5 NSCLC
5 NSCLC, , , , , 1FACT : 60 Problem : :
G.I. (ACEI) , , , . Airway irritants; Inhaled smokes, dusts,
fumes, postnasal drip, Aspiration (gastric contents, oral
secretion, foreign body)Airway diseases; URI, acute or chronic
bronchitis, cancer, asthma, bronchiectasis, external compression of
node or massParenchymal lung disease; pneumonia, lung abscess,
interstitial lung diseasesCHFDrug-induced (ACE inhibitors)
[stimuli, ligand] (receptor] (medulla) , , ,/, , , , Recurrent
laryngeal nerve()Closure of glottisPhrenic, spinal, vagal , ,
Glottis open COPD(virus, fungus, bacteria)IPFAsthma ,GERD ( )
(ACEI)()
3- ;
73-82% Postnasal drip syndrome (PNDS) ACE
COPD
ACEI - ACE .
- .
- 10 20 , 0 44 .
- 1 .
- Class ACE Inhbitor .ACEI ?- 1 4 .ARB .22 2 , .15 ACEI 3 , , ,
40 (ROS ) Fever/chill 39.6? 35/Inspiratory crackle, wheezing on
right lower anterior lung fields COPD(virus, fungus,
bacteria)IPFAsthma GERD ( ) (ACEI)() ?
(CAP), antihistamine, decongestantDry cough : , ACE
Pnuemothorax, , ILD, ( )Crackle and wheezing , .
.
conditionpercussionfremitusbreath soundvoice
transmissionadventitious
soundnormalresonantnormalvesicularnormalabsentconsolidation or
atelectasiswith patent
airwaydullbronchialbronchophony,whisperedpectoliloquy,egoghonycracklesconsolidation
or atelectasiswith blocked
airwaydullabsentAsthmaresonantnormalvesicularnormalwheezingILDresonantnormalvesicularnormalcracklesemphysemahyper-resonantabsent
or wheezingpneumothoraxhyper-resonantabsentpleural
effusiondullabsent or pleural friction rub
COPDCOPD 40 11.8% , . 60 1 40 (40) COPD . COPD . COPD .
localized .
CXR -( spirometer)FEV1.0%(FEV1.0/FVCx100%) 83%FEV1 ->
69%FEF25-75% -> 27%DLCO 79%
Chest x-ray
CT GGA3cm bronchus . Right hilum subcarnial area LN
bronchus necrosis mass 5 squamous cell carcinoma
. (cancer pearls) .
squamous cell carcinoma Cancer Staging staging
Metastasis , , , . Bone scan case stage IIIb .
stage IIIb carina involve pneumonectomy + tracheal sleeve
resection + bronchus reanastomosis( FEV1 1L )
5Stage 3b
Chemotherapy with Dosetaxel and cis-platinum neoadjuvant tx
stage .
