呼吸系统PPT课件：呼吸症状学.ppt

1、RESPIRATORY SYPTOMSSymptoms of Respiratory DiseasesCough and SputumCough 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 (exp

2、iratory 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 protect

3、ive reflex 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 8wks dry or productive (sputum production)Cough (a protective reflex): causes Respiratory diseases_ the most

4、 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

5、system agents Initiative cough, 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

6、) Clubbing fingers (bronchietasis, lung cancer, chronic lung abscess) Sputum: consistency Mucoid sputum Bronchitis (without bacterial infection) Asthma Early stage of pneumonia Serous sputum Pulmo edema Pus sputum Any bacterial infection Bloody sputumCough rhythm咳嗽的节律咳嗽的节律 急性咽喉炎、异物、百日咳、急性咽喉炎、异物、百日咳、

7、哮喘、支气管内膜结核等哮喘、支气管内膜结核等Paroxysm发作性咳嗽发作性咳嗽 慢支、支扩、肺脓肿、肺结慢支、支扩、肺脓肿、肺结核等核等Chronic慢性咳嗽慢性咳嗽Tone Quality咳嗽的音色咳嗽的音色 声带炎、喉结核、喉癌、喉返神经麻声带炎、喉结核、喉癌、喉返神经麻痹等痹等Hoarseness嘶嘶哑哑 纵隔肿瘤、主动脉瘤、支气管癌等压纵隔肿瘤、主动脉瘤、支气管癌等压迫气管迫气管Brassy 金金属音调属音调 百日咳，会咽、喉部疾患及气管受压百日咳，会咽、喉部疾患及气管受压High pitch 鸡鸡鸣样咳嗽鸣样咳嗽 极度衰弱、严重肺气肿、声带麻痹等极度衰弱、严重肺气肿、声带麻痹等We

8、ak 低低微或无声微或无声Character of Cough Non-sputumDry cough Sputum: infectious, edemaProductive cough(sputum :Quantity, traits)痰量及性状痰量及性状 多：肺泡细胞癌多：肺泡细胞癌 (alveolar cell carcinoma) 少少: 量量quantity 粘：真菌粘：真菌(fungi) 臭：厌氧臭：厌氧(Anaerobic bacteria) 韧：纤维性支气管炎韧：纤维性支气管炎性状性状traitsSputum: Color Mucoid or serofluid sputumW

9、hite General bacterial infectionYellow Aeruginosus -bacillus infectionGreen Dust inhalationGrey or black Lobar pneumoniaRusty Cardiac edemaPink HemoptysisRedSYMPTOMS AND SIGNS-sputum Color, quantity, consistency and unusual odor Colorless and transparent: mild inflammation and normal Productive and

10、purulent-bacterial infection as bronchitis pneumonia, lung abscess, bronchiectasis Blood streaked- cancer, tuberculosis, lung infarction Blood foamy- congestive heart failure Rust-colored pneumococal pneumonia Large quantity- lung abscess, bronchiectasis,lung cancer Purulent with foul odor- streptoc

11、occus and anaerobe in lung abscessAcute CoughViral infections Rhinoviruses, coronaviruses, and respiratory syncytial virus influenza, parainfluenza, and adenovirusesAllergic rhinitisExacerbations of COPD Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalisBordetella pertussis

12、infectionChronic Cough Upper airway cough syndrome(Postnasal drip ) Asthma Gastroesophageal reflux (GERD) Eosinophilic bronchitis ACE inhibitors Chronic bronchitis Bronchiectasis Interstitial Lung Disease Lung Cancer Congestive Heart Failure Psychogenic CoughComplications of cough pain from intercos

13、tal muscle strain cough fracture cough syncope cough-induced incontinence pneumothorax,pneumomediastiniumHaemoptysisSYMPTOMS AND SIGNS-haemoptysis The cough up of blood is termed haemoptysis Blood tinged sputum to pure bloodDifferentiation: upper airway, upper gastrointestinal tract(hematemesis-vomi

14、ting blood) Haemoptysisblood is bright red mixed with frothy sputum, alkaline Hematemesisdark, acidic, food particle Bronchial circulation massive Pulmonary circulation airways Pulmonary parenchyma. Vascular disordersOrigin and disordersHemoptysis Bleeding from lower respiratory tractThe amount vari

15、es from blood-strained sputum to several hundreds ml pure blood Mild: 100ml/d Moderate: 100-500/d Severe: 500ml/d, or 100-500/timeDifferential diagnosis Bleeding from upper respiratory tract HematemesisDistinguished hemoptysis from hematemesisHemoptysis Hematemesis Causes Lung/heartdigestive systemP

16、revious symptomsCough, chest tightnessNausea, vomitingSpit upCough upVomited Color Bright red Dark redMixture Sputum, frothy Gastric contents pH alkality acidity Tarry stools - or +Post-bleedingSputum with bloodNo sputumCommon CausesBronchial DisordersBronchiectasisBronchogenic carcinomaEndobronchia

17、l TBChronic BronchitisPulmo DiscordersPulmo TBPeumoniaLung abscessPulmo embolismTumorOthersHematologic disease,), leptospirosis (钩钩端螺旋体病端螺旋体病Epidemic Hemorrhagic fever, endometriosisCardiovascular DisordersAcute left heart failureMitral stenosis:capillaries,veinsPulmonary hypertensionPul embolismAcc

18、ompany SignsFeverInfectionChest painInfectionPulmo embolismCarcinomaPus sputumBronchie-ctasisLung abscessClubbing fingersBronchi-ectasisLung abscessCarcinomaHemorrha-gic spotsHematologic diseaseLeptospirosisEpidemic Hemorrhagic feverJaundicepneumoniaLeptospiro-sis (钩端螺钩端螺旋体病旋体病Pulmo infarctSYMPTOMS

19、AND SIGNS-haemoptysis Tuberculosis, bronchiectasis, lung cancer Parallel symptoms- intermittent, purulentbronchiectasis Parallel symptoms-older, long history of smoking, chest painlung cancer Parallel symptoms- sudden onset, chest pain, dyspneapulmonary embolism Parallel symptoms- menstration cyclee

20、ndometriosis Parallel symptoms- oliguriaGoodpaster syndrome Parallel symptoms-epidemiological historyparasite infectionSome Common Causes of Hemoptysis Infections Bronchitis Tuberculosis Fungal infections Pneumonia Lung abscess Bronchiectasis Neoplasms Bronchogenic carcinoma Bronchial adenoma Cardio

21、vascular disorders Pulmonary infarction from thromboembolism Mitral stenosis Trauma Foreign body Hematologic/immunologic Blood dyscrasia Goodpastures syndromeDIFFERENTIAL DIAGNOSIS Tracheobronchial sourceNeoplasm (bronchogenic carcinoma, endobronchialmetastatic tumor, Kaposis sarcoma, bronchialcarci

22、noid)Bronchitis (acute or chronic)BronchiectasisBroncholithiasisAirway traumaForeign bodyPulmonary parenchymal sourceLung abscessPneumoniaTuberculosisMycetoma (“fungus ball”)Goodpastures syndromeIdiopathic pulmonary hemosiderosisWegeners granulomatosisLupus pneumonitisLung contusionPrimary vascular

23、sourceArteriovenous malformationPulmonary embolismElevated pulmonary venous pressure (especiallymitral stenosis)Pulmonary artery rupture secondary to balloon-tippulmonary artery catheter manipulationMiscellaneous and rare causesPulmonary endometriosis (catamenial hemoptysis)Systemic coagulopathy or

24、use of anticoagulants orthrombolytic agentsNeoplasm 40-60 age Long history of smoking Troublesome cough and chest pain that precede and acompany hemoptysisInfection Staphylococcusrusty-looking, grossly blood Staphylococcusblood mixed with pus Klebsiellacurrant jelly Brisk(浓味道) bleedingblood mixed wi

25、th copious amount of foul-smelling pus2022-4-1232Investigation If coughed out or vomitted out文本】 Age,sex,colour Volume: how much Time duration Any accompanied appearancesChest PainSYMPTOMS AND SIGNSchest pain Pleuritis, lung infection, lung tumor, lung infarction are the major causes. Pleuritic ches

26、t painrespiration Sudden onset with dyspnae pneomothorax, lung infarction Superficial pain of chest wallintercostal neuropathy, viral infection Pericardial and poststernal- myocardial infarction-substernal pressure, constriction, or squeezing , neck or both arms. Pleuritic Pain Pulmonary Pain ChestW

27、all Pain Cardiac PainCommon CausesChest wallHerpes zosterRib fractureCardiovas-cularAngina (心绞痛） Myocardial infarctionPericarditisDissecting aneurysmRespirato-ryPleural disordersPneumotho-raxCarcinomaPneumoniaMediastin-alMediastinitisMediastinal emphysemaMediastinal tumorEsophageal lesionsHiatal her

28、nia (食管裂孔疝OthersLiver carcinomaLiver abscessSubdiaph-ragmatic absessSpleen infartChest wall painPersistent cough or breathlessnessMuscular strainsIntercostal myositisThoracic herpes zosterCoxsackie B infectionThoracic disc lesion or nerve compressionIntercostal nerve compression or infiltrationRib f

29、ractureRib tumour: primary or metastaticTietzes syndromeSlipping rib syndromePleural painInfective pleurisyPneumothoraxAutoimmune diseaseAsbestos pleural fibrosisMesotheliomaMetastatic tumourAirway painTracheitisInhalation of irritant gasIntubationCentral bronchial carcinomaMediastinal pain Cardiac

30、ischaemia/infarction Massive pulmonary embolism Oesophagitis Pericarditis Sarcoid adenopathy Lymphoma Mediastinitis Aortic dissection Aortic aneurysmClinical ManifestationAgeThe youngThe oldCharacteristicsBurning painPressing painBursting painPricking painDurationParoxysmPersistenceInfluential facto

31、rsExerciseRespirationFood intakeAdministration(response to trentment)Accompanied SignsCough, sputum and/ or feverRespiratory diseaseDyspneaSevere pneumoniaPneumotho-raxpleurisyPulmo- embolismHemoptysisCarcinomaPulmo -embolismPneumoniaShockMyocarial infarctionDissecting aneurysm (rupture)Large area p

32、ulmo -embolismEating related(Dysphagia)Esophageal disease2022-4-1240Assistant Examiantion Careful physical examming Serum D-dimer Serum Creatine Kinase, CK-MB, Cardiac Troponin I Arterial blood gas Electrocardiogram Chest Radiology: X-Ray, CT-scanDspnea or BreathlessnessSYMPTOMS AND SIGNSdyspneaMedi

33、cal 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 of sensations that range from an awareness of breathing to respiratory distressChanges in respiratory rate and rhythmKussmaul brea

34、thing-acidosisCheyne-Stroke respiration (Tidal breathing)-Unchanged-hypercapnia, narcotics,Psychogenic SOME DESCRIPTIONS AND PATHOPHYSIOLOGIC MECHANISMS OF SHORTNESS OF BREATHDESCRIPTORPATHOPHYSIOLOGYChest tightness or constrictionBronchoconstriction, interstitial edema (asthma, myocardial ischemia)

35、Increased work or effort of breathingAirway obstruction, neuromuscular disease (COPD, moderate to severe asthma, myopathy, kyphoscoliosis)Air hunger, need to breathe, Increased drive to breathe (CHF, pulmonary embolism,urge to breathe moderate to severe airflow obstruction)Cannot get a deep breath,

36、unsatisfying breathHyperinflation (asthma, COPD) and restricted tidal volume (pulmonary fibrosis, chest wall restriction)Heavy breathing, rapid breathing, breathing moreDeconditioningDYSPNEA PATHOPHYSIOLOGYSYMPTOMS AND SIGNSdyspnea Acute, chronic and recurrent Lung infarctionacute with chest pain No

37、cturnal orthoradox dyspneacongestive heart failure and asthma Progressive(a few wks to months) pleural effusion Chronic progressive interstitial lung disease Rucurrent and seasonalasthma Inspirationallarge airway obstruction Expiratory distal airway as asthma, bronchitisRespiratory causes of breathl

38、essness the airways-airflow obstruction; the lung parenchyma-progressive type of breathlessness with a restrictive pattern of lung function. the pulmonary circulation- progressive dyspnoea often with very severe exercise limitation the pleura- The chest wall.Some causes of breathlessness.Airways dis

39、easeChronic bronchiolitis and emphysemaAsthmaBronchiectasis and cystic fibrosisLaryngeal or pharyngeal tumourBilateral cord palsyCricoarytenoid rheumatoidTracheal obstructionTracheomalaciaAmyloid of airwaysParenchymal diseaseAllergic alveolitisSarcoidosisFibroses and diffuse alveolitisObliterative b

40、ronchiolitisPneumonias and toxic pneumonitisDiffuse infectionsRespiratory distress syndromeInfiltrative and metastatic tumourPneumothoraxPulmonary circulationPulmonary embolism and hypertensionPulmonary arteritis and thrombosisChest wall and pleuraEffusion or pleural fibrosisFractured ribsAnkylosing

41、 spondylitisKyphoscoliosisNeuromuscular, bilateral diaphragm paralysisSome causes of breathlessness.Cardiac Left ventricular failure Mitral valve disease Cardiomyopathy Pericardial effusion or constrictionNon-cardiorespiratory Psychogenic Anaemia Haemorrhage Acidosis Hypothalamic lesionsCauses of Ac

42、ute and Chronic DyspneaAcutePulmonary edemaAsthmaInjury to chest wall and intrathoracic structuresSpontaneous pneumothoraxPulmonary embolismPneumoniaAdult respiratory distress syndromePleural effusionPulmonary hemorrhageChronic, progressiveChronic obstructive pulmonary diseaseLeft ventricular failur

43、eDiffuse interstitial fibrosisAsthmaPleural effusionsPulmonary thromboembolic diseasePulmonary vascular diseasePsychogenic dyspneaAnemia, severePostintubation tracheal stenosisHypersensitivity disordersDyspnea: causesRespiratory system Obstruction: asthma, COPD, tumor Pulmo Diseases: pneumonia, inte

44、rstitial 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 abdominal cavity Cardiovascular system Heart failure Pulmo embolism Poisoning ketoacidosisCentral

45、nervous system cerebral tumor , trauma, abscess, hemorrhage, encephalitis, meningitis hematological system Severe anemia Respiratory Dyspnea Inspiratory dyspnea _obstruction in large airway Three depression sign depression in suprasternal fossa, supraclavicular fossa, intercostal space Expiratory dy

46、spnea _obstruction in small airway or alveolar elasticity decreased Prolonged expiratory time Expiratory rhonchi Mixed dyspnea _deficient gas exchange Respiratory rate increased Shallow breathingFeatures of left heart failure Underlying diseases Mixed dyspnea Position related dyspnea Moist crackles

47、or rhonchi in both lungs Relief of symptoms after digitalis, diuretic, vasodilator agent used 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

48、 Poisoning dyspnea Underlying diseases of metabolic acidosis (uremia, diabetic ketoacidosis ) deep breathing (Kussmaul breathing)Dyspnea: accompany signs (1) Rhonchi Asthma Acute left heart failure (cardiac asthma) Foreign body in large airway Acute laryngeal edema Chest pain Infection Pneumothorax

49、Pulmo embolism Lung cancer Acute myocardial infarct Dyspnea: accompany signs (2) Fever Infection Cough and sputum COPD Infection Left heart failure Unconsciousness CNS disorder Uremia diabetic ketoacidosisCyanosis Cyanosis refers to a bluish color of the skin and mucous membranes resulting from an i

50、ncreased 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 dilation of the venules and venous ends of the capil