Respiratory Symptoms Zhao Li, M.D.. Common symptoms  Cough  Expectoration  Hemoptysis  Chest pain  Cyanosis  Dyspnea

  • View

  • Download

Embed Size (px)

Text of Respiratory Symptoms Zhao Li, M.D.. Common symptoms  Cough  Expectoration  Hemoptysis ...

  • Slide 1

Respiratory Symptoms Zhao Li, M.D. Slide 2 Common symptoms Cough Expectoration Hemoptysis Chest pain Cyanosis Dyspnea Slide 3 Cough (a protective reflex): causes Respiratory diseases___ the most 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 system agents Initiative cough, encephalitis, meningitis Slide 4 Cough : manifestations Characteristics Dry cough (non-sputum: non-infectious) Productive cough (sputum: infectious, edema) Attack Time season motivation Tone Hoarseness High pitch Weak Brassy Slide 5 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) Clubbing fingers (bronchietasis, lung cancer, chronic lung abscess) Slide 6 Sputum: amount Bulk frothy sputum Pulmo edema Bulk serofluid sputum Alveolar carcinoma Bulk pus sputum Bronchiectasis Lung abscess Layering upper: frothy, middle: mucoid or mucopus, lower: necrosis substance Slide 7 Sputum: consistency Mucoid sputum Bronchitis (without bacterial infection) Asthma Early stage of pneumonia Serofluid sputum Pulmo edema Pus sputum Any bacterial infection Bloody sputum Slide 8 Sputum: color White mucoid or serofluid sputum Yellow general bacterial infection Green aeruginosus Bacillus infection Grey or black dust inhalation Rusty Lobar pneumonia Pink cardiac edema Red hemoptysis Grey or black Slide 9 Sputum: foul odor anaerobic bacterium infection Slide 10 Hemoptysis Bleeding from lower respiratory tract The amount varies from blood-strained sputum to several hundreds ml pure blood Mild: 100ml/d Moderate: 100-500/d Severe: >500ml/d, or 100-500/time Differential diagnosis Bleeding from upper respiratory tract Hematemesis Slide 11 Distinguished hemoptysis from hematemesis HemoptysisHematemesis CausesPulmo or cardiacdigestive system Previous symptomsCough, chest tightnessNausea, vomiting Spit upCough upVomited ColorBright redDark red MixtureSputum, frothy Gastric contents pHalkalityacidity Tarry stools - or ++ Post-bleedingSputum with bloodNo sputum Slide 12 Hemoptysis: causes Bronchial disorders Bronchiectasis Bronchogenic carcinoma endobronchial TB Chronic bronchitis Pulmo Disorders Pulmo TB Peumonia Lung abscess Pulmo embolism Cardiovascular disorders Acute left heart failure Mitral stenosis Others Hematologic disease, leptospirosis epidemic hemorrhagic fever endometriosis Slide 13 Hemoptysis: accompany signs Fever Infection or carcinoma Chest pain Infection Pulmo Embolism Carcinoma Pus sputum Bronchiectasis Lung abscess Clubbing fingers Bronchiectasis Lung abscess Carcinoma Hemorrhagic spots Hematologic disease, leptospirosis, epidemic hemorrhagic fever Slide 14 Chest pain: causes Chest wall herpes zoster, rib fracture Cardiovascular angina pectoris, myocardial infarction, pericarditis, dissecting aneurysm Respiratory Pleural disorders, pneumothorax, carcinoma Mediastinal Mediastinitis, mediastinal emphysema, mediastinal tumor Others esophageal carcinoma, liver abscess, subdiaphragmatic abscess, hiatal hernia Slide 15 Chest pain: characteristics location Referred pain Level or feature Burning pain, pressing pain, bursting pain, pricking pain Duration Influential factors Exertional, respiration, foodintake, administration Slide 16 Chest pain: accompany signs Cough, sputum and/or fever Respiratory disease Dyspnea Severe pneumonia, pneumothorax, pleurisy, pulmo embolism Hemoptysis Carcinoma, pulmo embolism Shock myocardial infarction, dissecting aneurysm (rupture ), large area pulmo embolism Dysphagia ( ) Esophageal disease Slide 17 Cyanosis An excess of desaturated hemoglobin causes a blue coloration of the skin or mucosae. methemoglobinemia ( Poisoning by nitrite (Methylthioninium Chloride iv, ) Slide 18 Cyanosis: classification Central (warm) Deficient oxygenation Right-to-left shunt Peripheral (cold) Reduced cardiac output Local vasoconstriction Mixed Heart failure Slide 19 Cyanosis: accompany signs Dyspnea Severe cardiac or respiratory disorder Clubbing fingers Congenital heart disease Chronic respiratory disease Unconsciousness Poisoning, shock, Severe cardiac or respiratory disorder Slide 20 Dyspnea: causes Respiratory system Obstruction: asthma, COPD, tumor Pulmo Diseases: pneumonia, interstitial lung disease, Chest wall or pleura: pleurisy, pneumothorax, trauma neuro-muscles: poliomyelitis ( ), myasthenia gravis ( ) Diaphragma movement disorder: obviously elevated pressure in abdominal cavity Cardiovascular system Heart failure Pulmo embolism Poisoning ketoacidosis Central nervous system cerebral tumor, trauma, abscess, hemorrhage, encephalitis, meningitis hematological system Severe anemia Slide 21 Respiratory Dyspnea Inspiratory dyspnea ____ obstruction in large airway Three depression sign depression in suprasternal fossa, supraclavicular fossa, intercostal space Expiratory dyspnea ____ obstruction in small airway or alveolar elasticity decreased Prolonged expiratory time Expiratory rhonchi Mixed dyspnea ____ deficient gas exchange Respiratory rate increased Shallow breathing Slide 22 Cardiac dyspnea ____ Heart failure Mechanism of left heart failure Pulmo edema diffusion capacity decreased Alveolar tension increased stimulating stretch receptor excitation of vagus nerve excitation of respiratory center Alveolar elasticity decreased vital capacity decreased Increased pressure of pulmo circulation stimulating respiratory center Slide 23 Features of left heart failure Underlying diseases Mixed dyspnea Position related dyspnea Moist crackles or rhonchi in both lungs Relief of symptoms after digitalis, diuretic, vasodilator agent used Slide 24 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 Slide 25 Nocturnal paroxysmal dyspnea Mechanism Elevated excitation of vagus nerve Contraction of coronary artery myocardium ischemia Contraction of bronchiole decreased alveolar ventilation Vital capacity decreased in supine position Returned blood volume increased pulmo edema Sensitivity of respiratory center decreased reaction after obvious hypoxia Slide 26 Poisoning dyspnea Underlying diseases of metabolic acidosis (uremia, diabetic ketoacidosis ) deep breathing (Kussmaul breathing) Slide 27 Dyspnea: accompany signs (1) Rhonchi Asthma Acute left heart failure (cardiac asthma) Foreign body in large airway Acute laryngeal edema Chest pain Infection Pneumothorax Pulmo embolism Lung cancer Acute myocardial infarct Slide 28 Dyspnea: accompany signs (2) Fever Infection Cough and sputum COPD Infection Left heart failure Unconsciousness CNS disorder Uremia diabetic ketoacidosis