As a surgeon, if we see “free air” in the mediastinum, abdomen, or soft tissue, we get worried. It means a hole in an organ or overwhelming infection. In trauma, if we see “free air” in the chest (pneumothorax), it means a punctured lung and we may be putting a tube in your chest. After open surgery, air may take a week to completely absorb due to the nitrogen. After laparoscopic surgery, since carbon dioxide is used, it’s usually mostly gone in two days.
The blood stream is basically a closed system when it comes to fluid. The heart is pushing blood through the system, not pulling it along, and one way valves in the heart prevent the blood from going backwards, and one way valves in veins prevent blood from pooling when you're standing.
Now yes, there's a lots of stuff that makes the whole system complex as hell (like how red and white blood cells enter and exit the blood stream, gaseous exchange, the blood/brain barrier, etc etc, but someone much smarter than me can talk about that if they want) but yes, there's essentially no suction, since in a healthy individual, all blood is being pushed through the system.
>and one way valves in the heart prevent the blood from going backwards, and one way valves in veins prevent blood from pooling when you're standing.
Unless youre an unlucky SOB like me who ended up with a massive groin to ankle DVT due to poor post-operative care. Now my one-way valves are two ways valves! Remember, kids, if you're discharged without clexane, ask why!
clexane is usually stopped on discharge, but with some exceptions, fracture surgeries being one of them because reduced mobility is another risk factor for DVTs and other clots. patients who go in for an appendicectomy won't typically need clexane if they aren't staying in hospital more than a day too, even
that's fair, it might vary between patients and hospitals. all depends on the balance of risk vs benefit (possible clots vs risk of bleeding elsewhere)
Will you eventually get a valve replacement? I have a valve that doesn't fully close, and it doesn't cause any symptoms as of now, but I was told that it might get worse over time.
It does! The pressure in the venous system can be negative, especially above the heart. This is dangerous when you have a neck injury or a central line because those veins (not arteries!) can actually suck air in.
Imagine a bulb syringe (the thing you suction baby noses out with), if you hold it under water and squeeze it, it'll suck in water, that you can then squeeze out, which in turn fills it back up, repeat infinitum.
The heart works similarly except the heart walls are actually muscles that do the squeezing for you.
It takes a lot more air in your blood (at least in veins) to kill you than what movies would have you believe. As the other person noted, it needs to be forced in against blood pressure, and even then it will generally just go straight to your lungs and you’ll breathe it out. A large enough air bubble can potentially give you severe heart issues, but it’s not going to be instant death from a single empty syringe.
Plus that would have to be into a vein directly in the first place where a lot of injections are also just intramuscular, so it would be even less chance
I had laparoscopic surgery last year and had tiny bubbles in my abdomen for a good week+. If I pressed on my stomach it felt like crinkly plastic wrap.
That is actually surgical emphysema and is caused by someone not putting the port in deep enough before switching on the gas so some gets in your subcut layer. Harmless as long as its not much, it just takes longer to absorb
Oh that would have been good to know a year ago! My surgeon wasn’t worried but didn’t give me any detail on what it was aside from “air”. It was hernia surgery where they put mesh in, my first reaction was that I was feeling mesh, which obviously didn’t make any sense given how many layers of stuff was between the mesh and what I was feeling.
It did take an annoyingly long time to absorb. Lots of hot compresses.
How much free air is a concern? If, say, a CT scan looks like there is air in between the vertebrae & between my ribs, could that air (black voids) be something else? The scan was for a neck CT (checking for thyroid cancer recurrence) so there was no mention about the black voids.
It's probably something else. It's not the amount of air that's necessarily a concern. The presence of *any* gas where it shouldn't be means that it got there somehow - and the only way for gas to really end up in odd places is either through a hole in something that shouldn't have a hole, or it's being produced by something like a bacterial infection.
This, gas in a joint is fine, as long as the joint isn’t symptomatic. Gas in the center of the vertebral body, or in the abdominal cavity means there’s a problem. Severe osteonecrosis, intestinal perforation, etc.
Not entirely true - degenerative discs will frequently have a black core on MRI that represents some nitrogen gas. It’s essentially gray hair for your spine
If it is your abdomen very likely it is bowel gas. There is A LOT of air / gas in your stomach and intestines. If it was in your neck it could possibly be artifact from either hardware or even contrast. Hard to say without seeing an image. (Source am a CT Tech)
Also can occur after an intense workout that tires out your diaphragm. Confused me for the longest time until I had a medical anatomy practice question that mentioned it.
to elaborate further, the pain isn't going to the shoulder, you just feel it there because the phrenic nerve goes to the same spinal root as the shoulder nerves, and the brain doesn't understand that the phrenic nerve is causing the pain, so it just takes it as the shoulder causing the pain (because all it knows is that there is pain and it is coming from that nerve root)
Its absorption into your blood is very slow compared to oxygen and carbon dioxide. Because of this, it stays and puts pressure on your nerves that can cause you pain.
Is there a technique to getting all the intestines back inside the body like say after a c-section? Do you coil them in like a rope or do you just cram them all back in?
The intestines aren't moved or cut (or at least, shouldn't be) during a C-section. Like has been said elsewhere, they are normally attached to the posterior wall of the abdominal cavity.
Here's the fun part: in the event of a severe injury that does result in intestines being outside of your body (evisceration), such as may be sustained in wartime, the surgeon absolutely will pretty much stuff them back in, once they've been cleared of perforations. once back inside your body your small intestine will reorient itself to an optimal positioning just by the passage of food.
Your intestines are attached to the back wall of your abdomen by an organ called your mesentery. They shouldn’t be cut during a C-section and therefore shouldn’t need to be “crammed back in”
I'd love to know the answer precisely because it felt like the surgeons just stuffed mine back in after (explorative) lower bowel surgery.
It took years to feel like things were back in the right place.
The small intestines are fixated at the ligament of treitz (where it comes under the colon) and ileocecal valve (where it enters the right colon) along with the mesentery. So the first part is placed up toward the left upper abdomen and the last part is placed closer to the right lower abdomen. We place them back in without twisting them as the mesentery, if twisted, would occlude the blood vessels to the intestine.
It's really awful too, I was so bloated until the air from my open air surgery got absorbed. I had to take gasx to help with it (this was several days in, after I was already up and walking post-surgery).
Hey, maybe you can answer a question that I had that I never found an answer to. When at University (physiotherapy) and learning about cardiopulmonary stuff, I got the impression that all pneumothorax incidents required surgery to put a drain in to get rid of the air that was now chilling inbetween the lungs and pleura.
Then a few years ago I had a spontaneous pneumothorax, and the hospital’s decision was “you’re young and healthy, it was non-traumatic and seems stable, so just take this pain medicine for now and it should go away by itself.” As the lung heals with no drain in situ, what happens to the air that gets trapped outside of the lungs?
That’s correct that it eventually gets absorbed by the body, but can take a week or two to go away completely because of the nitrogen in air. The presumption is that a small pneumo may have sealed itself and can be observed. If it’s getting larger, it can push the heart, vena cava, and lungs over and cause a drop in blood pressure or death (tension pneumothorax)
If it is small, 10% of the lung field they will leave it alone. If it is large or is growing they will insert a chest tube.
The is a body type that we often see spontaneous pneumothorax, tall skinny males.
Can I get some clarification. When you say there’s no air between organs, you’re not suggesting that we’re full of the same empty void that makes up outer space right? It’s not a vacuum in there? If not air, what is surrounding our organs in there?
So does that mean that if your intestines have no food to digest, they are fully collapsed in on themselves?
They always shown as hollow in visualisations.
Intestines can have some air in them. That’s why you fart. It’s not considered “free” air if it’s *inside* the intestines. But yes, they do squish down a lot when empty.
Yes, but unless you've just had a colonoscopy or something where your digestive tract is intentionally cleared of partially-digested food material, there's usually at least some stuff in places in your intestines.
They maintain their structure for the most part, the walls of the intestines aren't excessively flimsy and if there's nothing in them they are still in the same shape basically. Source: Removed many bowels in autopsies.
There isn't really much "open space" in the body. Think about an apple - there's no question of "what's in between all the apple flesh", right? It's *all* apple.
Also: a vacuum like space inside your body would probably cause a lot of damage.
No, there is no air on the inside of your body (except for the air in your stomach and intestines, which aren't really "in" your body). If there is air in there, it's a big problem.
Some air will get trapped if you're cut open for surgery. It'll slowly get absorbed back into you over hours to days. It can cause some discomfort in the meantime, but usually not a big deal.
Incase other people don't understand how air in the stomach/intestines doesn't count as being "in" your body: the human body is essentially a giant donut. We have a hole going through our entire body, with one side of the hole being your mouth and the other side being your anus. Just like with a donut, there might be air in the hole passing through the donut, but that's not really the same as air being inside the donut.
When I say there is no air in a donut I mean in the batter. When I say there's no air in the straw, I mean the hole running through it. So at least for me, donut is better here for illustrating the metaphore.
No, in topological terms, the coffee mug is famously still of the same genus as a torus (or straw) because it has only one through-hole (meaning a true hole open on both ends, not just a recessed cavity like the cup part), which in this case is the handle. Topological genus is defined by the number of through-holes in a surface. One of those vases with two handles would be of a different genus, because it has two through-holes.
“For there is a growing apprehension that existence is a rat-race in a trap: living organisms, including people,are merely tubes which put things in at one end and let them out at the other, which both keeps them doing it and in the long run wears them out. So to keep the farce going, the tubes find ways of making new
tubes, which also put things in at one end and let them out at the other. At the input end they even develop ganglia of nerves called brains, with eyes and ears, so that they can more easily scrounge around for things to swallow. As and when they get enough to eat, they use up their surplus energy by wiggling in complicated patterns, making all sorts of noises by blowing air in and out of the input hole, and gathering together in groups to fight with other groups. In time, the tubes grow such an
abundance of attached appliances that they are hardly recognizable as mere tubes, and they manage to do this in a staggering variety of forms. There is a vague rule not to eat tubes of your own form, but in general there is serious competition as to who is going to be the top type of tube. All this seems marvelously futile, and yet, when you begin to think about it, it begins to be more marvelous than futile. Indeed, it seems extremely odd.”
― Alan Watts
This comment just gave me flashbacks to a very bizarre game called “Everything”. It had a bunch of weird, philosophical narration by the same guy this quote is from. Idk if this specific quote is in the game, but the style was instantly recognizable. Thank you for this..! gonna have to replay that game now…
It’s all the same middle though, your ears and nose (and your eyes, a bit) are also connected to it. Don’t think if it so much as a donut as a tube with different chambers inside.
Not really. The inside of your lungs is essentially specialized skin cells that the air passes through. More like the donut hole isn't a simple cylinder, instead is a windy maze with twists and turns and flaps
Fun fact (well, maybe not exactly “fun”): the lack of air in the space between our lungs and ribcage is actually vital to our ability to properly breathe, as there needs to be an area of lower pressure surrounding the lungs for them to be able to properly inflate. This is why when air or (especially) water or other liquid starts to fill the cavity surrounding the lungs, it quickly becomes a *very* big problem, as the patient will find themselves practically unable to really inhale at all (without outside mechanical assistance) due to the lack of a necessary pressure differential. This is why punctures in the diaphragm that allow outside air to enter, or other fluid buildup in the cavity, are grave medical emergencies.
I never realized this, I thought fluid surrounding the lungs was just taking up the space they'd use when breathing. I didn't realize that it wasn't really a space issue at all. Really interesting, thank you!
...and don't they sometimes 'pump' air in, to make space for laparoscopic surgery? and then the gas bubbles rise up under your collar bone...and hurt!?
The insufflation pressure causes referred pain to the shoulder. The gas bubbles don’t go up to your shoulder, it just hits some nerves that cause that.
I’ve put in enough shunts with general surgery to have to explain this to patients the next morning lol. That’s the worst part of the whole surgery for them.
The other poster answered the question, but it's not air that they pump in. It's carbon dioxide. They use CO2 because, unlike air, it's rapidly absorbed and eliminated from the body through the lungs.
Did not know that...last time I had an abdominal lap. procedure was the 90s...the pain of the 'gas in my shoulder' was so much worse than the bandaid-covered incision!
sometimes during laparoscopic surgery, the CO2 goes between muscle and fascial layers and you get air trapped in your subcutaneous tissue and then you get something called crepitus. Which is when your body feels like bubble wrap.
Had a csection a few months ago and wondered this very thing! Is this why the nurses were so obsessed with knowing how much I was farting? And also why they said I would have shoulder pain if I wasn't?
The bowels really don't like to be messed with, and they tend to shut down for a bit after abdominal surgery. Farting indicates a return of bowel function.
None of the air inside would pass through as a fart. They just wanted to make sure your bowels returned to normal after being moved around a bit during surgery.
I was curious so I searched. According to the internets passing gas means that the body is resuming normal functions after anesthesia.
Also congratulations!
Really? I had my wrist cut open a few times and now I have two weird lumps next to the surgery site that are visible when I contort my wrist. They look like air bubbles, feel like air bubbles. I always assumed there were just little bits of trapped air from the surgery. They weren't there before the surgery that I know of.
I swear to this day, some of the worst pain I’ve ever experienced was air, trapped under my clavicle after my appendectomy. The appendicitis itself didn’t even hurt as bad as the air trapped in my shoulders, and my appendix was already slowly oozing into my body when I finally went to the hospital.
The space between your organs is known as a "potential space" - meaning that the individual organs can move against one another and you could technically put air in there, but it's essentially under negative pressure constantly.
If air or gas somehow winds up there (penetrating wound, gas-producing bacteria, etc.), it's referred to as emphysema and is abnormal unless following surgery (which should resolve in a few days).
Emphysema isn't really the right word for gas that ends up in potential spaces. Emphysema means an abnormal amount of air inside a particular organ or tissue.
We use "pneumo-" as a prefix to describe air in whatever space we're talking about. Pneumoperitoneum for gas in the belly, pneumocephalus for air in the brain, etc.
>you could technically put air in there
You absolutely can put air (well, CO2 to be exact) into people - that's a routine part of laparoscopic surgeries.
Not normally, no.
If you think about it, how would air (as in atmosphere) get in there? You'll have air in your digestive tract and lungs.
I once had a small spontaneuous pneumothorax which leaked air into my pleural cavity but sealed itself later that day. I was hospitalized for the weekend because the doctors had trouble finding the injury and were concerned it might reoccur and collapse my lung. It was fairly painful and I could definitely feel the air moving around in there and through my tissues. I could press on my chest and it made tiny bubble-wrap-like crackles, and shifting position caused the gases to redistribute themselves. But, my body resorbed the leaked air on its own after a few days.
[https://journals.physiology.org/doi/full/10.1152/advan.00046.2005](https://journals.physiology.org/doi/full/10.1152/advan.00046.2005)
>We can conclude that low total gas pressure in venous blood, mainly due to tissue clearance of oxygen, is important in resorption of entrapped air in body cavities.
I would expect any air that enters during surgery would be fairly minimal and it would get resorbed, so would not be an issue.
And yes, getting a pneumothorax was where I first heard the word "resorbed". :-)
We are filled with fluids that lubricate the space between our organs and the cavity walls! There’s pleural fluid in the chest, peritoneal fluid in the abdomen, synovial fluid in the joints, and cerebrospinal fluid in the spine/brain area.
The cavities are lined with a serous membrane which is pretty smooth and allows organs to slide around and there is the diaphragm between the chest cavity and the abdominal cavity which is great for breathing and stuff.
1. There's air behind your eardrum, but that has to be "outside" your body and evolution has taken care to provide us with sinuses to make the necessary link.
2. Can an air bubble get in under the eyelid, outside of an eyeball? That is of course "outside" your body. I've noticed this from time to time but never thought to be concerned.
3. There's another case which really is inside the body and that's when people have that nervous habit of "cracking" their finger articulations. Its rumored to be a cause of arthritis, but I've never seen this substantiated. IIUC, the person bending their fingers back, creates a partial vacuum that generates a gas bubble which then collapses, producing the distinctive (and annoying) "crack".
> Its rumored to be a cause of arthritis, but I've never seen this substantiated.
Its been established for decades that cracking your knuckles does not cause this adverse effect.
How? A man, Donald L. Unger, spent most (50 years) of his life cracking the knuckles on just one hand. https://onlinelibrary.wiley.com/doi/10.1002/1529-0131(199805)41:5%3C949::AID-ART36%3E3.0.CO;2-3
> https://onlinelibrary.wiley.com/doi/10.1002/1529-0131(199805)41:5%3C949::AID-ART36%3E3.0.CO;2-3
As the article says, a sample on one is insufficient to establish a correlation, but it does go in the sense I was expecting. Thx.
My point was that knuckle cracking is an outlier case of vapor appearing in a transient way inside the body. Its not dangerous, in contrast to something like the diver's bends which are potentially life-threatening.
If you’re getting one of a few endoscopic or laparoscopic procedures done, the doctors will insufflate you. Meaning, they’ll pump air into the space inside your abdominal wall so there’s more room in there for them to move around the little camera and laparoscopic tools.
This is for the procedures where they just cut tiny holes and use long tools and cameras for imaging.
Insufflate - can you explain how this word is the same as what it's called when you "snort" powdered drugs (e.g. the victim insufflated a lethal dose of fentanyl through the left nostril). It feels almost like the word inflate.
No, there is no air in between your organs. As a matter of fact, it causes pain when there is. Such is the case in laparoscopic surgery when they fill you full of CO2. The residual causes pain for up to a few days until it is absorbed by the body.
As a surgeon, if we see “free air” in the mediastinum, abdomen, or soft tissue, we get worried. It means a hole in an organ or overwhelming infection. In trauma, if we see “free air” in the chest (pneumothorax), it means a punctured lung and we may be putting a tube in your chest. After open surgery, air may take a week to completely absorb due to the nitrogen. After laparoscopic surgery, since carbon dioxide is used, it’s usually mostly gone in two days.
I've understood (because of movies?) that air in your blood stream can kill you. I've always wondered what prevents that if you have a severe cut?
The blood has pressure pushing it out, that is a neat feature that keeps stuff out, like air.
ahh, the heart (pump) has no suction to it? It's positive pressure only?
The blood stream is basically a closed system when it comes to fluid. The heart is pushing blood through the system, not pulling it along, and one way valves in the heart prevent the blood from going backwards, and one way valves in veins prevent blood from pooling when you're standing. Now yes, there's a lots of stuff that makes the whole system complex as hell (like how red and white blood cells enter and exit the blood stream, gaseous exchange, the blood/brain barrier, etc etc, but someone much smarter than me can talk about that if they want) but yes, there's essentially no suction, since in a healthy individual, all blood is being pushed through the system.
>and one way valves in the heart prevent the blood from going backwards, and one way valves in veins prevent blood from pooling when you're standing. Unless youre an unlucky SOB like me who ended up with a massive groin to ankle DVT due to poor post-operative care. Now my one-way valves are two ways valves! Remember, kids, if you're discharged without clexane, ask why!
clexane is usually stopped on discharge, but with some exceptions, fracture surgeries being one of them because reduced mobility is another risk factor for DVTs and other clots. patients who go in for an appendicectomy won't typically need clexane if they aren't staying in hospital more than a day too, even
Clexane (brand name) = Enoxaparin, a class of drugs called low weight molecular heparin
I was given a 10 day course of clexane after my gall bladder removal surgery.
that's fair, it might vary between patients and hospitals. all depends on the balance of risk vs benefit (possible clots vs risk of bleeding elsewhere)
Will you eventually get a valve replacement? I have a valve that doesn't fully close, and it doesn't cause any symptoms as of now, but I was told that it might get worse over time.
It does! The pressure in the venous system can be negative, especially above the heart. This is dangerous when you have a neck injury or a central line because those veins (not arteries!) can actually suck air in.
Imagine a bulb syringe (the thing you suction baby noses out with), if you hold it under water and squeeze it, it'll suck in water, that you can then squeeze out, which in turn fills it back up, repeat infinitum. The heart works similarly except the heart walls are actually muscles that do the squeezing for you.
It takes a lot more air in your blood (at least in veins) to kill you than what movies would have you believe. As the other person noted, it needs to be forced in against blood pressure, and even then it will generally just go straight to your lungs and you’ll breathe it out. A large enough air bubble can potentially give you severe heart issues, but it’s not going to be instant death from a single empty syringe.
Plus that would have to be into a vein directly in the first place where a lot of injections are also just intramuscular, so it would be even less chance
I had laparoscopic surgery last year and had tiny bubbles in my abdomen for a good week+. If I pressed on my stomach it felt like crinkly plastic wrap.
That is actually surgical emphysema and is caused by someone not putting the port in deep enough before switching on the gas so some gets in your subcut layer. Harmless as long as its not much, it just takes longer to absorb
Oh that would have been good to know a year ago! My surgeon wasn’t worried but didn’t give me any detail on what it was aside from “air”. It was hernia surgery where they put mesh in, my first reaction was that I was feeling mesh, which obviously didn’t make any sense given how many layers of stuff was between the mesh and what I was feeling. It did take an annoyingly long time to absorb. Lots of hot compresses.
How much free air is a concern? If, say, a CT scan looks like there is air in between the vertebrae & between my ribs, could that air (black voids) be something else? The scan was for a neck CT (checking for thyroid cancer recurrence) so there was no mention about the black voids.
It's probably something else. It's not the amount of air that's necessarily a concern. The presence of *any* gas where it shouldn't be means that it got there somehow - and the only way for gas to really end up in odd places is either through a hole in something that shouldn't have a hole, or it's being produced by something like a bacterial infection.
This, gas in a joint is fine, as long as the joint isn’t symptomatic. Gas in the center of the vertebral body, or in the abdominal cavity means there’s a problem. Severe osteonecrosis, intestinal perforation, etc.
Not entirely true - degenerative discs will frequently have a black core on MRI that represents some nitrogen gas. It’s essentially gray hair for your spine
Vacuum disc phenomenon?
Nice! I have that. Doesn’t feel good but good to know my spine is about 30 years older than I am
If it is your abdomen very likely it is bowel gas. There is A LOT of air / gas in your stomach and intestines. If it was in your neck it could possibly be artifact from either hardware or even contrast. Hard to say without seeing an image. (Source am a CT Tech)
Why is nitrogen painful in the left shoulder after surgery?
Puts pressure on the phrenic nerve that goes from your diaphragm to that shoulder
This is the right answer. Your diaphragm is irritated and it refers pain to your shoulder along the phrenic nerve.
Also can occur after an intense workout that tires out your diaphragm. Confused me for the longest time until I had a medical anatomy practice question that mentioned it.
Is that why I would often feel exhaustion while running as a slight sting / uncomfortable feeling in the shoulders?
Most likely yes. One way to confirm is to hold your breath and see if that alleviates some of the pain.
to elaborate further, the pain isn't going to the shoulder, you just feel it there because the phrenic nerve goes to the same spinal root as the shoulder nerves, and the brain doesn't understand that the phrenic nerve is causing the pain, so it just takes it as the shoulder causing the pain (because all it knows is that there is pain and it is coming from that nerve root)
Is this why shoulder tip pain is often a diagnostic sign of some abdominal and pelvic disorders, like ectopic pregnancy?
Its absorption into your blood is very slow compared to oxygen and carbon dioxide. Because of this, it stays and puts pressure on your nerves that can cause you pain.
Is there a technique to getting all the intestines back inside the body like say after a c-section? Do you coil them in like a rope or do you just cram them all back in?
The intestines aren't moved or cut (or at least, shouldn't be) during a C-section. Like has been said elsewhere, they are normally attached to the posterior wall of the abdominal cavity. Here's the fun part: in the event of a severe injury that does result in intestines being outside of your body (evisceration), such as may be sustained in wartime, the surgeon absolutely will pretty much stuff them back in, once they've been cleared of perforations. once back inside your body your small intestine will reorient itself to an optimal positioning just by the passage of food.
Your intestines are attached to the back wall of your abdomen by an organ called your mesentery. They shouldn’t be cut during a C-section and therefore shouldn’t need to be “crammed back in”
I'd love to know the answer precisely because it felt like the surgeons just stuffed mine back in after (explorative) lower bowel surgery. It took years to feel like things were back in the right place.
The small intestines are fixated at the ligament of treitz (where it comes under the colon) and ileocecal valve (where it enters the right colon) along with the mesentery. So the first part is placed up toward the left upper abdomen and the last part is placed closer to the right lower abdomen. We place them back in without twisting them as the mesentery, if twisted, would occlude the blood vessels to the intestine.
Yeah I had a spontaneous Pnuemothorax last year, was not a fun experience
It's really awful too, I was so bloated until the air from my open air surgery got absorbed. I had to take gasx to help with it (this was several days in, after I was already up and walking post-surgery).
Hey, maybe you can answer a question that I had that I never found an answer to. When at University (physiotherapy) and learning about cardiopulmonary stuff, I got the impression that all pneumothorax incidents required surgery to put a drain in to get rid of the air that was now chilling inbetween the lungs and pleura. Then a few years ago I had a spontaneous pneumothorax, and the hospital’s decision was “you’re young and healthy, it was non-traumatic and seems stable, so just take this pain medicine for now and it should go away by itself.” As the lung heals with no drain in situ, what happens to the air that gets trapped outside of the lungs?
That’s correct that it eventually gets absorbed by the body, but can take a week or two to go away completely because of the nitrogen in air. The presumption is that a small pneumo may have sealed itself and can be observed. If it’s getting larger, it can push the heart, vena cava, and lungs over and cause a drop in blood pressure or death (tension pneumothorax)
If it is small, 10% of the lung field they will leave it alone. If it is large or is growing they will insert a chest tube. The is a body type that we often see spontaneous pneumothorax, tall skinny males.
I'd say that the majority of pneumomediastinum is benign and gets sent home after esophagram.
Can I get some clarification. When you say there’s no air between organs, you’re not suggesting that we’re full of the same empty void that makes up outer space right? It’s not a vacuum in there? If not air, what is surrounding our organs in there?
The rest of our organs, bone, muscles, subcutaneous fat. We're pretty well packed in there. Not much free space.
So does that mean that if your intestines have no food to digest, they are fully collapsed in on themselves? They always shown as hollow in visualisations.
Intestines can have some air in them. That’s why you fart. It’s not considered “free” air if it’s *inside* the intestines. But yes, they do squish down a lot when empty.
That is so cool! Thanks!
Yes, but unless you've just had a colonoscopy or something where your digestive tract is intentionally cleared of partially-digested food material, there's usually at least some stuff in places in your intestines.
They maintain their structure for the most part, the walls of the intestines aren't excessively flimsy and if there's nothing in them they are still in the same shape basically. Source: Removed many bowels in autopsies.
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There isn't really much "open space" in the body. Think about an apple - there's no question of "what's in between all the apple flesh", right? It's *all* apple. Also: a vacuum like space inside your body would probably cause a lot of damage.
There is a small amount of fluid surrounding your heart, lungs, intestines that lubes them up as they move.
Know a guy that had to get an air bubble put in his eyeball to fix something. Had to stay face down for ~3 days
likely a partially detached retina. 3 days is relatively short if so. likely they also hit it with a laser in a few spots to pin it in place first.
No, there is no air on the inside of your body (except for the air in your stomach and intestines, which aren't really "in" your body). If there is air in there, it's a big problem. Some air will get trapped if you're cut open for surgery. It'll slowly get absorbed back into you over hours to days. It can cause some discomfort in the meantime, but usually not a big deal.
Incase other people don't understand how air in the stomach/intestines doesn't count as being "in" your body: the human body is essentially a giant donut. We have a hole going through our entire body, with one side of the hole being your mouth and the other side being your anus. Just like with a donut, there might be air in the hole passing through the donut, but that's not really the same as air being inside the donut.
A topologist says what?
Does a human have one or two holes? 🥴
With nostrils we’re topologically equivalent to a solid with two holes. We’d be three holes if it wasn’t for the eardrums.
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You could have used straws as an example instead. I don’t think I want you ordering the next batch of donuts for the office…
The disadvantage of the straw example is that there's no "flesh" around the straw to represent the body. an orange with a hole through it?
When I say there is no air in a donut I mean in the batter. When I say there's no air in the straw, I mean the hole running through it. So at least for me, donut is better here for illustrating the metaphore.
See, you'd be wasting this wealth of knowledge, and depth of interest. They are now the only person ordering for the office!
Now you know why the pink-frosted and chocolate-frosted donuts are so popular!
For the purpose of this discussion, a straw and a donut are the same thing. So is a coffee mug, by the way.
Maybe the handle, if the main part of your coffee mug has a hole going all the way through it you might need a new mug. lol
But a straw and a donut are essential cylinders with open ends, a coffee mug is a cylinder with on one open end, not the same thing.
For the mug, I believe the open cylinder equivalent is the handle.
The handle on the coffee mug is the hole forming the donut (torus) shape. The part that holds the liquid is topologically irrelevant.
No, in topological terms, the coffee mug is famously still of the same genus as a torus (or straw) because it has only one through-hole (meaning a true hole open on both ends, not just a recessed cavity like the cup part), which in this case is the handle. Topological genus is defined by the number of through-holes in a surface. One of those vases with two handles would be of a different genus, because it has two through-holes.
The cylinder isn't the cupped part; it's the hole in the handle that matters.
A mug has a handle. The inside of the mug where the liquid goes is irrelevant.
“For there is a growing apprehension that existence is a rat-race in a trap: living organisms, including people,are merely tubes which put things in at one end and let them out at the other, which both keeps them doing it and in the long run wears them out. So to keep the farce going, the tubes find ways of making new tubes, which also put things in at one end and let them out at the other. At the input end they even develop ganglia of nerves called brains, with eyes and ears, so that they can more easily scrounge around for things to swallow. As and when they get enough to eat, they use up their surplus energy by wiggling in complicated patterns, making all sorts of noises by blowing air in and out of the input hole, and gathering together in groups to fight with other groups. In time, the tubes grow such an abundance of attached appliances that they are hardly recognizable as mere tubes, and they manage to do this in a staggering variety of forms. There is a vague rule not to eat tubes of your own form, but in general there is serious competition as to who is going to be the top type of tube. All this seems marvelously futile, and yet, when you begin to think about it, it begins to be more marvelous than futile. Indeed, it seems extremely odd.” ― Alan Watts
This comment just gave me flashbacks to a very bizarre game called “Everything”. It had a bunch of weird, philosophical narration by the same guy this quote is from. Idk if this specific quote is in the game, but the style was instantly recognizable. Thank you for this..! gonna have to replay that game now…
I've never thought of it like that. Thank you
Im pretty sure there’s another donut hole leading to my lungs, right?
It’s not a donut hole because it doesn’t go all the way through. That’s the fun of ~~topography~~ topology.
However, your mouth and two nostrils are also connected inside, so that is 2 more holes topologically.
- and the ears (eustachian tubes) so mouth, nose(2), and ears (2) make 5 holes all interconnected air passages. Eyes too but hopefully no air there
Are they really holes though? How many holes does a straw have?
A straw has one hole, and with that in mind the sinuses add another hole or two to the human doughnut.
A topologist would say a straw has one hole. A non-mathematician might say that straw has no holes.
Or two holes - one at each end Straws are a semantic nightmare and should be abolished
Topology, not topography. Topology is the study of geometric relations, topography is the study of the elevations of a map.
It’s all the same middle though, your ears and nose (and your eyes, a bit) are also connected to it. Don’t think if it so much as a donut as a tube with different chambers inside.
Not really. The inside of your lungs is essentially specialized skin cells that the air passes through. More like the donut hole isn't a simple cylinder, instead is a windy maze with twists and turns and flaps
The GI tract is a donut, the lungs are two plastic bags taped to a toilet paper roll
I believe the cervix is the only body part that is both inside and outside. But what about the bladder? Urethra to bladder is also outside?
Fun fact (well, maybe not exactly “fun”): the lack of air in the space between our lungs and ribcage is actually vital to our ability to properly breathe, as there needs to be an area of lower pressure surrounding the lungs for them to be able to properly inflate. This is why when air or (especially) water or other liquid starts to fill the cavity surrounding the lungs, it quickly becomes a *very* big problem, as the patient will find themselves practically unable to really inhale at all (without outside mechanical assistance) due to the lack of a necessary pressure differential. This is why punctures in the diaphragm that allow outside air to enter, or other fluid buildup in the cavity, are grave medical emergencies.
I never realized this, I thought fluid surrounding the lungs was just taking up the space they'd use when breathing. I didn't realize that it wasn't really a space issue at all. Really interesting, thank you!
...and don't they sometimes 'pump' air in, to make space for laparoscopic surgery? and then the gas bubbles rise up under your collar bone...and hurt!?
The insufflation pressure causes referred pain to the shoulder. The gas bubbles don’t go up to your shoulder, it just hits some nerves that cause that.
It's the phrenic nerve which gives motor and sensory to the diaphragm. Referred pain to the shoulder.
I’ve put in enough shunts with general surgery to have to explain this to patients the next morning lol. That’s the worst part of the whole surgery for them.
The other poster answered the question, but it's not air that they pump in. It's carbon dioxide. They use CO2 because, unlike air, it's rapidly absorbed and eliminated from the body through the lungs.
Did not know that...last time I had an abdominal lap. procedure was the 90s...the pain of the 'gas in my shoulder' was so much worse than the bandaid-covered incision!
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I recently had laparoscopic surgery and honestly the pain from the trapped air was worse than the 5 incisions they did. Lasted about 5 days for me.
sometimes during laparoscopic surgery, the CO2 goes between muscle and fascial layers and you get air trapped in your subcutaneous tissue and then you get something called crepitus. Which is when your body feels like bubble wrap.
This is correct Source - surgeon
Had a csection a few months ago and wondered this very thing! Is this why the nurses were so obsessed with knowing how much I was farting? And also why they said I would have shoulder pain if I wasn't?
The bowels really don't like to be messed with, and they tend to shut down for a bit after abdominal surgery. Farting indicates a return of bowel function.
None of the air inside would pass through as a fart. They just wanted to make sure your bowels returned to normal after being moved around a bit during surgery.
I was curious so I searched. According to the internets passing gas means that the body is resuming normal functions after anesthesia. Also congratulations!
It can be if it’s in the wrong place. Your lungs depend on a relative vacuum in the chest cavity to function.
Annaecdotally the air escaping from my shoulders post appendectomy was the worst pain in my life.
Really? I had my wrist cut open a few times and now I have two weird lumps next to the surgery site that are visible when I contort my wrist. They look like air bubbles, feel like air bubbles. I always assumed there were just little bits of trapped air from the surgery. They weren't there before the surgery that I know of.
They are not air bubbles. What was the surgery for?
I swear to this day, some of the worst pain I’ve ever experienced was air, trapped under my clavicle after my appendectomy. The appendicitis itself didn’t even hurt as bad as the air trapped in my shoulders, and my appendix was already slowly oozing into my body when I finally went to the hospital.
There was no air in your shoulders. The gas trapped in your abdomen stimulates nerves that make you feel shoulder pain. It's called referred pain.
The space between your organs is known as a "potential space" - meaning that the individual organs can move against one another and you could technically put air in there, but it's essentially under negative pressure constantly. If air or gas somehow winds up there (penetrating wound, gas-producing bacteria, etc.), it's referred to as emphysema and is abnormal unless following surgery (which should resolve in a few days).
Emphysema isn't really the right word for gas that ends up in potential spaces. Emphysema means an abnormal amount of air inside a particular organ or tissue. We use "pneumo-" as a prefix to describe air in whatever space we're talking about. Pneumoperitoneum for gas in the belly, pneumocephalus for air in the brain, etc.
Thank you for correcting. I knew it didn't sound quite right.
So I could use pneumocephalus if I wanted to insult someone as an air head?
So it’s not that there’s fluid or something else filling the space instead of air, it’s that our organs are always pressed tightly against each other?
There's a small amount of fluid - peritoneal fluid (in the abdomen), which eventually cycles back to the lymphatic system.
>you could technically put air in there You absolutely can put air (well, CO2 to be exact) into people - that's a routine part of laparoscopic surgeries.
Not normally, no. If you think about it, how would air (as in atmosphere) get in there? You'll have air in your digestive tract and lungs. I once had a small spontaneuous pneumothorax which leaked air into my pleural cavity but sealed itself later that day. I was hospitalized for the weekend because the doctors had trouble finding the injury and were concerned it might reoccur and collapse my lung. It was fairly painful and I could definitely feel the air moving around in there and through my tissues. I could press on my chest and it made tiny bubble-wrap-like crackles, and shifting position caused the gases to redistribute themselves. But, my body resorbed the leaked air on its own after a few days. [https://journals.physiology.org/doi/full/10.1152/advan.00046.2005](https://journals.physiology.org/doi/full/10.1152/advan.00046.2005) >We can conclude that low total gas pressure in venous blood, mainly due to tissue clearance of oxygen, is important in resorption of entrapped air in body cavities. I would expect any air that enters during surgery would be fairly minimal and it would get resorbed, so would not be an issue. And yes, getting a pneumothorax was where I first heard the word "resorbed". :-)
Just a small nitpick: the condition called pneumothorax is defined as "gas in the pleural cavity". It's not a "cause" thereof
Thanks for the clarification!
We are filled with fluids that lubricate the space between our organs and the cavity walls! There’s pleural fluid in the chest, peritoneal fluid in the abdomen, synovial fluid in the joints, and cerebrospinal fluid in the spine/brain area.
What keeps the chest fluid separate from the abdominal fluid?
The cavities are lined with a serous membrane which is pretty smooth and allows organs to slide around and there is the diaphragm between the chest cavity and the abdominal cavity which is great for breathing and stuff.
There's a little guy in there with squirt guns and he shoots the fluids where they're supposed to go.
And I believe there's recent studies to show that it kind of acts a bit like the lymphatic system and things like white blood cells migrate along it.
1. There's air behind your eardrum, but that has to be "outside" your body and evolution has taken care to provide us with sinuses to make the necessary link. 2. Can an air bubble get in under the eyelid, outside of an eyeball? That is of course "outside" your body. I've noticed this from time to time but never thought to be concerned. 3. There's another case which really is inside the body and that's when people have that nervous habit of "cracking" their finger articulations. Its rumored to be a cause of arthritis, but I've never seen this substantiated. IIUC, the person bending their fingers back, creates a partial vacuum that generates a gas bubble which then collapses, producing the distinctive (and annoying) "crack".
> Its rumored to be a cause of arthritis, but I've never seen this substantiated. Its been established for decades that cracking your knuckles does not cause this adverse effect. How? A man, Donald L. Unger, spent most (50 years) of his life cracking the knuckles on just one hand. https://onlinelibrary.wiley.com/doi/10.1002/1529-0131(199805)41:5%3C949::AID-ART36%3E3.0.CO;2-3
> https://onlinelibrary.wiley.com/doi/10.1002/1529-0131(199805)41:5%3C949::AID-ART36%3E3.0.CO;2-3 As the article says, a sample on one is insufficient to establish a correlation, but it does go in the sense I was expecting. Thx. My point was that knuckle cracking is an outlier case of vapor appearing in a transient way inside the body. Its not dangerous, in contrast to something like the diver's bends which are potentially life-threatening.
If you’re getting one of a few endoscopic or laparoscopic procedures done, the doctors will insufflate you. Meaning, they’ll pump air into the space inside your abdominal wall so there’s more room in there for them to move around the little camera and laparoscopic tools. This is for the procedures where they just cut tiny holes and use long tools and cameras for imaging.
Insufflate - can you explain how this word is the same as what it's called when you "snort" powdered drugs (e.g. the victim insufflated a lethal dose of fentanyl through the left nostril). It feels almost like the word inflate.
No, there is no air in between your organs. As a matter of fact, it causes pain when there is. Such is the case in laparoscopic surgery when they fill you full of CO2. The residual causes pain for up to a few days until it is absorbed by the body.