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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

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common symptoms
Common symptoms
  • Cough
  • Expectoration
  • Hemoptysis
  • Chest pain
  • Cyanosis
  • Dyspnea
cough a protective reflex causes
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
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
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
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
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
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

sputum foul odor
Sputum: foul odor
  • anaerobic bacterium infection
hemoptysis
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
hemoptysis causes
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
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 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
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
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
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
Cyanosis: classification
  • Central (warm)
    • Deficient oxygenation
    • Right-to-left shunt
  • Peripheral (cold)
    • Reduced cardiac output
    • Local vasoconstriction
  • Mixed
    • Heart failure
cyanosis accompany signs
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
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
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 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
Cardiac dyspnea ____ Heart failure
features of left heart failure
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
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 dyspnea25

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 decreasedreaction after obvious hypoxia
Nocturnal paroxysmal dyspnea
poisoning dyspnea
Poisoning dyspnea
  • Underlying diseases of metabolic acidosis (uremia, diabetic ketoacidosis )
  • deep breathing (Kussmaul breathing)
dyspnea accompany signs 1
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
Dyspnea: accompany signs (2)
  • Fever
    • Infection
  • Cough and sputum
    • COPD
    • Infection
    • Left heart failure
  • Unconsciousness
    • CNS disorder
    • Uremia
    • diabetic ketoacidosis