common diseases of the respiratory system
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Common diseases of the respiratory system. Pneumonia. Lobar pneumonia Comlaints Pain Fever – continuous Cough - sputum Inspection Dyspnea Cyanosis Labial herpes Cough, sputum. Pneumonia. Palpation tactile fremitus – increases on the involved site Percussion relative dull sound

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pneumonia
Pneumonia
  • Lobar pneumonia
    • Comlaints
      • Pain
      • Fever – continuous
      • Cough - sputum
    • Inspection
      • Dyspnea
      • Cyanosis
      • Labial herpes
      • Cough, sputum
pneumonia1
Pneumonia
  • Palpation
    • 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
pneumonia2
Pneumonia
  • Diagnostics
    • Radiological investigation
    • Sputum analysis
      • Inspection
      • Gram’s stain
      • Microbiological culture
      • Cytology
bronchopneumonia
Bronchopneumonia
  • Complaints
    • Fever
    • Cough
    • Chest pain
    • Sputum
  • Physical examination – much less alterations
    • Inspection
      • In some cases: dyspnea, coughing, sputum
    • Palpation - no specific alteration
bronchopneumonia1
Bronchopneumonia
  • Percussion
    • Generally without alteration - sometimes dullness
  • Auscultation
    • Crackles, sometimes crepitation
lung abscess and gangrena
Lung abscess and gangrena
  • Complaint
    • High fever
    • Large amount of sputum, triple layered sputum
  • Diagnostics
    • Radiology: „basket” sign, (fluid niveau inside)
acute bronchitis
Acute bronchitis
  • Only the bronchus is ill
  • Complaint
    • 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

asthma
Asthma
  • Inflammatory disease
  • Increased bronchus reactivity
  • Paroxysmal, reversible obstructive dyspnea
asthma1
Asthma
  • Increased bronchial reactivity
    • Bronchospasm – smooth muscle hypertrophy
    • Mucosal edema
    • Viscous mucus

Reversible pulmonary obstruction

asthma2
Asthma
  • Complaint
    • Paroxysmal dyspnea
      • Causative factor?
    • Cough, sputum
      • Viscous mucus – Curshmann-spiral – cast of the bronchus
  • Inspection
      • Exspiratory dyspnea
      • Cyanosis
      • Respiratory insufficiency
asthma bronchiale
Asthma bronchiale
  • Palpation
  • Percussion acute emphysema
  • Auscultation
    • Prolonged expiration
    • Bronchial added sounds: wheezing, rhonchi
    • In terminal phase: weak, superficial breathing
asthma3
Asthma
  • Diagnostics
    • Search for the cause: extrinsic asthma - allergen

intrinsic

    • Spirometry
chronic obstructive pulmonary diseases copd
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
chronic bronchitis
Chronic bronchitis
  • Complaints
    • Productive cough, sputum
    • Dyspnea
    • Smoking
  • Inspection
    • Blue bloater
    • Polyglobulia and/or cyanosis
    • Emphysematous chest
    • Dyspnea
chronic bronchitis1
Chronic bronchitis
  • Palpation – no specific alteration
  • Percussion – hyperresonance
  • Auscultation
    • Bronchial breath sound, increased exspiration
    • Bronchial added sounds: wheezing, rhonchi
chronic bronchitis2
Chronic bronchitis
  • Diagnostics
    • Spirometry
    • Sputum examination
    • Radiology
emphysema
Emphysema
  • Complaints
    • 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°
emphysema1
Emphysema
  • Palpation – without specific alteration
  • Percussion – hyperresonance
  • Auscultation – weak breath sounds
lung cancer
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
lung cancer1
Lung cancer
  • Diagnostics
    • Radiology X-ray –
    • CT – spiral CT
    • Sputum cytology
    • Bronchoscopy
      • Biopsy
      • Cytology
    • Searching for metastases
pleural effusion
Pleural effusion
  • Complaint
    • 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
pleural effusion1
Pleural effusion
  • Diagnostics
    • Radiology (X-ray and ultrasound)
pleural effusion2
Pleural effusion
  • Thoracocentesis
    • 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
thickening of the pleura
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
pneumothorax
Pneumothorax
  • Cause a. external - injury, punction

b. internal – from the alveoli (rupture)

  • Types
    • Closed ptx.
    • Open ptx
    • Ventil ptx.
pneumothorax1
Pneumothorax
  • Complaints
    • Sudden onset, very sharp pain
    • Dyspnea
    • Collapse
  • Inspection: - decreased chest movements
  • Palpation: - tactile fremitus decreases
  • Percussion: – tympany
  • Auscultation: – weak or no breath sounds
pleuritis
Pleuritis
  • Complaints
    • Sharp pain during breathing
    • Shallow breathing, sometimes dyspnea
  • Types
    • Pleuritis sicca Auscultation: pleural

friction rub

    • Exsudative pleuritis - signs of pleural effusion
pulmonary embolism
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,

hemoptysis

pulmonary embolism1
Pulmonary embolism
  • In the history
    • Deep wein thrombosis
    • Immobilisation
    • Surgical intervention
    • Malignancy
    • Atrial fibrillation
pulmonary embolism2
Pulmonary embolism
  • Diagnostics
    • Radiology – CT-angiography
    • Lung scintigraphy
    • Angiography
pulmonary edema
Pulmonary edema
  • A sign of the left heart failure
  • Complaint
    • Dyspnea
    • Foamy, transparent sputum
  • Inspection
    • Dyspnea
  • Auscultation - crackles
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