PROFESSIONAL DISEASES OF RESPIRATORY ORGANS CONDITIONED BY DUST
PROFESSIONAL DISEASES OF RESPIRATORY ORGANS, CONDITIONED BY DUST IMPACT (BLACK-LUNG DISEASE, PNEUMOCONIOSIS)
BLACK-LUNG DISEASE is a respiratory disorder, a type of pneumoconiosis caused by repeated inhalation of coal dust over a period of years and dust depositing in lungs, and is also characterized by the development of diffusion fibrosis
The modern classification of pneumoconiosis (2002): 1. Silicosis 2. Silicatosis 3. Metalloconiosis 4. Carboconiosis 5. Hypersensitivity pneumonitis
The classification of dust aggresivity: 1. Dust diseases developing from a dust with high- and medium-fibrogenious influence (containing Si 02 or asbest more than 10 %) – a silicosis, silicoantracosis, silicosilicatosis, silicosis derosis, asbestosis 2. Dust diseases developing from a dust with mild-fibrogenious influence (with the contents free silicon dioxid less then 10%, bonded Si 02 or without Si 02) – silicosilicatosis (kaolinosis, talcosis); carboconiosis (anthracosis, grafitosis, pneumoconiosis of coal dust, diamond pneumoconiosis); metalloconiosis (siderosis, kaolinosis, baritosis, manganoconiosis, aluminosis); a dust disease of the electric welders, polishing, grinding
Hypersensitivity dust diseases from a dust (aerosolum) with toxico-allergic influence – berylliosis, pneumonites from influence of chrom, nickel, platinum and others rare-earth metals and alloys; pneumonites from a dust of plastic, polymeric pitches, drugs (toxicofibrogenious alveolites); a byssinosis, bagassosis, papricosis, exogenous allergic alveolitis, woodworkers
Radiological Characteristics of Pneumoconiosis Code Characteristics of shadows Spreading, density and (form and size) territory of shadows Absence of pneumoconiosis 0 Control Small nodular (small rounded shadows) p Double Nodules, up to 1. 5 mm in size Small number of shadows q Nodules, from 1. 5 to 3. 0 mm r Nodules, from 3 to 10 mm Stage Moderate number of shadows Numerous shadows 0 -1 I, II
Radiological Characteristics of Pneumoconiosis Code s Characteristics of shadows Spreading, density and (form and size) territory of shadows Interstitial (small shadows) Double, diffusive Linearly and cellulary Blurry outlines Stage I, II changes t Pulled changes Clear outlines (lung picture is clear) u Sharply expressed pulled Numerous shadows (lung changes picture is not defined) III
Radiological Characteristics of Pneumoconiosis Code Characteristics of shadows Spreading, density and (form and size) territory of shadows Big nodular (big rounded Double or one-sided shadows on nodular or interstitial background) A B Small nodular — diameter of Territory of spreading is not nodules from 1 to 5 cm more than 5 cm 2 Big nodular — diameter of Territory of spreading is not nodules from 5 to 10 cm more than 1/3 of the lung field C Massive — diameters of Territory is over 1/3 of the nodules is over 10 cm lung Stage
Clinical Characteristics of Pneumoconiosis Clinical and functional Disease progress Complications Fast progressing Tuberculosis: characteristics Bronchitis Bronchiolitis Slowly progressing a) with separating forms of tuberculosis (according to the Lung emphysema, stage I, III Lung failure, stage I, II, and III Regressing classification) b) without noting the form of TB (small nodular, big nodular and massive TB-silicon) Pneumonia Brochnoectatic disease Bronchial Cor pulmonale, compensated, decompensated, stage I, II and III asthma Pneumothorax Atrophic arthritis Neoplasm
SILICOSIS Silicosis is pneumoconiosis, caused by inhaling dust with free silicon dioxide (Si 02). This is the most spread form of pneumoconiosis, the progress of which is particularly complicated
SILICOSIS met: 1. in metal mining industry 2. fireproof and ceramic materials 3. tunnel boring, sand grinding, quartz, granite and other ores
PATHOGENESIS 1. Colloid-adsorbing theory 2. Immune theory
PATHOLOGIC ANATOMIA • subtrophic, and later atrophic and sclerotic changes • precolagen and collagen fibers, silicotic nodules. • emphysema of lungs • hyalinized fascicles
CLINICS OF STAGE I • • • dyspnea (much physical activity) pain in the chest variable dry coughing basal emphysema stiff, in some places vesicular breathing X-ray: deformation of lung picture, small nodular from 1 to 2 mm in size, located mostly in lower and mid lung
CLINICS OF STAGE II 1. 2. 3. 4. 5. 6. 7. 8. Intensification of dyspnea Pain in the chest Cough Limitation of the motion of the lower end of lungs Intensification and deformation of lung picture Number of nodular shadows from 3 to 10 mm Lung roots are expanded, carnified and start looking «cut» The pleura thickened and deformed
CLINICS OF STAGE III 1. 2. 3. 4. 5. Dyspnea in rest Intensive pain in the chest Coughing Box sound with dull X-ray – disseminated miliary tuberculosis ("snow storm"), massive shadowings, pleurodiaphragm and pleurocardial commissures, buliosnic emphysema 6. Increase of minute volume
DIFFERENTIAL DIAGNOSTICS 1. disseminated tuberculosis 2. silicotuberculosis 3. sarcoidosis 4. syndrome of Haman-Rich
Complications of silicosis silicotuberculosis pneumonia bronchiatic disease bronchial asthma atrophic arthritis spontaneous pneumothorax coniotic cavity
TREATMENT • Inhalation of mineral waters • Glucocorticoids: prednisolone 20 to 25 mg/day for 10 to 12 days • Oxygen therapy • Stimulators of activity the respiratory center (Cordiamin) • Expectoration drugs (3 % of potassium iodide solution or the tincture of termopsis herb) • Alcohol extract of eleuteroke • Ultrasound, electrophoresis • Сardiac glycosides (strophanthin 0. 5 ml of 0. 05% solution), aminophylline (5 -7 ml of 2. 4% solution), diuretic (furosemide and hydrochlorothiazide) • Anabolic steroids (metanedrostenolon – 0. 005 g 1 to 2 times a day before meals, retabolil – 1 ml of 5% oil solution intramuscularly, total 8 -10 injections)
Verification of work ability Stage I: rational job. Stage II: Invalidism Group (mostly Group III, + tuberculosis and respiratory insufficiency – Group II). Stage III: occupational disablement of group II or I.
SILICATOSES Silicatoses are pneumoconiosis, which develop in the result of inhaling of silicate dust ASBESTOSIS Asbestosis is silicatosis, which is caused by inhaling asbestos dust
Clinics of asbestosis Chronic bronchitis symptoms + lung emphysema + pneumosclerosis • dyspnea • dry rales • coughing • pain in the chest • headaches, general weakness and undue fatiguability • losing weight • dry disseminated crepitations
TALCOSIS Talcosis is silicatosis, which appears due to the talc dust action (magnesia silicate). (rubber, textile, paper, perfume industries) not earlier than after 10 years of work dyspnea at physical activity, pain in the chest, coughing, mostly dry with some mucus, weight losses, box sound
ANTHRACOSIS miners (mining coal), ore-dressing plants professional rout 15 to 20 years (2% of silicon dioxide)
Clinics of anthracosis Stage I: fast fatiguability, dyspnea at physical activity, coughing and pain in the chest. X-ray: small nuclear shadows, bigger shadows of lung roots. Stage II: dyspnea, emphysema and bronchitis. Stage III: general weakness, dyspnea, coughing, pain in the chest. X-ray: massive homogenous shadows.
Berylliosis is metaloconiosis, caused by inhaling beryllium (silvery-gray light metal) beryllium oxide, beryllium sulfate, beryllium chloride, beryllium fluoride X-ray tubes, luminescent lamps, atomic energy, ceramic production
Treatment of silicatoses • solux, ultraviolet radiation, oxygen therapy, respiratory exercises • bronchological, antihistamine and inflammatory drugs (P, ascorbic acid and nicotinic acid) • antibiotics and sulfanamides (pneumonia) • cardiac glucosides (strophanthin, corglucon) • diuretics (lasix, hydrochlorothiazide)
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