Respiratory Symptoms Zhao Li, M.D.
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Transcript Respiratory Symptoms Zhao Li, M.D.
Respiratory Symptoms
Zhao Li, M.D.
Common symptoms
Cough
Expectoration
Hemoptysis
Chest pain
Cyanosis
Dyspnea
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
Cough : manifestations
Characteristics
Dry cough (non-sputum: non-infectious)
Productive cough (sputum: infectious, edema)
Attack
Time
season
motivation
Tone
Hoarseness
High pitch
Weak
Brassy
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)
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
Sputum: consistency
Mucoid sputum
Bronchitis (without bacterial infection)
Asthma
Early stage of pneumonia
Serofluid sputum
Pulmo edema
Pus sputum
Any bacterial infection
Bloody sputum
Sputum: color
White
mucoid or serofluid sputum
Yellow
general bacterial infection
Green
aeruginosus Bacillus infection
Grey
oror
black
Grey
black
dust inhalation
Rusty
Lobar pneumonia
Pink
cardiac edema
Red
hemoptysis
Sputum: foul odor
anaerobic bacterium infection
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
Distinguished hemoptysis from
hematemesis
Hemoptysis
Hematemesis
Causes
Pulmo or cardiac
digestive system
Previous symptoms
Cough, chest tightness
Nausea, vomiting
Spit up
Cough up
Vomited
Color
Bright red
Dark red
Mixture
Sputum, frothy
Gastric contents
pH
alkality
acidity
Tarry stools
- or +
+
Post-bleeding
Sputum with blood
No sputum
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 (钩端螺旋体病),
epidemic hemorrhagic fever,endometriosis (子宫内膜异位症)
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
Chest pain: causes
Chest wall
herpes zoster, rib fracture
Cardiovascular
angina pectoris, myocardial infarction, pericarditis, dissecting
aneurysm (夹层动脉瘤)
Respiratory
Pleural disorders, pneumothorax, carcinoma
Mediastinal
Mediastinitis, mediastinal emphysema, mediastinal tumor
Others
esophageal carcinoma, liver abscess, subdiaphragmatic
abscess, hiatal hernia (食道裂孔疝)
Chest pain: characteristics
location
Referred pain
Level or feature
Burning pain, pressing pain, bursting pain,
pricking pain
Duration
Influential factors
Exertional, respiration, foodintake, administration
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 (吞咽困难)
Esophageal disease
Cyanosis
An excess of desaturated hemoglobin causes a
blue coloration of the skin or mucosae.
methemoglobinemia (高铁血红蛋白血症)
Poisoning by nitrite (Methylthioninium Chloride iv,
亚甲兰)
Cyanosis: classification
Central (warm)
Deficient oxygenation
Right-to-left shunt
Peripheral (cold)
Reduced cardiac output
Local vasoconstriction
Mixed
Heart failure
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
Dyspnea: causes
Respiratory system
Obstruction: asthma, COPD, tumor
Pulmo Diseases: pneumonia, interstitial lung disease,
Chest wall or pleura: pleurisy, pneumothorax, trauma
neuro-muscles: poliomyelitis ( 脊髓灰质炎), myasthenia gravis (重症肌无
力)
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
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
Cardiac dyspnea ____ Heart failure
Mechanism of left heart failure
Pulmo edema
Alveolar tension increased
receptor
diffusion capacity decreased
stimulating stretch
excitation of vagus nerve
excitation of
respiratory center
Alveolar elasticity decreased
Increased pressure of pulmo circulation
respiratory center
vital capacity decreased
stimulating
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
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
Nocturnal paroxysmal dyspnea
Mechanism
Elevated excitation of vagus nerve
Contraction of coronary artery
Contraction of bronchiole
Vital capacity decreased in supine position
Returned blood volume increased
Sensitivity of respiratory center decreased
after obvious hypoxia
myocardium ischemia
decreased alveolar ventilation
pulmo edema
reaction
Poisoning dyspnea
Underlying diseases of metabolic acidosis
(uremia, diabetic ketoacidosis )
deep breathing (Kussmaul breathing)
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
Dyspnea: accompany signs (2)
Fever
Infection
Cough and sputum
COPD
Infection
Left heart failure
Unconsciousness
CNS disorder
Uremia
diabetic ketoacidosis