1、Symptoms Signs of respiratory diseases气囊气囊肺泡肺泡细支气管细支气管支气管支气管气管气管Respiratory tractdifferential respiratory diseases Bronchi *Bronchial asthma *Chronic bronchitis Lungs *Consolidation *Hyperinflation(emphysema)*Atelectasis(collapse)Pleura *Pleural effusion *Pneumothorax *支气管哮喘支气管哮喘 *慢性支气管炎慢性支气管炎 *实变实变
2、:肺炎肺炎,肺梗死肺梗死 *过度充气过度充气(肺气肿肺气肿)*肺不张肺不张(塌陷塌陷)*胸腔积液胸腔积液 *气胸气胸 肋骨肋骨(rib)(rib)肋间隙肋间隙(intercostalintercostal space)space)intercostal spaceRetraction in inspiration indicates the obstruction of airway.Bulging at any time indicates:the massive pleural effusion,pneumothorax,severe emphysema,thoracic tumor,en
3、largement of the heart,Physical examination 查体查体视视触触扣扣听听Inspection Palpation Percussion Auscultation eye hand finger 听诊器听诊器 Respiratory movement Respiratory rateRespiratory depthRespiratory rhythmShape of thoracic bulging retcaction 饱满 收缩PalpationFocus on:*areas of tenderness(pain,lesions,bruises)*a
4、bnormalities in the skin(masses,sinus tracts)*thoracic expansion *fremitus(tactile fremitus,pleural friction fremitus)触觉震颤 胸膜摩擦感Percussion Techniques:Mediate percussion(Indirect percussion)finger-finger detecting small,superficial changes and the border of organ Immediate percussion(Direct percussio
5、n)detecting gross changes like pleural effusion and pneumothoraxFive percussion notes:*resonance(清音清音):normal lung*tympany(鼓音鼓音):gastric air bubble*dullness(浊音浊音):liver*flatness(实音实音):thigh(大腿大腿)*hyperresonance(过清音过清音):none normally You can practice the first four percussion notes on yourself 1.Loba
6、r Pneumonia 大叶性肺炎大叶性肺炎Lobar pneumonia is defined as an infection of lung parenchyma（肺实质）（肺实质）with a lobar distribution of consolidation.Its pathological changes could be divided into three stages,which include:congestion,consolidation,resolution.充血充血 实变实变 消散消散 Lobar PneumoniaSymptoms Young adults wi
7、th motivation,sudden onset.Chills,high fever,chest pain,cough,rusty sputum.Lobar Pneumonia General signs:Face of acute ill and fever,dyspnea(blue lips),herpes labialis疱疹 T,HR and RR BP may be low Special signs:Lobar PneumoniaSpecial signs:Inspection:decrease of respiratory movementPalpation:increase
8、 of vocal fremitus,trachea in middle positionPercussion:dullnessAuscultation:bronchial breath sound,pleural friction rub,rales.Lobar Pneumonia语音震颤 Crepitation bronchiorepiratory sound moist rales respiratory movement vocal fremitus trachea in middle positionobservetouchdullnesslistendullnesskncokcon
9、gestionconsolidationresolutiondyspnea，cynosis，herpes labialis2、慢性支气管炎、慢性支气管炎(chronic bronchitis)慢性阻塞性肺气肿慢性阻塞性肺气肿(chronic obstructive pulmonary emphysema)Chronic Obstructive Pulmonary Disease(COPD)慢性阻塞性肺病慢性阻塞性肺病2.Chronic Obstructive Pulmonary Disease 慢性阻塞性肺病慢性阻塞性肺病(COPD)COPD has been defined as a dis
10、ease characterized by the presence of airflow obstruction caused by chronic bronchitis or emphysema.The airflow obstruction is partially reversible and generally progressive.慢性支气管炎慢性支气管炎慢性阻塞性肺气肿慢性阻塞性肺气肿Chronic Obstructive Pulmonary DiseaseCOPDCOPD Symptoms Chronic productive coughwhitish mucoid frot
11、hy sputum,yellowish sputum when complicated with infection.aggravation in the wintershort of breath or dyspnea,wheezing,dyspnea with exertion.白色黏液泡沫痰白色黏液泡沫痰COPDSignsInspection:barrel chest,decrease of respiratory movementPalpation:decrease of vocal fremitus.Percussion:bilateral hyperresonanceAuscult
12、ation:decrease of breath sounds and diffused rhonchi and rales 干罗音干罗音 湿罗音湿罗音Barrel chest 桶状胸桶状胸 The diameter of AP:transverse like a barrel.Front ribs move up,intercostal space widen,infrasternal angle increases.It is common in older patients and those with emphysema.signs 慢性支气管炎慢性支气管炎 并发肺气肿并发肺气肿视视
13、桶状胸桶状胸 barrel chest触触 呼吸动度减弱呼吸动度减弱 语音震颤减弱语音震颤减弱叩叩 过清音过清音 hyperresonance 肺下界下移、移动度减小肺下界下移、移动度减小 心浊音界缩小或消失心浊音界缩小或消失 肝浊音界下移肝浊音界下移听听散在干、湿罗音散在干、湿罗音 呼吸音减弱呼吸音减弱 呼气音延长呼气音延长 Diffused ronchi and moist ralesWheezing喘鸣音喘鸣音3.Bronchial Asthma 支气管哮喘支气管哮喘 Bronchial asthma is a chronic inflammatory disorder of the a
14、irway in which many cells play a role.This chronic inflammation causes airway hyperresponsiveness andrecurrent episodes of wheezing,breathlessness,and cough,particularly at night and/or in the early morning.These symptoms are reversible either spontaneously or with treatment.These symptoms are rever
15、sible either spontaneously or with treatment.Bronchial Asthma Symptoms Childhood or adolescence onset,recurrent attacks and seasonality.Contact of allergen,allergic rhinitis(鼻炎鼻炎)Chest tightness,cough,expiratory dyspnea with wheezing Remission spontaneously or with treatment.Bronchial Asthma SignsIn
16、spection:expiratory dyspnea,forced sitting position,accessory respiratory muscle use,sweating,cyanosis,chest hyperinflation.Palpation:respiratory movement and fremitusPercussion:hyperresonant noteAuscultation:diffused wheezes.4.Pleural Effusion 胸腔积液胸腔积液abnormal accumulation of fluid.Caused by:excess
17、 fluid production or decreased absorptionPleural spaceThe pleural space:potential space between the visceral and parietal pleuraIn the pleural space:Negative pressureNo air-pneumothorax Little fluid(lubricate the surface of the pleurae)-pleural effusionPleural Effusion Symptoms The symptoms are not
18、obvious if the fluid is 300mlDry cough,pleuritic chest pain,the pain will be palliated when the fluid increaseshort breath and chest tightness when the fluid is 500ml dyspnea and cyanosis when the fluid is large.symptoms of the basic disease.Pleural Effusion SignsUsually there is no signs if the flu
19、id is 500mlMiddle to large fluidInspection:restriction of the respiratory movement on the affected side,bulging intercostals marginsPalpation:shift of apex beat and trachea to the uninvolved side.Absent tactile fremitus over effusionPercussion:dullness on the effusion area.Auscultation：Decreased or
20、absent breath sounds over the effusion.Bronchial breath sounds could be heard above the pleural effusion.Pleural rub could be heard in dry or fibrinous pleurisy Air in the pleural space5.Pneumothorax 气胸气胸5.Pneumothorax Air in the pleural spaceCan be classified as follows according to the causative f
21、actorsspontaneous pneumothorax:COPD,Tuberculosisartificial pneumothorax traumatic pneumothoraxClassified clinically as follows according to the pleural holeclosed pneumothoraxopen pneumothoraxtension pneumothorax.Pneumothorax Symptomsmotivation(strenuous exertion)sudden onset with unilateral pleurit
22、ic pain and dyspnea.The degree of dyspnea varies according to the size of the pneumothorax the lungs healthy conditionPneumothorax Symptomssmall closed pneumothorax with a good basic lung function,the initial dyspnea is slight and will improve after a few hours.large tension pneumothorax will produc
23、e sever dyspnea and even respiratory or circulatory failure Pneumothorax SignNo obvious signs if pneumothorax is smallLarge pneumothoraxInspection:the affected thoracic is full and the respiratory movement is restricted.Palpation:tracheal and apex beat deviation,vocal fremitus diminished or disappea
24、red.Percussion:hyper-resonance on percussionAuscultation:diminution of breath sounds.6.Atelectasis 肺不张肺不张Loss of alveolar volumeObstructive atelectasis foreign body,neoplasm,sputum plug,endobronchial tuberculosisNon-obstructive atelectasis Compressive,e.g.pneumothorax,pleural effusionAtelectasisSymp
25、toms:Varies according to the extent and degree of atelectasis.dyspnea,cough,toxic symptom associated with secondary infection.Atelectasis Signs:Inspection:retraction of the involved side and the respiratory movement is restricted.Palpation:heart and tracheal shift to the affected side,vocal fremitus
26、 is decreased,but increased in compressed atelectasisPercussion:dullness on percussion.Auscultation:diminution of breath sounds on the involved side,bronchial breath sounds could be heard on the compressive atelectasis.COPD and Asthma Clinic featuresDifferential diagnosis of diseasesCOPDAsthmaAirflo
27、w limitationir-reversible reversibleSymptomscough,sputum,exertion dyspneaWheezing 喘息喘息,dyspneaDyspneaafter doing somethingacute onsetLung functionnormalSignsrhonchi,rales干罗音干罗音 湿罗音湿罗音Wheezing喘鸣喘鸣Compare the similarities and differences between any 2 disease.pneumothorax-pleural effusion-emphysema -a
28、telectasisconsolidation 肺不张肺不张According to pathological change,imagine what the signs might be.Differential diagnosis of diseases视视触触扣扣听听DiseasesInspection Palpation Percussion Auscultation Consolidation MovementThorax normal Trachea:middleVocal fremitus dullness Bronchial breath soundAtelectasis Mo
29、vementThorax-retracted Trachea:affected sidevocal fremitus dullness breath sounds PneumothoraxmovementThorax bulged Trachea:normal sidevocal fremitus Hyper-resonance breath soundsemphysema Both sidesMovement Thorax bulgedTrachea:middlevocal fremitusHyper-resonancebreath soundsPleural effusion Moveme
30、nt Thorax bulgedTrachea:normal sidevocal fremitus dullness breath soundsExercises 视视触触扣扣听听Inspection Palpation Percussion Auscultation Emphysema 肺气肿肺气肿 Pneumothorax 气胸气胸视视触触扣扣听听Inspection Palpation Percussion Auscultation Atelectasis 肺不张肺不张 Consolidation 肺实变肺实变 视视触触扣扣听听Inspection Palpation Percussion Auscultation Plueral effusion Pneumothorax 胸腔积液体胸腔积液体 气气 胸胸视视触触扣扣听听Inspection Palpation Percussion Auscultation Plueral effusion Pneumothorax 胸腔积液体胸腔积液体 气气 胸胸
