Transcript Respiratory system

Dr. Hani Hussein, MD
Respiratory department
Jordan University Hospital
Respiratory System Functions
1.
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supplies the body with oxygen and disposes of carbon
dioxide
filters inspired air
produces sound
contains receptors for smell
rids the body of some excess water and heat
helps regulate blood pH
Organization and Functions of
the Respiratory System
 Consists of an upper respiratory tract (nose to larynx)
and a lower respiratory tract ( trachea onwards) .
 Conducting portion transports air.
- includes the nose, nasal cavity, pharynx, larynx,
trachea, and progressively smaller airways, from the
primary bronchi to the terminal bronchioles
 Respiratory portion carries out gas exchange.
- composed of small airways called respiratory
bronchioles, alveolar ducts and alveoli.
The Respiratory Epithelium of the Nasal Cavity and Conducting System
Figure 23.2
The symptoms of the respiratory
disease
 Cough.
 Sputum production.
 Haemoptysis.
 Breathlessness(dyspnea).
 Chest pain.
 Wheeze
 Apnea.
 Others(weight loss, fever, fatigue…)
Cough
 Forced expulsive maneuver against initially closed
glottis.
 Normal protective mechanism for clearing the
tracheo-bronchial tree of secretions and foreign
material.
 Patients seek medical advice when excessive, alteration
their lifestyle or concern about ehe cause specially fear
of cancer.
 Can be voluntary or as reflex.
 Afferent pathway: receptors within the sensory
distribution of the trigeminal, glossopharyngeal,
superior laryngeal and vagus nerves.
 Efferent pathway: recurrent laryngeal nerve and the
spinal nerves.
 Acute: less than 3 weeks.
 Chronic: more than 8 weeks.
 The most common cause of acute cough is acute viral
upper respiratory tract infection.
 frequency.
 Severity of cough: sever cough with airway obstruction
cause cough syncope.
Causes
Acute cough ( less than 3 weeks)
Viral respiratory tract infection
Bacterial infection(acute
bronchitis)
Inhaled foreign body
Inhalation of irritant: dust/fumes.
Pneumonia.
Acute extrinsic allergic alveolitis
Chronic cough(more than 8 weeks)
GERD.
Asthma
Post viral hyper-reactivity.
Chronic rhinitis/sinusitis
Lung tumour.
Tuberculosis.
Interstitial lung disease.
bronchiectasis
Smoking .
Medication: ACE inhibitors, Beta
 Sound:
Bovine cough: hoarseness of voice suggest lung cancer
invading the left recurrent laryngeal nerve.
Whooping cough: pertusis.
 Moist cough: secretions(URTI, acute bronchitis,
chronic bronchitis, bronchiactesis).
 Dry cough painful are seen in pneumonia and
tracheitis.
 Chronic dry cough: interstitial lung disease, drug
induced cough, asthma.
 Timing of the cough:
Morning productive cough: chronic bronchitis.
Nocturnal cough: bronchial asthma.
Daytime cough: GERD, chronic sinusitis.
Cough that improved at weekends, holidays are seen in
occupational asthma.
origin
Common Causes
Features
Pharynx
Post nasal drip
persistent
Larynx
Laryngitis, croup,
whooping cough, tumour
Harsh, painful, persistent
associated with stridor.
Trachea
Tracheitis
Bronchitis (acute-chronic)
Asthma
Painful
Productive, morning
Dry or productive , worse at night
or exposure to cold, allergens.
Persistent with hemoptysis
Dry initially then productive
Excessive sputum, more in
supine
Night, white or pink sputum
Different, fever, weight loss
Dry ,irritant, disturbing
Bronchial carcinoma
Pneumonia
Bronchiactesis
Pulmonary edema
Pulmonary TB
Lung fibrosis
Others
Drug induced
ACE inhibitors, Beta blocker
Sputum production
 Sputum expectoration always is abnormal.
 Amount.
 Viscosity.
 Color.
 Taste or smell.
 Solid material.
 Character.
Types of sputum
Type
Appearance
Cause
Serous
Clear , watery
Frothy may be pink.
Acute pulmonary edema
Alveolar cell CA(rare)
Mucoid
Clear, grey, white
Viscid.
Chronic bronchitis
Asthma
Purulent
Yellow
Acute bronchopulmonary
infection
Asthma (esinophils)
Green
Longer duration infection
Pneumonia, cystic fibrosis,
lung abscess,
bronchiactasis
Rusty red
Pneumococcal pneumonia
Rusty
 Chronic bronchitis and COPD usually cause clear
sputum if color changed this indicate infection.
 Yellow sputum: live neutropils in acute infection,
esinophils in asthma.
 Green sputum due to lysed neutrophils.
 Rusty sputum caused by lysed RBCs.
 Foul smell or vile-tasting indicates anaerobic bacterial
infection or empyema
Haemoptysis
 Coughing blood.
 Should always investigated.
 True haemoptysis or not.
 Amount of blood.
 Streaks of blood, fresh bright or clot.
 Duration: if more than one week think of LUNG
CANCER.
causes of haemoptysis
Tumour
Malignant:
Lung CA
Endobronchial metastases
Benign:
bronchial carcinoid
Infection
Bronchiactesis, TB, lung abscess, cystic fibrosis
Vascular
Pulmonary infarction, AV malformation
Vasculitis
Wegner’s granulomatosis, goodpastures syndrome .
Trauma
Chest trauma, inhalation foreign body.
Iatrogenic: due to procedure.
Cardiac
Mitral valve disease, acute left ventricular failure
Hematological
Breathlessness
 Undue awareness of breathing or the need to breath
more.
 Shortness of breath, not enough air enter.
 Mode of onset: Sudden or gradual.
 Duration and progression.
 Variability, aggravating/ relieving factor.
 Severity.
 Associated symptoms.
Causes of dyspnea
 Non cardiopulmonary causes:
Anemia, obesity, psychogenic, neurogenic, metabolic
acidosis.
 Cardiac:
Left ventricular failure, mitral valve disease,
cardiomyopathy, percardial effusion, constrictive
pericarditis.
 Pulmonary:
Airways: laryngeal tumor, foreign body, bronchial
asthma, COPD, lung CA, bronchiactesis.
Parenchyma: lung fibrosis, TB, pneumonia, sarcoidosis,
tumor.
Pulmonary circulation: PE, pulmonary HTN, pulmonary
vasculitis.
Pleural: pneumothorax, effusion, diffuse pleural fibrosis.
Chest wall: kyphoscoliosis, ankylosing spondylitis.
Neuromascular: mysthenia gravis, neuropathies,
muscular dystrophy, guillian barre syndrome.
Dyspnea (modes of onset, duration and progression)
Minutes:
PE
Pneumothorax
Inhaled foreign body
asthma
acute left ventricular failure
Hours to days:
Pneumonia
Asthma
Exacerbation of COPD.
Weeks to months:
Anemia
Plueral effusion
Months to years:
Pulmonary fibrosis
Pulmonary TB
COPD
respiratory neuromascular disorders
Chest pain
 Chest pain can originate from:
o The pleura
o The chest wall.
o The mediastinal structures.
 The lungs are not source of pain; autonomic
innervations only.
Pleural pain:
 Sharp stabbing, increased by inspiration or coughing
due to irritation to parietal pleura.
 Localized: upper six ribs
 Referred : irritation at the diaphragmatic part of the
parietal pleura(phrenic nerve) to neck and shoulder.
 Lower six ribs: through intercoastal nerves, pain is in
the upper abdomen
 The most common causes of pleuritic chest pain :
Pulmonary embolism.
Pneumonia.
Pneumothorax.
Rib fracture
 Chest wall pain:
musculoskeletal
Patient with chronic cough, asthma usually complaining
from chest tightness.
Sever lacerating may indicate malignancy.
 Mediastinal pain:
Retrosternal,central pain.
Pulmonary infarction, or tumor invading mediastinal
structure.
Wheezing or stridor
 Wheeze: high pitched whistling sound produced by
passage of air through narrowed small airways.
usually during expiration, but may be in both
inspiration and expiration in severe narrowing.
 stridor: rattling sound(loud) mostly during
inspiration caused by partial obstruction of major
airways
 Wheeze:
Bronchial asthma
COPD
 Stridor:
Upper airway obstruction
Vocal cord dysfunction
Tumor
Foreign body
Apnea/hypopnea
 Apnea is absence of breathing, awareness of stoop
breathing.
 Hypopnea: reduction in airflow or respiratory
movements by more than 50% for 10 seconds or more.
 Obstructive sleep apnea: multiple apnea during sleep,
excessive day time sleep, general weakness.
 Weight loss:
Consider significant weight loss if 10KG of weight during
3 months.
Lung CA
Pulmonary TB ,chronic infection or cystic fibrosis.
 Fever:
High grade indicates infection
Relapsing fever in Lung abscess or TB