1. Theme of lecture: Sympoms in diseases of respiratory organs based on the results of inquiry of a patient, palpation and percussion of a chest N. Bilkevych

3. bloody expectorations, pain in the chest.
The most typical complaints of the patient with respiratory pathology
dyspnoea,
cough,
bloody expectorations,
pain in the chest.
Fever, asthenia, indisposition and loss of appetite (secondary complaints)

4. Cough is a complicated reflex act which is actually a defence reaction aimed at clearing the larynx, trachea, or bronchi from mucus or foreign material. An inflamed bronchial mucosa produces a secretion which acts on the sensitive reflexogenic zones in the respiratory mucosa to stimulate the nerve endings and to activate the coughing reflex.

5. Sputum

6. Haemoptysis is expectoration of blood with sputum during cough
Haemoptysis is expectoration of blood with sputum during cough. The physician must determine the origin of haemoptysis and the amount and character of blood expectorated with sputum.

7. Pain in the chest may arise during the development of a pathological condition in the thoracic wall, the pleura, heart, and the aorta, and in diseases of the abdominal organs (by irradiation).
Pain in the chest in diseases of the respiratory organs depends on irritation of the pleura

9. General weakness Tuberculosis – 93 % of patients.
Cancer - 92 % of patients.
Purulent lung diseases – 90 % of patients.

12. Diffuse cyanosis in the case of respiratory failure

13. General appearance of a patient with pulmonary emphysema

14. History of present illness (anamnesis morbi)
When and under which circumstances did the disease develop,
Course of the disease,
Past examinations and treatment, their efficacy (in chronic disease).

15. Life history (anamnesis vitae)
Living conditions in childhood.
Living and working conditions in the past and now.
Diseases on the past
Harmful habits.
Heredity.
Allergy.

16. Objective examination. General inspection (inspectio)
General condition of the patient.
State of conscioussness.
Bearing and gare.
Woice.
Skin and visible mucosa.

18. Examination of the chest should be done according to a definite plan:
Data of objective examination of the patients with respiratory pathology.
The patient should be better examined in the upright (standing or sitting) position with the chest being naked.
Examination of the chest should be done according to a definite plan:
Static inspection:
general configuration of the chest (position of the clavicles, supra- and subclavicular fossae, shoulder blades);
Chest symmetry
Dynamic inspection:
the type, rhythm and frequency of breathing,
respiratory movements of the left and right shoulder blades, and of the shoulder girdle,
involvement of the accessory respiratory muscles in the breathing act.

20. Hypersthenic chest

21. 3Asthenic chest

22. Paralytic chest

24. The type, frequency, depth and rhythm of respiration can be determined by carefully observing the chest and the abdomen. Respiration can be costal (thoracic), abdominal, or mixed type.

25. Pathological changes of rhythm and depth of respiration are as follows:
The type of respiration disorder
In which pathological conditions it takes place 1.
Kussmaul’s respiration
Deep coma 2.
Cheyne-Stoke’s respiration
Acute and chronic insufficiency of cerebral circulation and brain hypoxia, heavy poisoning 3.
Biot’s respiration
Meningitis, agony with disorders of cerebral circulation 4.
Grocco’s respiration
Early stages of the same pathological conditions as (2)

27. Palpation of a chest It is used for assessment of: Pain
Elasticity of the chest
Assessment of vocal fremitus
Assessment of epigastric angle

28. Assessment of vocal fremitus
Intensifies on affected side:
Pulmonary tissue consolidation syndrome
Lessens on affected side:
Pneumosclerosis
Bronchial tumor with partial obstruction of bronchial lumen
Accumulation of small amount of fluid or air in pleural cavity
Pleural adhesions
Disappears on affected side:
Hydro- or pneumothorax
Lessens on both sides:
Pulmonary emphysema

29. Percussion of lungs
Comparative
Topographic

30. The rules of percussion (mediate):
The plessimeter is index or medial finger of the left lung.
2.Percussion strokes should be done with terminal phalange of medial finger of the right arm on the junction of medial and terminal phalange of plessimeter finger.
The nales should be cut, arms of a doctor should be warm.

31. Comparative percussion
Nornal percussion sound is resonant (clear pulmonary sound)
Pathological sounds:
Dull sound (pulmonary tissue consolidation, hydrothorax)
Thympanic sound (abscess, cavern, pneumothorax)
Hyperresonance (bundbox sound): pulmonary emphysema

32. Pathological processes in lungs

33. Topographic percussion of lungs
Lower lung border position
Lower lung border respiratory mobility
Lungs apexes height and width (Kroenig’s area).

34. Lower lung border position
Elevated on the affected side:
Pneumosclerosis
Athelectasis
Hepato- or splenomegaly
Pneumonia
Hydrothorax
Lobectomia
Elevated on both sides:
Pregnancy
Meteorism
Ascites

35. Lower liver border mobility

36. Bronchoscopy
Indications: suspition on tumour, foreign bodies of airways, hemopthysis ans lung bleeding as well as for sanation of airways
The procedure is executed on fasting stomach under local anaestesia or narcosis
It is possible to take material (mucosa) via biopsy for histological investiogation.

37. X-ray examination Plain X-ray is in wide use
contrast X-ray (bronchigraphy) lets to assess bronchial tree and is executed on fasting stomach.

38. Thank you!