manifestations of respiratory system dysfunctions l.
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Manifestations of respiratory system dysfunctions. M. Tatár. Cardinal respiratory symptoms and signs. cough sputum dyspnoea wheezing cyanosis chest pain. Disorders of lung mechanics. Disorders of the lung mechanics. Airway obstruction nasal cavity: nasal congestion

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cardinal respiratory symptoms and signs
Cardinal respiratory symptoms and signs

cough

sputum

dyspnoea

wheezing

cyanosis

chest pain

disorders of the lung mechanics
Disorders of the lung mechanics
  • Airway obstruction
    • nasal cavity: nasal congestion
    • pharynx: collapse during sleep
    • larynx: suffocation
    • central aw:
      • trachea: stridor
      • main bronchi: dyspnoea, wheezing
      • lobar bronchi: asymptomatic or minor dyspnoea
    • peripheral aw: dyspnoea
  • Lung parenchyma ( compliance): dyspnoea
  • Chest wall (abnormalities): dyspnoea
  • Respiratory muscles (fatigue): dyspnoea
disorders of airways defence mechanisms
Disorders of airways defence mechanisms
  • Nasal cavity
    • sneezing
    • nasal discharge
  • Airways
    • Cough: acute respiratory infections, foreign body aspiration, chronic bronchitis, chronic cough
    • Haemoptysis
    • Expectoration - Sputum
      • mucoid (mainly macrophages)
      • purulent (neutrophils)
      • Pneumococcus - bloody or rust-colored
      • Pseudomonas, Haemophilus - green sputum
cough
Cough
  • Physiologic reflex
  • Pathologic reflex
  • Acute cough
  • Chronic cough
    • Rhinitis/sinusitis
    • Asthma
    • Gastroesophageal reflux disease
slide10

 ventilatory

drive

100

40

50

50

PaO2

PaCO2

120

30

70%

chemoreceptors

SaO2

100%

hypoxemia

normocapnia

hypoxemia

hypercapnia

disorders of gas exchange
Disorders of gas exchange

Respiratory insufficiency (failure)

  • Hypoxemic
    • Decreased ventilation/perfusion ratio
    • Venous admixture (right-to-left intrapulmonary shunt)
    • Diffusion impairment
  • Hypercapnic
    • Overall alveolar hypoventilation
    • Critical amount of the compartments with low V´/Q´ ratio + limits for hyperventilatory compensation
hypoxemia
Hypoxemia

Tachycardia, tachypnea, dyspnoea, mental confusion and irritability

Secondary polycythemia ( hematocrit)

Cyanosis

threshold for central cyanosis is a capillary reduced haemoglobin content of 50 g/L

!!! ancillary non-specific signs

cyanosis
Cyanosis
  • Central
    • haemiglobin – methemoglobin, sulphhemoglobin
    •  content of reduced haemoglobin
      • Heart disorders – lung congestion
      • Lung disorders
        • acute: pneumonia, lung oedema
        • chronic: COPD, severe lung fibrosis
  • Peripheral
    • local perfusion disorders
  • False
    • pigmentation (silver)
hypercapnia
Hypercapnia

Morning headaches

Papilloedema, dilated conjunctival and superficial facial blood vessels

CO2 narcosis (rapid accumulation): anxiety may progress to delirium and somnolence

disturbed regulation of breathing
Disturbed regulation of breathing

Cheyne-Stokes breathing

Sleep apnoea

Hyperventilation (tetany)

Gasping

Hypopnoea

dyspnoea breathlessness
Dyspnoea - breathlessness
  • Air hunger, awareness of the act of breathing, chest tightness
  • Sensations: shortness of breath, feeling puffed, inability to get enough air, suffocation
  • Subject´s feelings – needs for increased ventilatory activity; mechanical rather than chemical disturbances
  • Tachypnoea with either shallow or deep breathing
  • Increased workload of respiratory muscles – normal gas exchange cannot be achieved without increased ventilatory effort
pathophysiology of dyspnoea
Pathophysiology of dyspnoea
  • Hyperventilation – acute hypoxemia
  • Relative hyperventilation - decreased ventilatory surface (atelectasis, pleural effusion, lung congestion, pneumothorax)
  • Disordered lung mechanics (most frequent cause)

- Upper airways stenosis

- Increased airways resistance = obstruction of peripheral airways (asthma, COPD, heart failure)

- Decreased muscle force (polyomyelitis, diaphragm paralysis, myasthenia gravis)

- Limited chest movements (kyphoscoliosis)

!!! acute or chronic state; rest or physical activity

causes of dyspnoea
Causes of dyspnoea

Oxygen content in atmosphere

Oxygen consumption during physical activity

Lung function disorders

Heart function disorders

Decreased haemoglobin content (during exercise)

Respiratory centre dysfunction (Cheyne-Stokes, acidosis)

Stimulation of airway and lung nerve-endings (pneumonia, lung congestion)

Obesity

Emotive factors (chronic hyperventilatory syndrome)

Brain disorders

Metabolic disorders – hyperthyroidism

systemic non respiratory responses
Systemic non-respiratory responses

Fever

Weakness, fatigue

Decreased exercise tolerance

Immunity: eosinophilia

Weight loss: advanced disease

Distant effects: finger clubbing and osteoarthropathy (periosteal overgrowth)

primary respiratory disorders can significantly affect the function of other systems
Primary respiratory disorders can significantly affect the function of other systems

Most frequently CVS (the lung is the recipient of the entire cardiac output through the lesser circulation)

  • Cor pulmonale: elevated jugular venous pulse, peripheral oedema
  • Massive pulmonary embolism and tension pneumothorax  circulatory shock: hypotension, weakness, pallor, cold sweat, oliguria, and develops impaired mentation
  • Obstructive sleep apnoea syndrome: daytime sleepiness, right heart failure, systemic arterial hypertension