Transcript respiratory_sustem

Sympoms in diseases
of respiratory organs
based on the results of
inquiry of a patient,
palpation and
percussion of a chest
The most typical complaints of the
patient with respiratory pathology
dyspnoea
cough
bloody expectorations
pain in the chest
Fever, asthenia, sweating
Dyspnoea can be subjective, objective, or
mixed.
Subjective dyspnoea is the subjective feeling of
difficult or laboured breathing (in hysteria,
thoracic radiculitis)
Objective dyspnoea is determined by objective
examination and is characterized by changes in the
respiration rate, depth, or rhythm, and also the
duration of the inspiration or expiration (in
pulmonary emphysema or pleural obliteration).
Mixed dyspnoea (i.e. subjective and objective).
Inspiratory dyspnoea - inspiration become
difficult (mechanical obstruction in the upper
respiratory ducts)
Expiratory dyspnoea - expiration become
difficult (narrowed lumen in the fine bronchi
and bronchioles due to inflammatory oedema
and swelling of their mucosa, or else in spasms
in the smooth muscles)
Mixed dyspnoea both expiration and inspiration
become difficult (most respiratory pathology)
Physiological dyspnoea is caused by heavy
exercise
Pathological dyspnoea is associated with
pathology of the respiratory organs,
diseases of the cardiovascular and
haemopoietic systems, and poisoning).
Paroxysmal attacks of dyspnoea are called asthma.
Cough is a complicated reflex
act which is actually a defence
reaction aimed at clearing the
larynx, trachea, or bronchi from
mucus or foreign material.
Cough may be dry, without sputum, and
moist whith expectoration of sputum
Dry cough – laryngitis, dry pleurisy or
compression of the main bronchi by the
lymph nodes.
Moist - bronchitis, pulmonary tuberculosis,
abscess, bronchiectatic disease, pneumoia,
lung cancer.
Morning cough is characteristic of patients
with chronic bronchitis, bronchiectasis, lung
abscess, and cavernous tuberculosis of the
lungs.
The sputum accumulates during the night sleep
in the lungs and the bronchi, but as the patient
gets up, the sputum moves to the neighbouring
parts of the bronchi to stimulate the
reflexogenic zones of the bronchial mucosa.
This causes cough and expectoration of the
sputum.
"Night" cough is characteristic of tuberculosis,
lymphogranulomatosis, or cancer. Enlarged
mediastinal lymph nodes in these diseases
stimulate the reflexogenic zone of the
bifurcation, especially during night when the
tone of the vagus nerve increases, to produce
the coughing reflex.
Cough may be permanent and
periodic.
Permanent cough is rarer and
occurs in laryngitis, bronchitis,
cancer of the lungs, and in certain
forms of pulmonary tuberculosis.
Periodic cough occurs more
frequently.
Haemoptysis is expectoration of
blood with sputum during cough.
Pulmonary tuberculosis and cancer,
virus pneumonia, bronchiectasis,
abscess and gangrene of the lung,
thrombosis or embolism of the
pulmonary arteries.
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Degrees of haemoptysis:
blood streaks in sputum
diffuse bloody colouration to the sputum, which can be
jelly-like or foamy.
lung haemorrhage (cavernous tuberculosis,
bronchiectases, degrading tumor and pulmonary
infarction
Blood expectorated with sputum can be fresh (scarlet) or altered.
Scarlet (fresh) blood in the sputum is characteristic of pulmonary
tuberculosis, lung bleeding, cancer of the lung, bronchiectasis.
Altered blood: in acute lobar pneumonia (second stage) has the
colour of rust (rusty sputum) due to decomposition of the red
blood cells and formation of the pigment haemosiderin.
Pain in the chest
is classified by its location (upper, medial
or lower parts of a chest), origin (heart,
lungs, pleura), character (dull, acute,
stubbing, pressing), intensity, duration, and
irradiation.
 Pleural pain is connected with the
respiratory movements and cough.
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Pain in the chest may be
caused by affection of
pleura, the chest wall
(trauma, neuralgia) and
heart.
Objective examination of the patients with
respiratory pathology.
Inspection – position of a patient, consciousness, skin,
configuration of the chest (position of the clavicles,
supra- and subclavicular fossae, shoulder blades), type,
rhythm and frequency of breathing, involvement of the
accessory respiratory muscles in the breathing act.
Palpation – vocal fremitus, pain, resistance of the chest.
Percussion – comparative and topographic.
Auscultation – main and adventitious respiratory sounds.
The shape of the chest may be normal or
pathological.
A normal chest may be asthenic, normosthenia
and hypersthenic.
Pathological shape of the chest may be the result of
congenital bone defects and of various chronic
diseases (emphysema of the lungs, rickets,
tuberculosis).
Normal form of the chest.
1. Normosthenic (conical) chest resembles a
truncated cone. The anteroposterior (sterno
vertebral) diameter of the chest is smaller than
the lateral (transverse) one, and the
supraclavicular fossae are slightly pronounced.
Тhe epigastric angle nears 90°. The ribs are
moderately inclined as viewed from the side; the
shoulder blades closely fit to the chest and are at
the same level; the chest is about the same
height as the abdominal part of the trunk.
2. Hypersthenic chest has the shape of a cylinder.
The anteroposterior diameter is about the
same as the transverse one; the supraclavicular
fossae are absent (level with the chest). The
epigastric angle exceeds 90°; the ribs in the
lateral parts of the chest are nearly horizontal,
the intercostal space is narrow, the shoulder
blades closely fit to the chest, the thoracic part
of the trunk is smaller than the abdominal
one.
3. Asthenic chest is elongated, narrow
(both the anteroposterior and
transverse diameters are smaller
than normal); the chest is flat. The
supra- and subclavicular fossae are
distinctly pronounced. The
epigastric angle is less than 90°.
The ribs are more vertical at the
sides; the intercostal spaces are
wide, the shoulder blades are
winged (separated from the chest),
the muscles of the shoulder girdle
are underdeveloped, the chest is
longer than the abdominal part of
the trunk.
Pathological chest.
1. Emphysematous (barrel-like) chest resembles a
hypersthenic chest in its shape, but has a barrellike configuration, the intercostal spaces are
enlarged. Active participation of accessory
respiratory muscles in the respiratory act
(especially m. sternocleidomastoideus and m.
trapezius).
This type of chest is found in chronic emphysema
of the lungs.
2. Paralytic chest resembles the asthenic chest.
Marked atrophy of the chest muscles and
asymmetry of the clavicles and dissimilar
depression of the supraclavicular fossae can be
observed. The shoulder blades are not at one
level either, and their movements during
breathing are asynchronous.
It is found in emaciated patients, in general
asthenia and constitutional underdevelopment; it
often occurs in grave chronic diseases, more
commonly in pulmonary tuberculosis and
pneumosclerosis.
3. Rachitic chest (keeled or pigeon chest). It is
characterized by a markedly greater
anterioposterior diameter (compared with the
transverse diameter) due to the prominence of
the sternum (which resembles the keel of a
boat.) The anterolateral surfaces of the chest
are as if pressed on both sides and therefore
the ribs meet at an acute angle at the sternal
bone, while the costal cartilages thicken like
beads at points of their transition to bones
(rachitic beads).
4. Funnel chest has a funnel-shaped
depression in the lower part of the
sternum. This deformity can be
regarded as a result of abnormal
development of the sternum or
prolonged compressing effect. In
older times this chest would be
found in shoemaker adolescents.
5. Foveated chest is almost the same as
the funnel chest except that the
depression is found mostly in the
upper and the middle parts of the
anterior surface of the chest. This
abnormality occurs in
syringomyelia, a rare disease of the
spinal cord.
The shape of the chest can readily change due
to enlargement or diminution of one half of the
chest (asymmetry of the chest). These changes
can be transient or permanent.
The enlargement of the volume of one half of
the chest can be due to escape of considerable
amounts of fluid as the result of accumulation
of fluid in the pleural cavity, or due to
penetration of air inside the chest in injuries
(pneumothorax).
Respiratory movements of the
chest should be examined during
inspection of the patient. During
examinaion a doctor puts one hand
on patient’s pulse and other hand
on patient’s chest and calculate
respiratory rate (to take patient
aware of the procedure).
The type, frequency,
depth and rhythm of
respiration can be
determined by
carefully observing
the chest and the
abdomen. Respiration
can be costal (thoracic),
abdominal, or mixed type.
Thoracic (costal) respiratio. Respiratory
movements are carried out mainly by the
contraction of the intercostal muscles. This type
of breathing is known as costal and is mostly
characteristic of women.
Abdominal respiration. Breathing is mainly
accomplished by the diaphragmatic muscles.
This type of respiration is also called
diaphragmatic and is mostly characteristic of
men.
Respiration rate in norm is within
16-20 breathing movements a min.
It is increased in dyspnea and rises
in the case of inhibition of
respiratory center.
Palpation of the chest
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1. Vocal fremitus. A doctor puts his palms on
the symmetrical parts of patient’s chest and asks
him to say wards with letter “R”. Vocal fremitus
must be of equal intensity on symmetrical points
of the chest.
Resistance of the chest. A doctor presses the
chest in lateral and anerior-posterior directions.
Pain
Percussion o the chest
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You must know topographic lines on the chest.
Comparative percussion
Topographic percussion (lower lung borders,
respiratory mobility of the lower lung border,
high of lungs apexes and width of Kroenig’s
area)