A Medical lecture about major manifestation of lung diseases in medicine.

1. Major manifestation of the lung diseases
1. Dyspnoea.
Acue & chronic.
2. Chest pain
Anginal Esophageal
Pleuretic Pericardial
3. Cough Acute & chronic
Productive & non productive
4, Hemoptysis
5. Cyanosis Peripheral & Central
Causes

2. Dyspnoea:
is unpleasant or uncomfortable breathing, Or
Subjective awareness of the sensation of breathing.
The experience of dyspnea likely results from a complex
interaction between chemoreceptor stimulation, mechanical
abnormalities in breathing, and the perception of those
abnormalities by the CNS.
causes according to physiological bases:
1. Increased ventilatory rate
a. Increase PaC02 e.g. COADs.
b. Decrease Pa 02, cyanotic CHD, COAD
c. Metabolic acidosis.
d. Exercise
e. Fever
2. Reduced Ventilatory capacity
a. Decrease lung volume
b. Increase resistance to air flow
c. Pleural pain

3. Grading
Mild
Moderate
Severe
Orthopnoea

4. D.D of chronic exertional dyspnoea:
1. COADs.
2. Heart diseases.
3. Interstitial lung diseases.
4. Large pleural effusion.
5. Severe anemia.
6. Chronic Pulmonary Thrombo-Embolism.
7. Psychogenic breathlessness:
8. Hysterical hyperventilation.

5. Psychologenic breathlessness
Is very important to be confident of the diagnosis
a. We should exclude other causes
b. Anxiety could be associated with other organic
Conditions
c. In some conditions such as Primary Pulmonary
Hypertension & Pulmonary thrombo-embolisation
There are no signs on examination
d. Anxiety related
e. Absent of symptoms on exertion
f. Unable to take deep breath with frequent sighing/
Erratic breathing
g. No signs on examination
h. Not able to do spirometry
i. Short breath holding time in the absence of severe respiratory
diseases
n. PaCO2 is low & PaO2 is high in ABG

6. Hysterical hyperventilation.
Severe hyperventilation associated with
Carpo-pedal spasm
Respiratory Alkalosis

7. Causes of acute dyspnoea
a.Cardiac, Acute myocardial infarction, pul. Oedema, pul.
Embolism, Papillary muscle dysfunction or rupture, Pericardial
effusion or tamponade
b. Respiratory, Acute severe asthma, acute
exacerbation of COAD, Pneumothorax, Pulmonary embolism
Pneumonia, ARDS, Inhaled foreign body, lobar collapse,
Laryngeal oedema, etc.
c. Metabolic, Diabetic ketoacidosis, Renal failure, Lactic
acidosis, Aspirin overdose.
E. Other causes, Diaphragmatic paralysis.

8. Paroxysmal nocturnal dyspnoea
Left ventricular failure
Nocturnal dyspnoea could be due to
Asthma
Sleep apnoea syndrome
Interstial lung diseases
GERD

9. Chest pain:
Anginal getting worse on exertion and relieved by
rest
Pleuretic getting worse on coughing and
inspiration
Pericrdial,
Oesophageal. getting worse on drinking hot
fluid

10. Cardiac causes:
1. Ischemic heart diseaeses, Angina, MI, Coronary
spasm.
2. Aortic dissection, sudden and tearing chest and back
pain.
3. Pericarditis, Pleuretic chest pain.
3. Myocarditis.
4. Hypertrophic cardiomyopathy.
5. Mitral valve prolapse
6. Cardiac arrythmias.
7. Aortic stenosis,

11. Pulmonary causes:
Causes pleuretic chest pain.
Is a chest pain exacerbated by forceful breathing or coughing
Causes include
1. Pleurisy
2. Pulmonary embolism
3. Pneumonia
4. Pneumothorax
5.Tracheobronchitis
6. Mediastinal emphysema
7. Pericarditis

12. Chest Wall causes..
All causes pleuretic chest pain
Costocondritis – Tietze syndrome
Rib fracture
Chest wall injury
Chest wall or rib malignancy
Myalgia
Herpes zoster infection
Neuritis-radiculitis
Thoracic outlet obstruction
Sickle cell disease

13. Gastrointestinal
Oesophagitis
Gastro esophageal reflux disorder
Esophageal Motility disorders
Biliary Colic
Gastointestinal perforation
Assessment of patients hemodynamic stability.
If the patient is stable a detailed history followed by physical
examination would help to limit the number of differentials.
Investigations like ECG, Chest X ray, ECHO, Cardiac enzyme
levels will rule in or rule out the commonest causes.
If the patient is unstable, effort must be taken to rule out the
critical etiologies like aortic dissection, myocardial infarction,
pneumothorax, pulmonary embolism and infarction, cardiac
arrhythmia, GI perforation, pancreatitis etc.

14. Mechanism of Cough
Cough is a protective reflex serving a normal physiologic function of
clearing excessive secretions and debris from the pulmonary tract.
Is the most frequent symptom of respiratory diseases.
It is productive or non productive
It is caused by stimulation of sensory nerves in the mucosa of the
pharynx, larynx, trachea and bronchi
cough

15. The cough reflex
It has 3 components: an afferent sensory limb, a central processing
center, and an efferent limb.
The Afferent sensory path way is mainly through vagus Nerve
Receptors are located throughout the airway from the pharynx to the
terminal bronchioles, with the greatest concentration located in the
larynx, carina, and the bifurcation of larger bronchi.
Afferent impulses are transmitted to the cough center of the brain,
which is poorly localized mainly in medulla ablongata and in the
nucleus tractus solitarius of the medulla. And also other brain parts
Efferent impulses leave the medulla and travel to the larynx and
tracheobronchial tree via the vagus, and superior laryngeal nerve
while the phrenic and spinal motor nerves of C3 to S2 supply the
intercostals muscles, abdominal wall, diaphragm, and pelvic floor.

16. Acute cough.
Less than 3 weeks
Acute coughs can be divided into infectious (caused by an
infection) and noninfectious causes.
Infectious causes of acute cough include
viral upper respiratory infections.
sinus infections,
pneumonia, lung abscess
whooping cough.
Noninfectious causes of cough include
Foreign body inhalations
Asthma
Exposure to irritants such as smoke or perfumes, change
of air temperature and environmental allergies.
•Angiotensin-converting enzyme inhibitor
•Psychological

17. Chronic cough
More than 8 weeks, This include
1. Enviromental irritants: cigarette smoke, irritant substance
2. Lung diseases
asthma, emphysema, and chronic bronchitis, bronchiectasis, Less
common causes of lung-induced chronic cough include. Bronchogenic
carcinoma, sarcoidosis, Fibrosing alveolitis.
3. Heart diseases Congestive heart failure.
4. Upper respiratory tract diseases:
Chronic sinusitis, Chronic post nasal drip, and chronic pharyngitis &
GERD
5. ACEI
6, psycholodical

18. Chronic cough continues
Causes of chronic cough with normal CX-Ray
1. Chronic bronchitis
2. Asthma
3. Post nasal drip,
4. Gastro-esophageal reflux
5. Eosinophilic bronchitis ( non asthmatic)
6. ACE inhibitor

19. Complications of cough
1. fainting spells due to decreased blood flow
to the brain when coughs are prolonged and forceful
2. Insomnia
3. cough-induced vomiting
4. Subconjectival hemorrhage
5. Spontaneous pneumothorax or Mediastinal
emphysema
6. Fractures of ribs
7.Cough induced urination and defecation
8. Prolapse of uterus in female
9. Abdominal and pelvic hernia

20. Hemoptysis.
Is the expectoration of blood or of blood-stained sputum
It comes from the bronchi, larynx, trachea, or lungs
Is alarming symptom and the patients nearly always seek medical
advice.
We should be able to differentiate it from Hematemesis, and some
times from epistaxis.
Hemoptysis must always be assumed to have a serious cause
until this is excluded.
Many episodes remain unexplained, even after full investigations
and are likely to be caused by simple bronchial infections.
A full history should be taken
All relevant investigations should be done.

21. Hemoptysis
Common cases less common causes
a. Acute bronchits 1. bronchial adenoma
b. Bronchiectasis 2. foreign body
c. Bronchogenic CA. 3. lung abscess
d. Pulmonary Embolism 4. truma
e. MS & Pul. Oedema 5. hydatid cyst
f. Pneumonia 6. aspergilloma
g. TB 7. actinomycosis
Other causes: Idiopathic Pul. Haemosiderosis
A-V malformation Polyareritis Nodosa Aortic
aneurysm Blood disorders, leukemia, hemophelia
anticoagulant, chronic bronchitis
Diagnosis
Treatment; according to the cause in severe cases
Tranexamic acid 1gm 8 hrly oraly
Bronchial artery embolisation

22. Cyanosis
is the appearance of a blue discoloration of the skin or mucous
membrane due to hypoxia.
The onset of cyanosis is 2.5 g/dL of deoxy-hemoglobin.
The bluish color is more readily apparent in those with high
hemoglobin counts than it is with those with anemia.
Also the bluish color is more difficult to detect on deeply pigmented
skin.
Cyanosis is divided in to two main types:
Central, Tongue and mucous membrane of the mouth
Peripheral, the extremities are affected, fingers, extremities. Ear
It develops when the arterial blood O2 saturation is about 85%.
The causes are diseases of CNS, Cardiovascular, Respiratory
systems. Les common causes include, Methhemoglobinemia,
polycythemia, high altidude, and hypothermia.
SPO2 of less than 92% is indication for O2 therapy

24. Summary
Major manifestation of the lung diseases are
common presenting symptoms of
respiratory lesions.