Surgical valve replacement may help when heart failure is due to valvular heart disease.

Acute respiratory distress syndrome Formerly known as adult respiratory distress syndrome (ARDS), this produces pulmonary congestion because of leakage of ?uid through pulmonary capillaries. It complicates a variety of illnesses such as sepsis, trauma, aspiration of gastric contents and di?use pneumonia. Treatment involves treating the cause and supporting the patient by providing oxygen.

Collapse of the lung may occur due to blockage of a bronchial tube by tumour, foreign body or a plug of mucus which may occur in bronchitis or pneumonia. Air beyond the blockage is absorbed into the circulation, causing the affected area of lung to collapse. Collapse may also occur when air is allowed into the pleural space – the space between the lining of the lung and the lining of the inside of the chest wall. This is called a pneumothorax and may occur following trauma, or spontaneously

– for example, when there is a rupture of a subpleural air pocket (such as a cyst) allowing a communication between the airways and the pleural space. Lung collapse by compression may occur when ?uid collects in the pleural space (pleural e?usion): when this ?uid is blood, it is known as a haemothorax; if it is due to pus it is known as an empyema. Collections of air, blood, pus or other ?uid can be removed from the pleural space by insertion of a chest drain, thus allowing the lung to re-expand.

Tumours of the lung are the most common cause of cancer in men and, along with breast cancer, are a major cause of cancer in women. Several types of lung cancer occur, the most common being squamous cell carcinoma, small- (or oat-) cell carcinoma, adenocarcinoma, and large-cell carcinoma. All but the adenocarcinoma have a strong link with smoking. Each type has a di?erent pattern of growth and responds di?erently to treatment. More than 30,000 men and women die of cancer of the trachea, bronchus and lung annually in England and Wales.

The most common presenting symptom is cough; others include haemoptisis (coughing up blood), breathlessness, chest pain, wheezing and weight loss. As well as spreading locally in the lung – the rate of spread varies – lung cancer commonly spawns secondary growths in the liver, bones or brain. Diagnosis is con?rmed by X-rays and bronchoscopy with biopsy.

Treatment Treatment for the two main categories of lung cancer – small-cell and nonsmall-cell cancer – is di?erent. Surgery is the only curative treatment for the latter and should be considered in all cases, even though fewer than half undergoing surgery will survive ?ve years. In those patients unsuitable for surgery, radical RADIOTHERAPY should be considered. For other patients the aim should be the control of symptoms and the maintenance of quality of life, with palliative radiotherapy one of the options.

Small-cell lung cancer progresses rapidly, and untreated patients survive for only a few months. Because the disease is often widespread by the time of diagnosis, surgery is rarely an option. All patients should be considered for CHEMOTHERAPY which improves symptoms and prolongs survival.

Wounds of the lung may cause damage to the lung and, by admitting air into the pleural cavity, cause the lung to collapse with air in the pleural space (pneumothorax). This may require the insertion of a chest drain to remove the air from the pleural space and allow the lung to re-expand. The lung may be wounded by the end of a fractured rib or by some sharp object such as a knife pushed between the ribs.... lungs, diseases of

A symptom, medically known as haemoptysis, that is caused by rupture of a blood vessel in the air-ways, lungs, nose, or throat. The coughed-up blood may appear as brightred or rusty-brown streaks, clots in the sputum, a pinkish froth, or, more rarely, blood alone. In all cases, medical assessment is needed. Many disorders can cause haemoptysis. The most common are infections, such as pneumonia or bronchitis; and congestion in and rupture of blood vessels in the lungs due to heart failure, mitral stenosis, or pulmonary embolism. A cancerous tumour can also produce haemoptysis by eroding the wall of a blood vessel.

Investigations into coughing up blood include chest X-ray, and, in some cases, bronchoscopy. In about a 3rd of cases, no underlying cause is found. Treatment depends on the cause.... coughing up blood

The most common lung disorders are infections. These diseases include pneumonia, tracheitis, and croup. Bronchitis and bronchiolitis, which are inflammatory disorders affecting the airways within the lungs, can be complications of colds or influenza. The disorder bronchiectasis may occur as a complication of severe bacterial pneumonia o.

cystic fibrosis. The lungs can also be affected by allergic disorders. The most important of these is asthma. Another such disorder is allergic alveolitis, which is usually a reaction to dust of plant or animal origin. Irritation of the airways, usually by tobacco-smoking, can cause diseases characterized by damage to lung tissue and narrowing of the airways (see pulmonary disease, chronic obstructive). The lungs can also be affected by cancerous tumours; lung cancer is one of the most common cancers. Noncancerous lung tumours are uncommon.

Injury to a lung, usually resulting from penetration of the chest wall, can cause the lung to collapse (see pneumothorax; haemothorax). Damage to the interior of the lungs can be caused by inhalation of toxic substances (see asbestosis; silicosis). Blood supply to the lungs may be reduced by pulmonary embolism.

Lung disorders can be investigated in various ways, such as chest X-ray, bronchoscopy, and pulmonary function tests.... lung, disorders of

A cancerous tumour of the pharynx. Pharyngeal cancer usually develops in the mucous membrane lining. In the West, almost all cases of pharyngeal cancer are related to smoking and to drinking alcohol. The incidence rises with age, and the disorder is more common in men.

Cancerous tumours of the oropharynx (the middle section of the pharynx) usually cause difficulty swallowing, often with a sore throat and earache. Bloodstained sputum may be coughed up. Sometimes there is only the feeling of a lump in the throat or a visible enlarged lymph node in the neck. Cancer of the laryngopharynx (the lowermost part of the pharynx) initially causes a sensation of incomplete swallowing, then a muffled voice, hoarseness, and increased difficulty in swallowing. Tumours of the nasopharynx have different causes.Diagnosis of cancer of the pharynx is made by biopsy, often in conjunction with laryngoscopy, bronchoscopy, or oesophagoscopy.

The growth may be removed surgically or treated with radiotherapy.

Anticancer drugs may also be given.... pharynx, cancer of

An infectious disease, commonly called , caused in humans by the bacterium MYCOBACTERIUM TUBERCULOSIS. is usually transmitted in airborne droplets expelled when an infected person coughs or sneezes. An inhaled droplet enters the lungs and the bacteria begin multiplying. The immune system usually seals off the infection at this point, but in about 5 per cent of cases the infection spreads to the lymph nodes. It may also spread to other organs through the bloodstream, which may lead to miliary tuberculosis, a potentially fatal form of the disease.

In about another 5 per cent of cases, bacteria held in a dormant state by the immune system become reactivated months, or even years, later. The infection may then progressively damage the lungs, forming cavities.

The primary infection is usually without symptoms. Progressive infection in the lungs causes coughing (sometimes bringing up blood), chest pain, shortness of breath, fever and sweating, poor appetite, and weight loss. Pleural effusion or pneumothorax may develop. The lung damage may be fatal.

A diagnosis is made from the symptoms and signs, from a chest X-ray, and from tests on the sputum. Alternatively, a bronchoscopy may also be carried out to obtain samples for culture.

Treatment is usually with a course of 3 or 4 drugs, taken daily for 2 months, followed by daily doses of isoniazid and rifampicin for 4–6 months. However, bacteria are increasingly resistant to the drugs used in treatment, and others may have to be used and treatment carried out for a longer period. If the full course of drugs is taken, most patients recover.

can be prevented by BCG vaccination, which is offered routinely at birth or age 10–14.

Any contacts of an infected person are traced and examined, and, if infected, are treated early to reduce the risk of the infection spreading.... tuberculosis