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Common diseases of the respiratory system
Pneumonia
• Lobar pneumonia– Comlaints
• Pain• Fever – continuous• Cough - sputum
– Inspection• Dyspnea• Cyanosis• Labial herpes• Cough, sputum
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
Pneumonia
• Diagnostics– Radiological investigation– Sputum analysis
• Inspection• Gram’s stain• Microbiological culture• Cytology
Bronchopneumonia
• Complaints– Fever– Cough– Chest pain– Sputum
• Physical examination – much less alterations– Inspection
• In some cases: dyspnea, coughing, sputum
– Palpation - no specific alteration
Bronchopneumonia
• Percussion– Generally without alteration - sometimes
dullness
• Auscultation– Crackles, sometimes crepitation
Lung abscess and gangrena• Complaint
– High fever– Large amount of sputum, triple layered sputum
• Diagnostics– Radiology: „basket” sign, (fluid niveau inside)
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
Asthma
• Inflammatory disease
• Increased bronchus reactivity
• Paroxysmal, reversible obstructive dyspnea
Asthma
• Increased bronchial reactivity– Bronchospasm – smooth muscle hypertrophy– Mucosal edema– Viscous mucus
Reversible pulmonary obstruction
Asthma
• Complaint– Paroxysmal dyspnea
• Causative factor?
– Cough, sputum• Viscous mucus – Curshmann-spiral – cast of the
bronchus
• Inspection• Exspiratory dyspnea• Cyanosis• Respiratory insufficiency
Asthma bronchiale
• Palpation• Percussion acute emphysema
• Auscultation– Prolonged expiration– Bronchial added sounds: wheezing, rhonchi– In terminal phase: weak, superficial breathing
Asthma
• Diagnostics– Search for the cause: extrinsic asthma - allergen
intrinsic
– Spirometry
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
Chronic bronchitis
• Complaints– Productive cough, sputum– Dyspnea– Smoking
• Inspection– Blue bloater– Polyglobulia and/or cyanosis– Emphysematous chest– Dyspnea
Chronic bronchitis
• Palpation – no specific alteration
• Percussion – hyperresonance
• Auscultation– Bronchial breath sound, increased exspiration– Bronchial added sounds: wheezing, rhonchi
Chronic bronchitis
• Diagnostics– Spirometry– Sputum examination– Radiology
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°
Emphysema
• Palpation – without specific alteration
• Percussion – hyperresonance
• Auscultation – weak breath sounds
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
Lung cancer
• Diagnostics– Radiology X-ray – – CT – spiral CT– Sputum cytology– Bronchoscopy
• Biopsy• Cytology
– Searching for metastases
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
Pleural effusion
• Diagnostics– Radiology (X-ray and ultrasound)
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
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
Pneumothorax
• Cause a. external - injury, punction b. internal – from the alveoli (rupture)
• Types– Closed ptx.– Open ptx– Ventil ptx.
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
Pleuritis
• Complaints– Sharp pain during breathing– Shallow breathing, sometimes dyspnea
• Types– Pleuritis sicca Auscultation: pleural
friction rub– Exsudative pleuritis - signs of pleural effusion
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
Pulmonary embolism
• In the history– Deep wein thrombosis– Immobilisation– Surgical intervention– Malignancy– Atrial fibrillation
Pulmonary embolism
• Diagnostics– Radiology – CT-angiography– Lung scintigraphy– Angiography
Pulmonary edema
• A sign of the left heart failure
• Complaint– Dyspnea– Foamy, transparent sputum
• Inspection– Dyspnea
• Auscultation - crackles
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