Common diseases of the respiratory system

1. Common diseases of the respiratory system

2. Pneumonia • Lobar pneumonia • Comlaints • Pain • Fever – continuous • Cough - sputum • Inspection • Dyspnea • Cyanosis • Labial herpes • Cough, sputum

3. 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

4. Pneumonia • Diagnostics • Radiological investigation • Sputum analysis • Inspection • Gram’s stain • Microbiological culture • Cytology

5. Bronchopneumonia • Complaints • Fever • Cough • Chest pain • Sputum • Physical examination – much less alterations • Inspection • In some cases: dyspnea, coughing, sputum • Palpation - no specific alteration

6. Bronchopneumonia • Percussion • Generally without alteration - sometimes dullness • Auscultation • Crackles, sometimes crepitation

7. Lung abscess and gangrena • Complaint • High fever • Large amount of sputum, triple layered sputum • Diagnostics • Radiology: „basket” sign, (fluid niveau inside)

8. 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

9. Asthma • Inflammatory disease • Increased bronchus reactivity • Paroxysmal, reversible obstructive dyspnea

10. Asthma • Increased bronchial reactivity • Bronchospasm – smooth muscle hypertrophy • Mucosal edema • Viscous mucus Reversible pulmonary obstruction

12. Asthma • Complaint • Paroxysmal dyspnea • Causative factor? • Cough, sputum • Viscous mucus – Curshmann-spiral – cast of the bronchus • Inspection • Exspiratory dyspnea • Cyanosis • Respiratory insufficiency

13. Asthma bronchiale • Palpation • Percussion acute emphysema • Auscultation • Prolonged expiration • Bronchial added sounds: wheezing, rhonchi • In terminal phase: weak, superficial breathing

14. Asthma • Diagnostics • Search for the cause: extrinsic asthma - allergen intrinsic • Spirometry

15. 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

16. Chronic bronchitis • Complaints • Productive cough, sputum • Dyspnea • Smoking • Inspection • Blue bloater • Polyglobulia and/or cyanosis • Emphysematous chest • Dyspnea

17. Chronic bronchitis • Palpation – no specific alteration • Percussion – hyperresonance • Auscultation • Bronchial breath sound, increased exspiration • Bronchial added sounds: wheezing, rhonchi

18. Chronic bronchitis • Diagnostics • Spirometry • Sputum examination • Radiology

19. 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°

20. Emphysema • Palpation – without specific alteration • Percussion – hyperresonance • Auscultation – weak breath sounds

21. 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

22. Lung cancer • Diagnostics • Radiology X-ray – • CT – spiral CT • Sputum cytology • Bronchoscopy • Biopsy • Cytology • Searching for metastases

23. 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

24. Pleural effusion • Diagnostics • Radiology (X-ray and ultrasound)

25. 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

26. 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

27. Pneumothorax • Cause a. external - injury, punction b. internal – from the alveoli (rupture) • Types • Closed ptx. • Open ptx • Ventil ptx.

28. 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

29. Pleuritis • Complaints • Sharp pain during breathing • Shallow breathing, sometimes dyspnea • Types • Pleuritis sicca Auscultation: pleural friction rub • Exsudative pleuritis - signs of pleural effusion

30. 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

31. Pulmonary embolism • In the history • Deep wein thrombosis • Immobilisation • Surgical intervention • Malignancy • Atrial fibrillation

32. Pulmonary embolism • Diagnostics • Radiology – CT-angiography • Lung scintigraphy • Angiography

33. Pulmonary edema • A sign of the left heart failure • Complaint • Dyspnea • Foamy, transparent sputum • Inspection • Dyspnea • Auscultation - crackles