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1、,RESPIRATORY SYPTOMS,Symptoms of Respiratory Diseases,Cough and Sputum,Cough,Cough is a deep inspiration followed by a strong expiration against a closed glottis,which then opens with an expulsive flow of air,followed by a restorative inspiration;these are the inspiratory,compressive,expulsive(expir
2、atory or explosive),and recovery phases of cough,The stimuli that can elicit a cough,inhaled particles,Mucus on the lining of the airways,Inflammatory exudate in airways or parenchyma,a new growth or foreign body in an airway,pressure on the external wall of the bronchus.,COUGH,It is a protective re
3、flex which removes secretions or inhaled solid material,provoked by physical or chemical stimulation of irritant receptors in the larynx,trachea or bronchial tree.,Classification,Acute 8wksdry or productive(sputum production),Cough(a protective reflex):causes,Respiratory diseases_ the most common ca
4、usesAirway agentsBronchitis,bronchiectasis,asthma,endobronchial tuberculosis,tumor,pharyngitisLung agentsInfection,edema,fibrosis,tumorPleural agentsPleurisy,pneumothorax,mesothelioma of pleuraCardiovascular diseasesCardiogenesis edema,pulmonary embolism Central nervous system agentsInitiative cough
5、,encephalitis,meningitis,Cough:accompany signs,Fever(infection)Chest pain(infection,tumor,pleurisy,pneumothorax,pulmo embolism)Dyspnea Hemoptysis(bronchietasis,tuberculosis,tumor)Bulk pus sputum(bronchietasis,lung abscess)Wheezing(asthma,foreign body)Clubbing fingers(bronchietasis,lung cancer,chroni
6、c lung abscess),Sputum:consistency,Mucoid sputumBronchitis(without bacterial infection)AsthmaEarly stage of pneumoniaSerous sputumPulmo edemaPus sputumAny bacterial infection Bloody sputum,Cough rhythm咳嗽的节律,Tone Quality咳嗽的音色,Character of Cough,(sputum:Quantity,traits)痰量及性状,Sputum:Color,SYMPTOMS AND
7、SIGNS-sputum,Color,quantity,consistency and unusual odorColorless and transparent:mild inflammation and normalProductive and purulent-bacterial infection as bronchitis pneumonia,lung abscess,bronchiectasisBlood streaked-cancer,tuberculosis,lung infarctionBlood foamy-congestive heart failureRust-colo
8、red pneumococal pneumoniaLarge quantity-lung abscess,bronchiectasis,lung cancerPurulent with foul odor-streptococcus and anaerobe in lung abscess,Acute Cough,Viral infectionsRhinoviruses,coronaviruses,and respiratory syncytial virus influenza,parainfluenza,and adenovirusesAllergic rhinitisExacerbati
9、ons of COPDStreptococcus pneumoniae,Haemophilus influenzae,and Moraxella catarrhalisBordetella pertussis infection,Chronic Cough,Upper airway cough syndrome(Postnasal drip)AsthmaGastroesophageal reflux(GERD)Eosinophilic bronchitisACE inhibitorsChronic bronchitisBronchiectasisInterstitial Lung Diseas
10、eLung CancerCongestive Heart FailurePsychogenic Cough,Complications of cough,pain from intercostal muscle straincough fracturecough syncopecough-induced incontinencepneumothorax,pneumomediastinium,Haemoptysis,SYMPTOMS AND SIGNS-haemoptysis,The cough up of blood is termed haemoptysisBlood tinged sput
11、um to pure bloodDifferentiation:upper airway,upper gastrointestinal tract(hematemesis-vomiting blood)Haemoptysisblood is bright red mixed with frothy sputum,alkalineHematemesisdark,acidic,food particle,Bronchial circulation massivePulmonary circulation airways Pulmonary parenchyma.Vascular disorders
12、,Origin and disorders,Hemoptysis,Bleeding from lower respiratory tractThe amount varies from blood-strained sputum to several hundreds ml pure bloodMild:100ml/dModerate:100-500/dSevere:500ml/d,or 100-500/timeDifferential diagnosisBleeding from upper respiratory tractHematemesis,Distinguished hemopty
13、sis from hematemesis,Common Causes,Accompany Signs,SYMPTOMS AND SIGNS-haemoptysis,Tuberculosis,bronchiectasis,lung cancerParallel symptoms-intermittent,purulentbronchiectasisParallel symptoms-older,long history of smoking,chest painlung cancerParallel symptoms-sudden onset,chest pain,dyspneapulmonar
14、y embolismParallel symptoms-menstration cycleendometriosisParallel symptoms-oliguriaGoodpaster syndrome Parallel symptoms-epidemiological historyparasite infection,Some Common Causes of Hemoptysis,InfectionsBronchitisTuberculosisFungal infectionsPneumoniaLung abscessBronchiectasis,NeoplasmsBronchoge
15、nic carcinomaBronchial adenomaCardiovascular disordersPulmonary infarction from thromboembolismMitral stenosis,TraumaForeign bodyHematologic/immunologicBlood dyscrasiaGoodpastures syndrome,DIFFERENTIAL DIAGNOSIS,Tracheobronchial sourceNeoplasm(bronchogenic carcinoma,endobronchialmetastatic tumor,Kap
16、osis sarcoma,bronchialcarcinoid)Bronchitis(acute or chronic)BronchiectasisBroncholithiasisAirway traumaForeign body,Pulmonary parenchymal sourceLung abscessPneumoniaTuberculosisMycetoma(“fungus ball”)Goodpastures syndromeIdiopathic pulmonary hemosiderosisWegeners granulomatosisLupus pneumonitisLung
17、contusion,Primary vascular sourceArteriovenous malformationPulmonary embolismElevated pulmonary venous pressure(especiallymitral stenosis)Pulmonary artery rupture secondary to balloon-tippulmonary artery catheter manipulation,Miscellaneous and rare causesPulmonary endometriosis(catamenial hemoptysis
18、)Systemic coagulopathy or use of anticoagulants orthrombolytic agents,Neoplasm,40-60 ageLong history of smokingTroublesome cough and chest pain that precede and acompany hemoptysis,Infection,Staphylococcusrusty-looking,grossly bloodStaphylococcusblood mixed with pusKlebsiellacurrant jellyBrisk(浓味道)b
19、leedingblood mixed with copious amount of foul-smelling pus,2023/3/22,32,Investigation,Chest Pain,SYMPTOMS AND SIGNSchest pain,Pleuritis,lung infection,lung tumor,lung infarction are the major causes.Pleuritic chest painrespirationSudden onset with dyspnae pneomothorax,lung infarctionSuperficial pai
20、n of chest wallintercostal neuropathy,viral infectionPericardial and poststernal-myocardial infarction-substernal pressure,constriction,or squeezing,neck or both arms.,Pleuritic PainPulmonary PainChestWall PainCardiac Pain,Common Causes,Chest wall painPersistent cough or breathlessnessMuscular strai
21、nsIntercostal myositisThoracic herpes zosterCoxsackie B infectionThoracic disc lesion or nerve compressionIntercostal nerve compression or infiltrationRib fractureRib tumour:primary or metastaticTietzes syndromeSlipping rib syndrome,Pleural painInfective pleurisyPneumothoraxAutoimmune diseaseAsbesto
22、s pleural fibrosisMesotheliomaMetastatic tumourAirway painTracheitisInhalation of irritant gasIntubationCentral bronchial carcinoma,Mediastinal painCardiac ischaemia/infarctionMassive pulmonary embolismOesophagitisPericarditisSarcoid adenopathyLymphomaMediastinitisAortic dissectionAortic aneurysm,Cl
23、inical Manifestation,Accompanied Signs,2023/3/22,40,Assistant Examiantion,Dspnea or Breathlessness,SYMPTOMS AND SIGNSdyspnea,Medical term for breathlessness or shortness of breath caused by air hunger with accessory respiratory muscle joining in respiration.This term is used to designate a variety o
24、f sensations that range from an awareness of breathing to respiratory distressChanges in respiratory rate and rhythmKussmaul breathing-acidosisCheyne-Stroke respiration(Tidal breathing)-Unchanged-hypercapnia,narcotics,Psychogenic,SOME DESCRIPTIONS AND PATHOPHYSIOLOGIC MECHANISMS OF SHORTNESS OF BREA
25、TH,DYSPNEA PATHOPHYSIOLOGY,SYMPTOMS AND SIGNSdyspnea,Acute,chronic and recurrentLung infarctionacute with chest painNocturnal orthoradox dyspneacongestive heart failure and asthmaProgressive(a few wks to months)pleural effusionChronic progressive interstitial lung disease Rucurrent and seasonalasthm
26、aInspirationallarge airway obstructionExpiratory distal airway as asthma,bronchitis,Respiratory causes of breathlessness,the airways-airflow obstruction;the lung parenchyma-progressive type of breathlessness with a restrictive pattern of lung function.the pulmonary circulation-progressive dyspnoea o
27、ften with very severe exercise limitation the pleura-The chest wall.,Some causes of breathlessness.,Airways diseaseChronic bronchiolitis and emphysemaAsthmaBronchiectasis and cystic fibrosisLaryngeal or pharyngeal tumourBilateral cord palsyCricoarytenoid rheumatoidTracheal obstructionTracheomalaciaA
28、myloid of airways,Parenchymal diseaseAllergic alveolitisSarcoidosisFibroses and diffuse alveolitisObliterative bronchiolitisPneumonias and toxic pneumonitisDiffuse infectionsRespiratory distress syndromeInfiltrative and metastatic tumourPneumothorax,Pulmonary circulationPulmonary embolism and hypert
29、ensionPulmonary arteritis and thrombosisChest wall and pleuraEffusion or pleural fibrosisFractured ribsAnkylosing spondylitisKyphoscoliosisNeuromuscular,bilateral diaphragm paralysis,Some causes of breathlessness.,CardiacLeft ventricular failureMitral valve diseaseCardiomyopathyPericardial effusion
30、or constriction,Non-cardiorespiratoryPsychogenicAnaemiaHaemorrhageAcidosisHypothalamic lesions,Causes of Acute and Chronic Dyspnea,AcutePulmonary edemaAsthmaInjury to chest wall and intrathoracic structuresSpontaneous pneumothoraxPulmonary embolismPneumoniaAdult respiratory distress syndromePleural
31、effusionPulmonary hemorrhage,Chronic,progressiveChronic obstructive pulmonary diseaseLeft ventricular failureDiffuse interstitial fibrosisAsthmaPleural effusionsPulmonary thromboembolic diseasePulmonary vascular diseasePsychogenic dyspneaAnemia,severePostintubation tracheal stenosisHypersensitivity
32、disorders,Dyspnea:causes,Respiratory systemObstruction:asthma,COPD,tumor Pulmo Diseases:pneumonia,interstitial lung disease,Chest wall or pleura:pleurisy,pneumothorax,trauma neuro-muscles:poliomyelitis(脊髓灰质炎),myasthenia gravis(重症肌无力)Diaphragma movement disorder:obviously elevated pressure in abdomin
33、al cavity Cardiovascular systemHeart failurePulmo embolism PoisoningketoacidosisCentral nervous systemcerebral tumor,trauma,abscess,hemorrhage,encephalitis,meningitis hematological system Severe anemia,Respiratory Dyspnea,Inspiratory dyspnea _obstruction in large airway Three depression sign depress
34、ion in suprasternal fossa,supraclavicular fossa,intercostal spaceExpiratory dyspnea _obstruction in small airway or alveolar elasticity decreased Prolonged expiratory timeExpiratory rhonchiMixed dyspnea _deficient gas exchange Respiratory rate increasedShallow breathing,Features of left heart failur
35、e,Underlying diseases Mixed dyspnea Position related dyspnea Moist crackles or rhonchi in both lungs Relief of symptoms after digitalis,diuretic,vasodilator agent used,Nocturnal paroxysmal dyspnea,Characteristics Awoken due to chest tightness or dyspneaForced sitting position or orthopnea Severe swe
36、at Tachycardia Moist crackles or rhonchi in both lungs Pink frothy sputum,Poisoning dyspnea,Underlying diseases of metabolic acidosis(uremia,diabetic ketoacidosis)deep breathing(Kussmaul breathing),Dyspnea:accompany signs(1),RhonchiAsthma Acute left heart failure(cardiac asthma)Foreign body in large
37、 airwayAcute laryngeal edema Chest pain InfectionPneumothoraxPulmo embolismLung cancerAcute myocardial infarct,Dyspnea:accompany signs(2),FeverInfectionCough and sputum COPDInfectionLeft heart failureUnconsciousness CNS disorderUremiadiabetic ketoacidosis,Cyanosis,Cyanosis refers to a bluish color o
38、f the skin and mucous membranes resulting from an increased quantity of reduced hemoglobin or of hemoglobin derivatives in the small blood vessels of those areas.It is usually most marked in the lips,nail beds,ears,and malar eminences.,an increase in the quantity of venous blood as a result of dilat
39、ion of the venules and venous ends of the capillaries orby a reduction in the SaO2 in the capillary blood.,Central CyanosisPeripheral Cyanosis,Cyanosis in Pulmonary DiseaseCyanosis Due to Venous AdmixtureCyanosis Due to Abnormal Pigments in Blood,Decreased arterial oxygen saturation,Decreased atmosp
40、heric pressurehigh altitudeImpaired pulmonary functionAlveolar hypoventilationUneven relationships between pulmonary ventilationand perfusion(perfusion of hypoventilated alveoli)Impaired oxygen diffusionAnatomic shuntsCertain types of congenital heart diseasePulmonary arteriovenous fistulasMultiple small intrapulmonary shuntsHemoglobin with low affinity for oxygen,Central Cyanosis,Decreased arterial oxygen saturation:respiratory;cardiacHemoglobin abnormalities,Peripheral Cyanosis,Cold exposureRedistribution of blood flow from extremitiesArterial obstructionVenous obstruction,
