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Respiratory Symptoms

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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 ... – PowerPoint PPT presentation

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Title: Respiratory Symptoms


1
Respiratory Symptoms
Zhao Li, M.D.
2
Common symptoms
  • Cough
  • Expectoration
  • Hemoptysis
  • Chest pain
  • Cyanosis
  • Dyspnea

3
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

4
Cough manifestations
  • Characteristics
  • Dry cough (non-sputum non-infectious)
  • Productive cough (sputum infectious, edema)
  • Attack
  • Time
  • season
  • motivation
  • Tone
  • Hoarseness
  • High pitch
  • Weak
  • Brassy

5
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)

6
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

7
Sputum consistency
  • Mucoid sputum
  • Bronchitis (without bacterial infection)
  • Asthma
  • Early stage of pneumonia
  • Serofluid sputum
  • Pulmo edema
  • Pus sputum
  • Any bacterial infection
  • Bloody sputum

8
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
9
Sputum foul odor
  • anaerobic bacterium infection

10
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 gt500ml/d, or 100-500/time
  • Differential diagnosis
  • Bleeding from upper respiratory tract
  • Hematemesis

11
Distinguished hemoptysis from hematemesis
12
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
    (??????),epidemic hemorrhagic fever,endometriosis
    (???????)

13
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

14
Chest pain causes
  • Chest wall
  • herpes zoster, rib fracture
  • Cardiovascular
  • angina pectoris, myocardial infarction,
    pericarditis, dissecting aneurysm (?????)
  • Respiratory
  • Pleural disorders, pneumothorax, carcinoma
  • Mediastinal
  • Mediastinitis, mediastinal emphysema, mediastinal
    tumor
  • Others
  • esophageal carcinoma, liver abscess,
    subdiaphragmatic abscess, hiatal hernia (?????)

15
Chest pain characteristics
  • location
  • Referred pain
  • Level or feature
  • Burning pain, pressing pain, bursting pain,
    pricking pain
  • Duration
  • Influential factors
  • Exertional, respiration, foodintake,
    administration

16
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 (????)
  • Esophageal disease

17
Cyanosis
  • An excess of desaturated hemoglobin causes a blue
    coloration of the skin or mucosae.
  • methemoglobinemia (????????)
  • Poisoning by nitrite (Methylthioninium Chloride
    iv, ???)

18
Cyanosis classification
  • Central (warm)
  • Deficient oxygenation
  • Right-to-left shunt
  • Peripheral (cold)
  • Reduced cardiac output
  • Local vasoconstriction
  • Mixed
  • Heart failure

19
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

20
Dyspnea causes
  • Respiratory system
  • Obstruction asthma, COPD, tumor
  • Pulmo Diseases pneumonia, interstitial lung
    disease,
  • Chest wall or pleura pleurisy, pneumothorax,
    trauma
  • neuro-muscles poliomyelitis ( ?????), myasthenia
    gravis (?????)
  • 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

21
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

22
Cardiac dyspnea ____ Heart failure
23
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

24
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

25
Nocturnal paroxysmal dyspnea
26
Poisoning dyspnea
  • Underlying diseases of metabolic acidosis
    (uremia, diabetic ketoacidosis )
  • deep breathing (Kussmaul breathing)

27
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

28
Dyspnea accompany signs (2)
  • Fever
  • Infection
  • Cough and sputum
  • COPD
  • Infection
  • Left heart failure
  • Unconsciousness
  • CNS disorder
  • Uremia
  • diabetic ketoacidosis
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