Tag: lung cancer

Posted in Psychology & Medicine

Viscera: Lungs

Posted on by Jinavie

(Learn more about the organs of the human bodies in other posts in the Viscera series here: https://jineralknowledge.com/tag/viscera/?order=asc)

Everyone knows that we need oxygen to survive. The way we get oxygen from the atmosphere is through our lungs – the organ where gas exchange takes place. The pair of lungs take up a large proportion of the chest cavity and they link up with each other to form the trachea (windpipe). The left lung is slightly smaller to accommodate for the heart.

The lung is extremely soft and light, so much that it floats on water. It is essentially made up of an intricate tree-like system of airways, which become narrower and narrower as it divides out from the trachea. Since every airway divides up, the number of airways increases exponentially. Every bronchiole (small airways) ends in a bubble-like sac called an alveolus. Because of the sheer number of alveoli, the lungs actually have a total surface area the size of a tennis court. To picture this, scrunch up a piece of newspaper into a ball to pack a large surface area into a small space. The massive surface area allows for enough gas exchange to occur to give us the oxygen we need and excrete all the carbon dioxide we produce.

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When we take a breath in, the chest cavity expands and stretches the lungs in all directions because of the negative pressure (like a vacuum). Air fills the airways all the way to the alveoli. The alveoli are extremely thin; so thin that the oxygen in the air effortlessly seeps through into the blood vessels that surround the alveoli. On the other hand, carbon dioxide seeps out of the blood into the alveoli, which is then breathed out as the muscles of your ribcage contract to force the air out. This process is called gas exchange and is driven by diffusion – the movement of particles from an area of high concentration to an area of low concentration (like how dye spreads throughout water).

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It is well-known that smoking is bad for your lungs. This is because of two major reasons: COPD and lung cancer. COPD (chronic obstructive pulmonary disorder) is when your lungs become so damaged by smoking that they cannot function, leading to hypoxia (lack of oxygen) and hypercapnia (excess of carbon dioxide). Smoking causes inflammation in the lungs, which causes airways to shut down from swelling and mucus, while destroying the fine walls of the alveoli. This causes the alveoli to thicken from scarring and less elastic due to the destruction of elastic tissue. Ultimately, the lungs become hyperinflated as the patient cannot breathe out air properly and the lungs are not elastic enough to return to their original shape and size. Ergo, the patient becomes progressively breathless, gasping for breath as they suffer a sensation of impending death as the carbon dioxide level builds and the oxygen level falls.

Posted in Psychology & Medicine

Clubbing

Posted on by Jinavie

Among the thousands of signs and symptoms in the field of medicine, there is one that every doctor and medical student knows since the development of medicine. Clubbing is an easily noticeable sign in a patient’s fingers that can have wide implications on their health.

Clubbing is essentially when the angle (gap) between the fingernail bed and finger disappears. The formal definition is much more complicated, such as “the loss of the normal <165° angle, or Lovibond angle between the nailbed and the fold”, but for all intents and purposes the simple definition is sufficient.

To see if a patient has clubbing, the physician carefully studies the fingers against light. There are a few ways to check for clubbing but the most popular methods are holding the fingers out straight and holding them parallel to the ground, checking the angle between the nailbed and finger, or the Schamroth’s window test. The latter test is done by holding two opposing fingers (such as the left and right index fingers) against each other nail to nail. The fingers are then held against the light so that the light can shine through the “window” that is made. If the window is not seen, the test is positive and the patient has clubbing.

What does clubbing suggest? Clubbing was first noticed by Hippocrates, the father of Western medicine, who observed that people with clubbing tended to grab their chest and fall dead. This is one of the most common associations to clubbing – a congenital cyanotic heart defect such as tetralogy of Fallot or patent ductus arteriosus. Other common associations are related to the lungs, such as lung cancer (one of the most common causes) and various other lung diseases such as interstitial lung disease, tuberculosis and other chronic infections. There are also a myriad of other diseases associated to clubbing, including but not limited to: Crohn’s disease, ulcerative colitis, cirrhosis, celiac disease, Graves disease and certain types of cancers (lung, gastrointestinal and Hodgkin’s lymphoma mainly). Clubbing can also be idiopathic, where there is no apparent cause for the clubbing and the person just has it (possibly just born with it).

Despite knowing about clubbing for over 2000 years, we still do not know the exact reasons for clubbing. There are theories that it is related to a fall in blood oxygen content leading to vasodilation in the peripheries. As the pathophysiology is not clear and so many diseases are associated with it, when clubbing is found in the patient the physician should investigate the related organ systems (heart, lungs, GI mainly) to narrow down the possible cause of it. As many of the causes (such as lung cancer) carry a rather morbid prognosis, it is quite important to notice whether the patient has clubbing when doing a physical examination.