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Respiratory System Analysis & Diagnosis Assessment
- 1. Respiratory System Analysis & Diagnosis Assessment 1 (Via Physiological Aspects) Shri.Dr.S.Arul selvan BSMS.,(CRRI) @Government Siddha Medical College & Hospital, Tirunelveli. Mail ID: aaalselvan2000gmail.com
- 3. Symptoms 3 • • • • • • Cough Dyspnea Chest Pain Hemoptysis (Coughing up blood) Wheeze / Stridor(High pitched breath sound) Hoarseness of voice
- 4. Cough 4 • • • • • • Is it acute, subacute or chronic? Dry or Productive? Associated symptoms – fever, dyspnea, chest pain, etc.? Risk factors – Smoking, environmental factors, HIV, family h/o TB ? Symptoms of postnasal discharge, GERD(Acid reflux)? Is the patient on ACE (Angiotensin converting enzyme)inhibitor?
- 5. Acute cough <3 week's 5 • • • URI - Upper Respiratory Infection (URI or Common Cold) Pneumonia Pulmonary embolism
- 6. Subacute cough (3- 8 weeks) 6 • • • • Viral infections Post infectious Post nasal drip (Secretions from the nose that drain down into the throat, causing congestion and cough. Postnasal drip is usually caused by allergies or the common cold) GERD
- 7. Chronic cough >8 weeks 7 • • • • Pulmonary Tuberculosis Asthma COPD (Chronic obstructive pulmonary) disease Bronchogenic CA (Bronchogenic carcinoma begin as a small focus of atypical epithelial cells within the bronchial mucosa.) • Eosinophilic bronchitis (Airway inflammation due to • • excessive mast cell recruitment) Post nasal drip GERD
- 8. Nocturnal cough 8 • • • • • Post nasal drip. GERD Chronic brochitis. Bronchial asthma. Obstructive sleep apnea
- 10. Serous Mucoid Mucopurulent URI Bronchoalvelolar CA Chronic bronchitis, Bronchial Asthma Bacterial infection. Consistency 10
- 11. Sputum : Copious Amount ❖ Bronchiectasis (condition in which the lungs airways become dama making it hard to clear mucus.) ❖ Lung Abscess - formation of cavities (more than 2 cm) containing nec debris or fluid caused by microbial infection. ❖ Necrotizing pneumonia (characterized by rapid progression consolidation to necrosis and cavitation which may lead to pulmo gangrene) ❖ Alveolar cell CA ❖ Empyema rupturing into bronchus Postural variation ➢ Lung Abscess & Bronchiectasis 1
- 12. Color of sputum 12 ❖Yellow / Green — Bacterial infection ❖Black — coal worker pneumoconiosis (inhalation of dust has caused interstitial fibrosis) ❖Pink frothy sputum — Pulmonary edema ❖Anchovy sauce ( Brown colored pus to compared this one )— Ruptured amoebic liver abscess.
- 13. • Foul Smell — ❖Lung abscess ❖Bronchiectasis ❖Anaerobic bacterial infection. 13
- 14. Dyspnea 14 • Within minutes ❖Pneumothorax ❖Pulmonary embolism ❖Inhalation of foreign body ❖Larnygeal edema
- 15. Dyspnea 15 • Hours to Days ❖ARDS (Acute respiratory distress syndrome) ❖Bronchial Asthma ❖Pneumoia
- 16. Dyspnea 16 • Weeks to Months ❖ COPD ❖ILD - Interstitial Lung Disease (umbrella term used for a large group of diseases that cause scarring fibrosis of the lungs) ❖Pleural effusion ❖ Anemia ❖Thyrotoxicosis
- 17. Haemoptysis Causes-- • Infection— ➢ TB ➢ LungAbscess ➢ Bronchiectasis ➢ Pneumonia ➢ Fungal infection (aspergillosis, blastomycosis - inhal Blastomyces dermatitidisspores ) • Neoplasm--- ➢ BronchogenicCA ➢ Bronchial adenoma ➢ Metastatictumour 17
- 18. Causes-- • CVS - Cardiovascularsystem; ➢ MS (multiple sclerosis) ➢ PHT (pulmonary hypertension) ➢ Pulmonary embolism ➢Arteriovenous malformations (abnormal connection betwe • ➢ arteries and veins, usually in the brain or spine) Collagenvasculardisorder; Vasculitis ➢ Blood flo Wegener’s granulomatosis (Granulomatosis with polyangiitis can affect the lungs, organs and tissues may be reduced, causing damage.) ➢ is Goodpastures’s syndrome (anti-glomerular basement membrane disease, rare autoimmune disease) • Traumatic; • Iatrogenic & Bleeding Disorders 18
- 20. • • 20 Retrosternal Pain :- Upper • Tracheatis • Mid and Lower • Mediastinitis • Mediastinal tumor • GERD • Achalasia cardia (severe spasm of circular muscles of lower end in oesophagus)
- 21. Examination 21
- 22. General condition-- • • • • Built Nourishment Tripod position Purse lip breathing 22
- 23. Pulse : • • Bradycardia - Hypoxia. Tachycardia - Pneumonia , Embolism, • Paradoxus – severe asthma, Pulmonary ARDS Pulsus Acquired COPD • Collapsing /bounding pulse — CO2 narcosis. 23
- 24. Respiratory Rate & Breathing Pattern-- 24 • Tachypnoea> 20/min • Causes ➢ Pneumonia ➢ Acute pulmonaryodema ➢ Pulmonaryembolism ➢ ARDS ➢ Metabolicacidosis • • Others causes Fever , hypoxia, excitation, nervousness
- 25. Respiratory Failure Hypoxia • • • • • • Irritability Disorientation/ Confusion Somnolence (feeling of drowsiness) Bradycardia Cyanosis Seizures Hypercapnea • • • • • • • • Anxiety Delirium Confused Somonolence Flappingtremors/ Asterixis Thready or bounding pulse Papillodema Seizures 25 (Asterixis)
- 26. Anemia : 26 • • • Chronic Infections – TB Chronic inflammatory disorders – ILD Malignancies.
- 27. Cyanosis 27 ▪ Respiratory disorders • Acute severe Asthma • Tension Pneumothorax • PulmonaryA V malformations • Acute laryngeal oedema • ARDS
- 29. Lymphadenopathy Causes-- • • • • • • URI Tuberculosis HIV Sarcoidosis Lung Carcinoma Lymphoma 29
- 30. Clubbing • Causes ➢Bronchogenic CA ➢Bronchiactasis ➢Lung abscess ➢Empyema ➢Cystic fibrosis ➢Interstitial lung disorder ➢Unilateral clubbing — Pancoast tumour 30
- 31. Inspection 31 • Symmetry of chest • Position of Trachea • Position of Apex impulse • Movements of chest • Accessory muscles • Hollowness/Bulging/flattening/retraction/ crowding of ribs • Kyphosis / Scoliosis. • Scar/sinus/dilated veins.
- 32. Symmetry of chest-- 32 • Flat chest — Pulm TB,Fibrothorax • Barrel chest — COPD (Emphysema) • Pectus carinatum -- rickets, marfan’s syndrome, • • • Down’s, Noonan, osteogenesis imperfecta. Rachitic rosary — rickets. Scorbutic rosary - Vit C Def. Pectus excavatum (cobbler’s chest or funnel chest)-- Marfan’s syndrome, spinal muscular atrophy.
- 34. Manish Chandra Prabhakar Rachitic Rosary 34
- 37. Symmetry of chest-- • Spinal deformity — Kyphosis , Scoliosis. 37 • • Bulging — Pleural effusion, Pneumothorax, empyema necessitans (pleural space infections and occurs when the infected fluid dissects spontaneously into the chest wall from the pleural space. Flattening or depression — Fibrosis, Collapse.
- 38. 38
- 39. Scar 39
- 40. Dilated Veins 40
- 41. Palpation 41 • • • • • • • T emperature Tenderness Position of trachea and apex beat Movement of chest Chest expansion Tactile vocal fremitus Others – flow in dilated veins, subcutaneous emphysema.
- 42. Local pain / tenderness 42 • • • • • Empyema Infiltration of chest wall by tumor Osteomyelitis Costochondritis Herpes zoster
- 43. • • Chest expention – Normal 2 inch < 1.5 inch..abnormal • • Chest movements are assessed in all areas. Inspection is better then palpation (for movements) 43
- 44. Chest expansion General Restriction • • • • • Extensive bilateral disorder (abnormal accumulation of surfactant-derived lipoprotein compounds within the alveoli of the lung) COPD ILD Ankylosing spondylitis Spinal deformity • • • • • 44 Asymmetrical expansion Pleural effusion Pneumothorex Consolidation Collapse Fibrosis
- 45. Percussion 45 • Position of Patient : Sitting • • • Anterior – Hands by the side Posterior – Hands over opposite shoulders Lateral – Hands over head.
- 46. 46
- 48. Percussion • • • • • • Resonant - normal lung Tympanic – Hollow viscous Hyper-resonant - Pneumothorax Impaired - Pulmonary fibrosis. Dull – Consolidation, Collapse, Pleural thickening Stony dullness– pleural effusion, empyema. 48
- 50. Type / Nature Vesicular • • • • Soft, Low pitched ~ 100 Hz Gentle rustling Continuous Inspiration > Expiration • • • • Bronchial Loud, High pitched 300 – 400 Hz Hollow Pause Inspiration = < Expiration 50
- 51. Crackles • • Short, Explosive, DiscontinuousNonmusical sounds Bubbling/ clicking /Explosive sounds • Mechanism: • • Flow of air through secretions Sudden opening of a succession of small airways, due to rapid equalization of pressure between 2 airway compartments • Types—Fine—Arisefrom alveoli Coarse—Arise from bronchus& Bronchioles. 51
- 52. Wheeze ◆ ◆ ◆ ◆ ◆ ASTHMA BRONCHITIS VOCAL CORD DYSFUNCTION FOREIGN BODYASPIRA TION INFECTIONS – CROUP LARYNGITIS ◆ ◆ ◆ ◆ ◆ CONGESTIVE HEART FAILURE COPD CYSTIC FIBROSIS ILD FIBROSING ALVELOLITIS NOTALLTHAT WHEEZES ISASTHMA 52
- 53. Pleural rub • Friction of inflamed visceral & parietal pleural surfaces against each other in respiration • Creaking leathery sound • During both phases • Best heard at Lateral & Posterior bases of lung 53
- 54. Disease Mediastin al shift Percussion Breath sounds Added sounds Consolida Midline Dull ↑ Crackles+ Rub+/- tion Bronchial (tubular) Fibrosis Same side Impaired ↑/↓, Crackles+ Bronchial Collapse Same side Dull ↓ Vesicular None (Major bronchus obstructio n) Collapse Same side Dull ↑ Early – None Late (Patent Bronchial – Coarse crackles bronchus) tubular 54
- 55. Disease Mediastinal shift Percussi on Breath sounds Added sounds Cavity Midline or Same side(if associated fibrosis) Impaired ↑ Bronchial (Cavernous) Crackles +/- Pleural Effusion Opposite side Stony dull ↓ or Absent, above level - Bronchial Pleural rub above level Pneumoth orax Opposite side Hyper- resonant ↓ or Absent None Emphyse ma Midline Hyper- resonant Low Wheeze +/- But low 55
- 56. Clinical Examination of the Respiratory system Hands; ✓ Digital Clubbing (tar staining) ✓ Peripheral cyanoisis, ✓ Signs of occupation, ✓ CO2 Retention flap. Radial pulse; ✓ Rate, ✓ Rhythm. Blood pressure; ✓ Arterial paradox? Jugular venous pulse (JVP) ✓ Elevated? ✓ pulsatile? 56
- 57. Clinical Examination of the Respiratory system Face, Mouth, Eyes; Pursed lips? Central cyanosis, Anaemia? Horner’s sysndrome. Inspection; Scars, Deformity(e.g, pectus excavatus) Intercostal indrawing? Hyperinhalation? Paradoxical rib movement?
- 58. Clinical Examination of the Respiratory system Leg oedema; Cor pulmonale? Pulmonary artery thrombosis?