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Manifestations of respiratory system dysfunctions

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Manifestations of respiratory system dysfunctions. M. Tatar, J. Hanacek ... lobar bronchi: asymptomatic or minor dyspnea. peripheral aw: dyspnea ... – PowerPoint PPT presentation

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Title: Manifestations of respiratory system dysfunctions


1
Manifestations of respiratory system dysfunctions
  • M. Tatar, J. Hanacek

2
Cardinal respiratory symptoms and signs
  • cough
  • sputum
  • dyspnea
  • wheezing
  • cyanosis
  • chest discomfort
  • chest pain

3
Disorders of lung mechanics
4
Disorders of the lung mechanics
  • Airway obstruction
  • nasal cavity nasal congestion
  • pharynx collapse during sleep
  • larynx suffocation
  • central aw
  • trachea stridor
  • main bronchi dyspnea, wheezing
  • lobar bronchi asymptomatic or minor dyspnea
  • peripheral aw dyspnea
  • Lung parenchyma (? or ?compliance) dyspnea
  • Chest wall (abnormalities) dyspnea
  • Respiratory muscles (fatigue) dyspnea

5
Disorders of airway defence mechanisms
6
Disorders of airways defence mechanisms
  • Nasal cavity
  • sneezing
  • nasal dyscharge
  • Airways
  • Cough acute respiratory infections, foreign body
    aspiration, chronic bronchitis, chronic cough
  • Expectoration - Sputum
  • mucoid (mainly macrophages)
  • purulent (neutrophils)
  • Pneumococcus - bloody or rust-colored
  • Pseudomonas, Haemophilus - green sputum

7
Hyperplasia and hypertrophy of submucosal glands
8
Disorders of gas exchange
9
Disorders of gas exchange
  • Respiratory insufficiency (failure)
  • Hypoxemic
  • Decreased ventilation/perfusion ratio
  • Venous admixture
  • Diffusion impairment
  • Hypercapnic
  • Overall alveolar hypoventilation
  • Limits for hyperventilatory compensation
  • of decreased ventilation/perfusion ratio

10
Vznik hypoxémie vplyvom zníženia V/Q pomeru

11
Kompenzacné mechanizmy pri hyperkapnii
12
Disturbed regulation of breathing
  • Cheyne-Stokes respiration
  • Sleep apnea
  • Hyperventilation
  • Gasping
  • Hypopnea
  • Shortness of breath

13
Cheyne-Stokes breathing
14
General body responses
  • Fever
  • Weakness, fatigue
  • Decreased exercise tolerance
  • Immunity eosinophilia
  • Weight loss advanced disease

15
Cough
  • Physiologic reflex
  • Pathologic reflex
  • Acute cough
  • Chronic cough
  • Rhinitis/sinusitis
  • Asthma
  • Gastroesophageal reflux disease

16
Dyspnea
  • Air hunger, chest tighness
  • Subjects feelings needs for increased
    ventilatory activity
  • Tachypnoea with either shallow or deep breathing
  • Increased workload of respiratory muscles
    normal gas exchange cannot be achieved without
    increased ventilatory effort

17
Pathophysiology of dyspnea
  • Hyperventilation acute hypoxemia
  • Relative hyperventilation - decreased
    ventilatory surfice (atelectasis, pleural
    effusion, lung congestion, pneumotorax)
  • Disordered lung mechanics (most frequent cause)
  • - Upper airways stenosis
  • - Increased arways resistence obstruction of
    peripheral airways (asthma, COPD, heart failure)
  • - Decreased muscle force (polyomyelitis,
    diaphragm paralysis, myastenia gravis)
  • - Limited chest movements (kyphoscoliosis)
  • !!! acute or chronic state rest or physical
    activity

18
Causes of dyspnea
  • ? oxygen content in atmosphere
  • ? oxygen consumption during physical activity
  • Lung function disorders
  • Heart function disorders
  • Decreased hemoglobin content (during exercise)
  • Respiratory center dysfunction (Cheyne-Stokes,
    acidosis)
  • Stimulation of airway and lung nerve-endings
    (pneumonia, lung congestion)
  • Obesity
  • Emotive factors (chronic hyperventilatory
    syndrom)
  • Brain dysorders
  • Metabolic dysorders hyperthyreosis

19
Hypoxemia
  • Tachycardia, tachypnea, dyspnea, mental status
    changes
  • Secondary polycythemia (? hematocrit)
  • Cyanosis
  • threshold for central cyanosis is a capillary
    reduced hemoglobin content of 5 g/dL
  • !!! ancillary nonspecific signs

20
Relation between SaO2 and arterial Hb
21
Cyanosis
  • Central
  • hemiglobin methemoglobin, sulphhemoglobin
  • hemoglobin - ? content of reduced Hb
  • Heart disorders lung congestion
  • Lung disorders
  • acute pneumonia, lung edema
  • chronic COPD, severe lung fibrosis
  • Peripheral
  • local perfusion disorders
  • False
  • pigmentation (silver)

22
Peripheral and central cyanosis
Central
Peripheral
23
Hypercapnia
  • Morning headaches
  • Papilledema, dilated conjunctival and superficial
    facial blood vessels
  • CO2 narcosis anxiety may progress to delirium
    and
  • somnolency

24
Primary respiratory disorders can significantly
affect the function of other systems
  • Most frequently CVS
  • Cor pulmonale
  • elevated jugular venous pulse, peripheral edema
  • Massive pulmonary embolism and tension
    pneumothorax circulatory shock hypotension,
    weakness, pale, sweaty, oliguric, and develops
    impaired mentation
  • OSAS
  • daytime sleepiness, right heart failure,
    systemic arterial hypertension
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