manifestation of respiratory disease 3rd year د فاخر عملي

Objectives 1-to enumerate the main respiratory features . 2-to discuss each one of them . 3-to make approach of diagnosis .


Respiratory diseases share the same manifestation from simple diseases like flu to the more serious disease like bronchogenic carcinoma. So we have to concentrate on these manifestation to differentiate between them.
1- cough 2- sputum 3- haemoptysis 4-chest pain 5- dyspnea 6-cyanosis 7-clubbing

cough

Dry or productive: Dry >> bronchitis Productive >> smoker, chronic bronchitis Painful or painless: change in the pattern of cough example from normal to bovine and the patient has horsiness of voice. If the cough persists for more time 2-3weeks the patient should be send to the chest x-ray (CXR).

sputum

expectorated secretions which are produced out by coughing. *quantity: small or large. *quality: thin or thick(purulent). *color: white , yellow (mean there is infection) or green (must serious one). If the sputum mixed with blood called Hemoptysis. How we deal with sputum? 1.Gross examination. 2. Microscopical examination.

Investigation

1. Gram stain: for bacterial examination. 2.AFB(acid fast bacillus) :for tuberculosis. 3.Cytology: for bronchiogenic carcinoma.

Hemoptysis

it is coughing of blood whether mixed with the sputum or pure. It may be small in amounts or large in amounts. The causes of large amounts of hemoptysis: 1. Bronchiectasis. 2. Lung abscess. 3. Tuberculosis.



CHEST PAIN
is a frequent manifestation of both cardiac and respiratory disease and is considered in detail on. Pleural or chest wall involvement by lung disease gives rise to peripheral chest pain which is exacerbated by deep breathing or coughing). Central chest pain suggests heart disease but occurs with tumours affecting the mediastinum, oesophageal disease) or disease of the thoracic aorta).

Chest pain

Chest pain : Cardiac Lung Esophagus Aorta Central :angina pectoris Peripheral :pneumonia


Cardiac Myocardial ischaemia (angina) Myocardial infarction Myocarditis Pericarditis Mitral valve prolapse syndrome Aortic Aortic dissection Aortic aneurysm

Esophageal Oesophagitis Oesophageal spasm Mallory-Weiss syndrome Massive pulmonary embolus Mediastinal Tracheitis Malignancy

Lungs/pleura Pulmonary infarct Pneumonia Pneumothorax Malignancy Tuberculosis Connective tissue disorders

Musculoskeletal2 Osteoarthritis Costochondritis (Tietze's Rib fracture/injury syndrome) Intercostal muscle injury Epidemic myalgia (Bornholm disease) Neurological Prolapsed intervertebral disc Herpes zoster Thoracic outlet syndrome

Breathlessness or dyspnea

can be defined as the feeling of an uncomfortable need to breathe. It is unusual among sensations in having no defined receptors, no localized representation in the brain, and multiple causes both in health (e.g. exercise) and in diseases of the lungs, heart or muscles.


Dysponea : shortness of breathHeart failureRespiratory failurePneumoniaAsthmaMetabolic :diabetic ketoacidosis –renal failure


Dyspnea in asthma is associated with episodes of wheeze or chest tightness, varying in severity over time, but usually worse in the morning and often waking the patient overnight. There may be a history of childhood wheeze, or of wheeze or rhinitis provoked by pollens, dusts, household pets or occupational allergens. In exercise-induced asthma, wheeze and chest tightness typically come on immediately after exercise.
Asthma


Heart disease Impaired left ventricular function can cause exertional dyspnoea. Orthopnea, cough and wheeze may also be present, as in lung disease. A history of angina or hypertension may be useful in implicating a cardiac cause. On examination, an increase in heart size as judged by a displaced apex beat, a raised JVP and cardiac murmurs may indicate cardiac disease (although these signs can occur in severe cor pulmonale). The chest X-ray may show cardiomegaly

Cyanosis

clubbing
loss of the angle between the nail and nail bed. normally the angle 175 (less than 180 ) and becomes 180 and more in clubbing. Clubbing characterized by : 1. Increase curvature of the nail. 2. Swelling of the terminal phalanges (drumstick). Causes of the clubbing: 1. Lung abscess. 2. Fibrosing alveoli. 3. Bronchiogenic carcinoma.