Respiratory Symptoms Zhao Li, M.D.. Common symptoms Cough Expectoration Hemoptysis Chest pain ...
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Transcript of Respiratory Symptoms Zhao Li, M.D.. Common symptoms Cough Expectoration Hemoptysis Chest pain ...
Respiratory SymptomsRespiratory Symptoms
Zhao Li, M.D.Zhao Li, M.D.
Common symptomsCommon symptoms
Cough Expectoration Hemoptysis Chest pain Cyanosis Dyspnea
Cough Cough ((a protective reflexa protective reflex): ): causescauses
Respiratory diseases___ the most common causes Airway agents
Bronchitis, bronchiectasis, asthma, endobronchial tuberculosis, tumor, pharyngitis
Lung agents Infection, edema, fibrosis, tumor
Pleural agents Pleurisy, pneumothorax, mesothelioma of pleura
Cardiovascular diseases Cardiogenesis edema, pulmonary embolism
Central nervous system agents Initiative cough, encephalitis, meningitis
Cough : Cough : manifestationsmanifestations
Characteristics Dry cough (non-sputum: non-infectious) Productive cough (sputum: infectious, edema)
Attack Time season motivation
Tone Hoarseness High pitch Weak Brassy
Cough: Cough: accompany signsaccompany signs
Fever (infection) Chest pain (infection, tumor, pleurisy, pneumoth
orax, pulmo embolism) Dyspnea Hemoptysis (bronchietasis, tuberculosis, tumor) Bulk pus sputum (bronchietasis, lung abscess) Wheezing (asthma, foreign body) Clubbing fingers (bronchietasis, lung cancer, chr
onic lung abscess)
Sputum: Sputum: amountamount
Bulk frothy sputum Pulmo edema
Bulk serofluid sputum Alveolar carcinoma
Bulk pus sputum Bronchiectasis Lung abscess
Layeringupper: frothy, middle: mucoid or mucopus, lower: necrosis substance
Sputum: Sputum: consistencyconsistency
Mucoid sputum Bronchitis (without bacterial infection) Asthma Early stage of pneumonia
Serofluid sputum Pulmo edema
Pus sputum Any bacterial infection
Bloody sputum
Sputum: Sputum: colorcolor
White mucoid or serofluid sputum
Yellow general bacterial infection
Green aeruginosus Bacillus infection
Grey or black dust inhalation
Rusty Lobar pneumonia
Pink cardiac edema
Red hemoptysis
Grey or black
Sputum: Sputum: foul odorfoul odor
anaerobic bacterium infection
Hemoptysis Hemoptysis
Bleeding from lower respiratory tract
The amount varies from blood-strained sputum to several hun
dreds ml pure blood
Mild: 100ml/d
Moderate: 100-500/d
Severe: >500ml/d, or 100-500/time
Differential diagnosis
Bleeding from upper respiratory tract
Hematemesis
Distinguished hemoptysis from hematDistinguished hemoptysis from hematemesisemesis
Hemoptysis Hematemesis
Causes Pulmo or cardiac digestive system
Previous symptoms Cough, chest tightness Nausea, vomiting
Spit up Cough up Vomited
Color Bright red Dark red
Mixture Sputum, frothy Gastric contents
pH alkality acidity
Tarry stools - or + +
Post-bleeding Sputum with blood No sputum
Hemoptysis: Hemoptysis: causescauses
Bronchial disorders Bronchiectasis Bronchogenic carcinoma endobronchial TB Chronic bronchitis
Pulmo Disorders Pulmo TB Peumonia Lung abscess Pulmo embolism
Cardiovascular disorders Acute left heart failure Mitral stenosis
Others Hematologic disease, leptospirosis (钩端螺旋体病), epidemi
c hemorrhagic fever, endometriosis (子宫内膜异位症)
Hemoptysis: Hemoptysis: accompany signsaccompany signs
Fever Infection or carcinoma
Chest pain Infection , Pulmo Embolism , Carcinoma
Pus sputum Bronchiectasis , Lung abscess
Clubbing fingers Bronchiectasis , Lung abscess , Carcinoma
Hemorrhagic spots Hematologic disease, leptospirosis, epidemic h
emorrhagic fever
Chest pain: Chest pain: causescauses
Chest wall herpes zoster, rib fracture
Cardiovascular angina pectoris, myocardial infarction, pericarditis, dissecting an
eurysm (夹层动脉瘤) Respiratory
Pleural disorders, pneumothorax, carcinoma Mediastinal
Mediastinitis, mediastinal emphysema, mediastinal tumor Others
esophageal carcinoma, liver abscess, subdiaphragmatic abscess, hiatal hernia (食道裂孔疝)
Chest pain: Chest pain: characteristicscharacteristics
location Referred pain Level or feature
Burning pain, pressing pain, bursting pain, pricking pain
Duration Influential factors
Exertional, respiration, foodintake, administration
Chest pain: Chest pain: accompany signsaccompany signs
Cough, sputum and/or fever Respiratory disease
Dyspnea Severe pneumonia, pneumothorax, pleurisy, pulmo embolism
Hemoptysis Carcinoma, pulmo embolism
Shock myocardial infarction, dissecting aneurysm (rupture ), lar
ge area pulmo embolism Dysphagia ( 吞咽困难 )
Esophageal disease
Cyanosis Cyanosis
An excess of desaturated hemoglobin causes a
blue coloration of the skin or mucosae.
methemoglobinemia ( 高铁血红蛋白血症) Poisoning by nitrite (Methylthioninium Chloride iv,
亚甲兰 )
Cyanosis: Cyanosis: classificationclassification
Central (warm) Deficient oxygenation Right-to-left shunt
Peripheral (cold) Reduced cardiac output Local vasoconstriction
Mixed Heart failure
Cyanosis: Cyanosis: accompany signsaccompany signs
Dyspnea Severe cardiac or respiratory disorder
Clubbing fingers Congenital heart disease Chronic respiratory disease
Unconsciousness Poisoning, shock, Severe cardiac or respiratory dis
order
Dyspnea: Dyspnea: causescauses Respiratory system
Obstruction: 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
al cavity Cardiovascular system
Heart failure Pulmo embolism
Poisoning ketoacidosis
Central nervous system cerebral tumor , trauma, abscess, hemorrhage, encephalitis, meningitis
hematological system Severe anemia
Respiratory DyspneaRespiratory Dyspnea Inspiratory dyspnea ____obstruction in large airway
Three depression sign depression in suprasternal fossa, supraclavicular fossa, intercostal spac
e Expiratory dyspnea ____obstruction in small airway or alveolar elasticity decreased
Prolonged expiratory time Expiratory rhonchi
Mixed dyspnea ____deficient gas exchange
Respiratory rate increased Shallow breathing
Cardiac dyspnea ____ Cardiac dyspnea ____ Heart failureHeart failure
Mechanism of left heart failure
Pulmo edema diffusion capacity decreased
Alveolar tension increased stimulating stretch recepto
r excitation of vagus nerve excitation of respirator
y center
Alveolar elasticity decreased vital capacity decreased
Increased pressure of pulmo circulation stimulating
respiratory center
Features of left heart failureFeatures of left heart failure
Underlying diseases
Mixed dyspnea
Position related dyspnea
Moist crackles or rhonchi in both lungs
Relief of symptoms after digitalis, diuretic, vasodila
tor agent used
Nocturnal paroxysmal dyspnea Nocturnal paroxysmal dyspnea
Characteristics
Awoken due to chest tightness or dyspnea
Forced sitting position or orthopnea
Severe sweat
Tachycardia
Moist crackles or rhonchi in both lungs
Pink frothy sputum
Nocturnal paroxysmal dyspneaNocturnal paroxysmal dyspnea
Mechanism Elevated excitation of vagus nerve
Contraction of coronary artery myocardium ischemia
Contraction of bronchiole decreased alveolar ventilation
Vital capacity decreased in supine position
Returned blood volume increased pulmo edema
Sensitivity of respiratory center decreased reaction aft
er obvious hypoxia
Poisoning dyspneaPoisoning dyspnea
Underlying diseases of metabolic acidosis (ure
mia, diabetic ketoacidosis )
deep breathing (Kussmaul breathing)
Dyspnea: Dyspnea: accompany signs (1)accompany signs (1)
Rhonchi Asthma Acute left heart failure (cardiac asthma) Foreign body in large airway Acute laryngeal edema
Chest pain Infection Pneumothorax Pulmo embolism Lung cancer Acute myocardial infarct
Dyspnea: Dyspnea: accompany signs (2)accompany signs (2)
Fever Infection
Cough and sputum COPD Infection Left heart failure
Unconsciousness CNS disorder Uremia diabetic ketoacidosis