Introduction to respiratory diseases
المرحلة الرابعة-د.خلدون العبايجيSurface area of ventilation is 140 m2 .
Respiratory symptoms: cough, sputum, hemoptysis, dyspnea, chest pain, wheezes, others: fever, weight loss……..
Diseases: asthma, carcinoma, pneumonia, T.B, systemic diseases (SLE, rheumatoid arthritis), drugs causing lung diseases, .. Immunecompromised: HIV, lymphoma, metastasis.
Advances in therapy of respiratory diseases cystic fibrosis- gene therapy, asthma, ARDS- molecular & cellular, Lung transplant
Clinical examination
Observation: respiratory rate, catchexia, fever, rash, sputum, fetor, 02 , nebulisers, inhalers.
Pulse, B.P, temp., JVP
Hands, face, legs
Chest examination:
Inspection
palpation
Percussion
Auscultation
Sputum
Serous: clear, watery, frothy e.g pulmonary oedema, bronchoalveolar cancer.
Mucoid: gray white e.g COPD, asthma
Purulent: yellow, green, brown e.g infection
Rusty: pneumonia
Haemoptysis: acute bronchitis. Carcinoma, adenoma, AV malformation.
Common respiratory diseases
Viral infections
COPD
Asthma
Pneumonia
Pleural effusion
Tuberculosis
Bronchial cancer
Major manifestation of respiratory diseases
Cough
Sensory fibres stimulation in pharynx and lung parenchyma.
Causes: infection, carcinoma, allergy, asthma, drugs, GERD, nasal drip (sinusitis), pulmonary edema, psychogenic.
Dry, productive
Vocal cord paralysis: hoarseness, bovine cough. Stridor: major airway obstruction e.g laryngeal oedema, foreign body, tumor
Dyspnea
pathophysiology
A. Increased ventilatory drive: hypercapnoea, hypoxia, acidaemia, exercise, fever
B. Reduced ventilatory capacity:
- Diminished lung volume e.g ILD, pul.oedema, pneumonia
- Pleural pain
- Increased resistance to air flow e.g asthma, upper air way obstruction
Causes
A. Acute
- Cardiovascular: pulmonary oedema
- Respiratory: asthma, pneumothorax, pulmonary embolism
- Metabolic acidosis: uraemia, aspirin poisoning
- Psychogenic
B. Chronic
- Cardiovascular: chronic heart failure e.g valve disease, ischaemia.
- Respiratory: COPD, chronic asthma, CA bronchus
fibrosing alveolitis, pleural effusion
- Sever anaemia, obesity.
Other causes
Chest wall disease: kyphoscoliosis
Respiratory muscle paralysis: Gullian-Barre syndrome, motor neuron disease.
Diaphragmatic paralysis: increased dyspnea during lying.
Retrosternal goitre: compress trachea ( stridor
Chest pain
Central: massive pulmonary embolism, tracheitis, malignancy, cardiac, aortic aneurysm, esophageal, anxiety.
Peripheral: pleurisy e.g pul.infarction, pneumonia, T.B, malignancy, connective tissue disease.
others: musculoskeletal, neurological e.g prolapsed disc, herpes zoster, thoracic outlet syndrome.
Haemoptysis
causes
Bronchogenic carcinoma
foreign body inhalation
Acute bronchitis, bronchiectasis, lung abscess
Tuberculosis
Pulmonary infarction
Good pasteur syndrome
Cardiac: pulmonary oedema, mitral stenosis, aortic aneurysm
Blood diseases: leukaemia, haemophilia, anticoagulant.