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Common diseases of the respiratory system
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Pneumonia Lobar pneumonia Comlaints Inspection Pain Fever – continuous
Cough - sputum Inspection Dyspnea Cyanosis Labial herpes Cough, sputum
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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
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Pneumonia Diagnostics Radiological investigation Sputum analysis
Inspection Gram’s stain Microbiological culture Cytology
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Bronchopneumonia Complaints
Fever Cough Chest pain Sputum Physical examination – much less alterations Inspection In some cases: dyspnea, coughing, sputum Palpation - no specific alteration
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Bronchopneumonia Percussion Auscultation
Generally without alteration - sometimes dullness Auscultation Crackles, sometimes crepitation
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Lung abscess and gangrena
Complaint High fever Large amount of sputum, triple layered sputum Diagnostics Radiology: „basket” sign, (fluid niveau inside)
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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
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Asthma Inflammatory disease Increased bronchus reactivity
Paroxysmal, reversible obstructive dyspnea
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Asthma Increased bronchial reactivity
Bronchospasm – smooth muscle hypertrophy Mucosal edema Viscous mucus Reversible pulmonary obstruction
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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
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Asthma bronchiale Palpation Percussion acute emphysema Auscultation
Prolonged expiration Bronchial added sounds: wheezing, rhonchi In terminal phase: weak, superficial breathing
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Asthma Diagnostics Search for the cause: extrinsic asthma - allergen
intrinsic Spirometry
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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
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Chronic bronchitis Complaints Inspection Productive cough, sputum
Dyspnea Smoking Inspection Blue bloater Polyglobulia and/or cyanosis Emphysematous chest
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Chronic bronchitis Palpation – no specific alteration
Percussion – hyperresonance Auscultation Bronchial breath sound, increased exspiration Bronchial added sounds: wheezing, rhonchi
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Chronic bronchitis Diagnostics Spirometry Sputum examination Radiology
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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°
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Emphysema Palpation – without specific alteration
Percussion – hyperresonance Auscultation – weak breath sounds
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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
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Lung cancer Diagnostics Radiology X-ray – CT – spiral CT
Sputum cytology Bronchoscopy Biopsy Cytology Searching for metastases
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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
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Pleural effusion Diagnostics Radiology (X-ray and ultrasound)
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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
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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
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Pneumothorax Cause a. external - injury, punction
b. internal – from the alveoli (rupture) Types Closed ptx. Open ptx Ventil ptx.
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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
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Pleuritis Complaints Types Sharp pain during breathing
Shallow breathing, sometimes dyspnea Types Pleuritis sicca Auscultation: pleural friction rub Exsudative pleuritis - signs of pleural effusion
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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,
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Pulmonary embolism In the history Deep wein thrombosis Immobilisation
Surgical intervention Malignancy Atrial fibrillation
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Pulmonary embolism Diagnostics Radiology – CT-angiography
Lung scintigraphy Angiography
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Pulmonary edema A sign of the left heart failure Complaint Inspection
Dyspnea Foamy, transparent sputum Inspection Auscultation - crackles
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