Common diseases of the respiratory system

Pneumonia Lobar pneumonia Comlaints Inspection Pain Fever – continuous Cough - sputum Inspection Dyspnea Cyanosis Labial herpes Cough, sputum

Pneumonia Palpation Percussion Auscultation 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 Auscultation 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 Inspection 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 Inspection Paroxysmal dyspnea Cough, sputum 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 Inspection Productive cough, sputum Dyspnea Smoking Inspection Blue bloater Polyglobulia and/or cyanosis Emphysematous chest

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 Inspection 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 Inspection Palpation 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 Cytology 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 Inspection: - decreased chest movements 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 Types 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,

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 Inspection Dyspnea Foamy, transparent sputum Inspection Auscultation - crackles