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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