Common diseases of the respiratory system

Pneumonia

• Lobar pneumonia– Comlaints

• Pain• Fever – continuous• Cough - sputum

– Inspection• Dyspnea• Cyanosis• Labial herpes• Cough, sputum

Pneumonia

• Palpation– tactile fremitus – increases on the involved

site

• Percussion– relative dull sound

• Auscultation– 1st phase: crepitatio indux– 2nd phase: bronchial breath sound – 3rd phase: crepitatio redux

Pneumonia

• Diagnostics– Radiological investigation– Sputum analysis

• Inspection• Gram’s stain• Microbiological culture• Cytology

Bronchopneumonia

• Complaints– Fever– Cough– Chest pain– Sputum

• Physical examination – much less alterations– Inspection

• In some cases: dyspnea, coughing, sputum

– Palpation - no specific alteration

Bronchopneumonia

• Percussion– Generally without alteration - sometimes

dullness

• Auscultation– Crackles, sometimes crepitation

Lung abscess and gangrena• Complaint

– High fever– Large amount of sputum, triple layered sputum

• Diagnostics– Radiology: „basket” sign, (fluid niveau inside)

Acute bronchitis

• Only the bronchus is ill• Complaint

– Fever– Sore throat, flu-like symptomps– Very painful breathing

• Inspection• Palpation – no specific alteration• Percussion – no specific alteration• Auscultation: breathing : bronchial, expiration prolongs Less and more viscous fluid: wheezing, rhonchi More and less viscous fluid: crackles

Asthma

• Inflammatory disease

• Increased bronchus reactivity

• Paroxysmal, reversible obstructive dyspnea

Asthma

• Increased bronchial reactivity– Bronchospasm – smooth muscle hypertrophy– Mucosal edema– Viscous mucus

Reversible pulmonary obstruction

Asthma

• Complaint– Paroxysmal dyspnea

• Causative factor?

– Cough, sputum• Viscous mucus – Curshmann-spiral – cast of the

bronchus

• Inspection• Exspiratory dyspnea• Cyanosis• Respiratory insufficiency

Asthma bronchiale

• Palpation• Percussion acute emphysema

• Auscultation– Prolonged expiration– Bronchial added sounds: wheezing, rhonchi– In terminal phase: weak, superficial breathing

Asthma

• Diagnostics– Search for the cause: extrinsic asthma - allergen

intrinsic

– Spirometry

Chronic obstructive pulmonary diseases -COPD

• Chr.bronchitis – more than 3-3 month of productive cough during two consecutive years

• Pulmonary emphysema – progressive dilation of the air space distal to the terminal bronchioli

Chronic bronchitis

• Complaints– Productive cough, sputum– Dyspnea– Smoking

• Inspection– Blue bloater– Polyglobulia and/or cyanosis– Emphysematous chest– Dyspnea

Chronic bronchitis

• Palpation – no specific alteration

• Percussion – hyperresonance

• Auscultation– Bronchial breath sound, increased exspiration– Bronchial added sounds: wheezing, rhonchi

Chronic bronchitis

• Diagnostics– Spirometry– Sputum examination– Radiology

Emphysema

• Complaints– Dyspnea– Cough less, mucoid sputum– Smoking

• Inspection– Pink puffer– Emphysematous chest - barrel chest

• Anteroposterior diameter increases• Increasing of the distance between interspaces• Ribs are going horizontally• Depressed diaphragm• Costal angle more than 90°

Emphysema

• Palpation – without specific alteration

• Percussion – hyperresonance

• Auscultation – weak breath sounds

Lung cancer

• Complaints– Symptomless for a long time– Smoking– Chronic cough– Hemoptysis– General tumor signs

• Physical investigation – generally no alteration– Possible cause of recidive pneumonias– Possible cause of pleural effusion

Lung cancer

• Diagnostics– Radiology X-ray – – CT – spiral CT– Sputum cytology– Bronchoscopy

• Biopsy• Cytology

– Searching for metastases

Pleural effusion

• Complaint– Dyspnea

• Inspection– Chest movement decreases on the affected site

• Palpation– Tactile fremitus – decreases on the affected site

• Percussion – absolute dull• Auscultation – weak breath sounds above the

dullness

Pleural effusion

• Diagnostics– Radiology (X-ray and ultrasound)

Pleural effusion

– Thoracocentesis• Transsudate low protein content < 30g/l

low SG < 1015

cause: right side heart failure• Exsudate high protein content > 30 g/l

high SG > 1015

cause: inflammation, cancer

– Cytology

Thickening of the pleura

• Cause: chr. inflammation – callus

tumor

• Inspection:retractio thoracis

decreased chest movements

• Palpation: tactile fremitus – decreases

• Percussion: absolute dullness

• Auscultation: weak breath sounds

Pneumothorax

• Cause a. external - injury, punction b. internal – from the alveoli (rupture)

• Types– Closed ptx.– Open ptx– Ventil ptx.

Pneumothorax

• Complaints– Sudden onset, very sharp pain– Dyspnea– Collapse

• Inspection: - decreased chest movements

• Palpation: - tactile fremitus decreases

• Percussion: – tympany

• Auscultation: – weak or no breath sounds

Pleuritis

• Complaints– Sharp pain during breathing– Shallow breathing, sometimes dyspnea

• Types– Pleuritis sicca Auscultation: pleural

friction rub– Exsudative pleuritis - signs of pleural effusion

Pulmonary embolism

• Complaint – depends on the occluded vessel– Total - sudden death– Subtotal – sudden death

- shock

– serious dyspnea

– Partial - chest pain, dyspnea, cyanosis,

hemoptysis– Microembolism - chest pain, dyspnea, cyanosis,

hemoptysis

Pulmonary embolism

• In the history– Deep wein thrombosis– Immobilisation– Surgical intervention– Malignancy– Atrial fibrillation

Pulmonary embolism

• Diagnostics– Radiology – CT-angiography– Lung scintigraphy– Angiography

Pulmonary edema

• A sign of the left heart failure

• Complaint– Dyspnea– Foamy, transparent sputum

• Inspection– Dyspnea

• Auscultation - crackles