Health

1. Manifestations of respiratory system
dysfunctions
M. Tatar, J. Hanacek

2. Cardinal respiratory symptoms and signs
cough
sputum
dyspnea
wheezing
cyanosis
chest discomfort
chest pain

3. Disorders of lung mechanics

4. Disorders of the lung mechanics
• Airway obstruction
– nasal cavity: nasal congestion
– pharynx: collapse during sleep
– larynx: suffocation
– central aw:
• trachea: stridor
• main bronchi: dyspnea, wheezing
• lobar bronchi: asymptomatic or minor dyspnea
– peripheral aw: dyspnea
• Lung parenchyma ( or compliance): dyspnea
• Chest wall (abnormalities): dyspnea
• Respiratory muscles (fatigue): dyspnea

5. Disorders of airway
defence mechanisms

6. Disorders of airways defence mechanisms
• Nasal cavity
– sneezing
– nasal dyscharge
• Airways
– Cough: acute respiratory infections, foreign body
aspiration, chronic bronchitis, chronic cough
– Expectoration - Sputum
• mucoid (mainly macrophages)
• purulent (neutrophils)
• Pneumococcus - bloody or rust-colored
• Pseudomonas, Haemophilus - green sputum

7. Hyperplasia and hypertrophy of submucosal glands

8. Disorders of gas
exchange

9. Disorders of gas exchange
Respiratory insufficiency (failure)
– Hypoxemic
• Decreased ventilation/perfusion ratio
• Venous admixture
• Diffusion impairment
– Hypercapnic
• Overall alveolar hypoventilation
• Limits for hyperventilatory compensation
of decreased ventilation/perfusion ratio

10. Vznik hypoxémie vplyvom zníženia V/Q pomeru
?
20 40 60 80 100 120 mmHg
PaO2
C
C
D
C
A
C
B
C
20
10
Vol
%
O
2
Vysoký V´A=11
/2
V´A/Q´
Q´=1
V´A=1
/2 Nízky
V´A/Q´
Q´=1
Fyziologický V´A/Q´
V´A=1 V´A=1
Q´=1 Q´=1
’

11. Kompenzačné mechanizmy pri hyperkapnii
50
25
mmHg 20 40
60
PaCO2
Vol
%
CO
2
B
A
C
Nízky V´A=2
/3
V´A/Q´
Q´ = 1
V´A=11
/3
Vysoký Q´=1
V´A/Q´ Fyziologický V´A/Q´
Q´=1 V´A=1 V´A=1 Q´=1
11
/3 + 2
/3 = 2
P
Z

12. Disturbed regulation of breathing
Cheyne-Stokes respiration
Sleep apnea
Hyperventilation
Gasping
Hypopnea
Shortness of breath

13. Cheyne-Stokes breathing

14. General body responses
Fever
Weakness, fatigue
Decreased exercise tolerance
Immunity: eosinophilia
Weight loss: advanced disease

15. Cough
• Physiologic reflex
• Pathologic reflex
• Acute cough
• Chronic cough
– Rhinitis/sinusitis
– Asthma
– Gastroesophageal reflux disease

16. Dyspnea
• Air hunger, chest tighness
• Subject´s feelings – needs for increased ventilatory activity
• Tachypnoea with either shallow or deep breathing
• Increased workload of respiratory muscles – normal gas
exchange cannot be achieved without increased ventilatory
effort

17. Pathophysiology of dyspnea
• Hyperventilation – acute hypoxemia
• Relative hyperventilation - decreased ventilatory surfice
(atelectasis, pleural effusion, lung congestion,
pneumotorax)
• Disordered lung mechanics (most frequent cause)
- Upper airways stenosis
- Increased arways resistence = obstruction of peripheral
airways (asthma, COPD, heart failure)
- Decreased muscle force (polyomyelitis, diaphragm
paralysis, myastenia gravis)
- Limited chest movements (kyphoscoliosis)
- !!! acute or chronic state; rest or physical activity

18. Causes of dyspnea
 oxygen content in atmosphere
 oxygen consumption during physical activity
Lung function disorders
Heart function disorders
Decreased hemoglobin content (during exercise)
Respiratory center dysfunction (Cheyne-Stokes, acidosis)
Stimulation of airway and lung nerve-endings (pneumonia, lung
congestion)
Obesity
Emotive factors (chronic hyperventilatory syndrom)
Brain dysorders
Metabolic dysorders – hyperthyreosis

19. Hypoxemia
Tachycardia, tachypnea, dyspnea, mental status changes
Secondary polycythemia ( hematocrit)
Cyanosis
threshold for central cyanosis is a capillary reduced
hemoglobin content of 5 g/dL
!!! ancillary nonspecific signs

20. Relation between SaO2 and arterial Hb

21. Cyanosis
• Central
– hemiglobin – methemoglobin, sulphhemoglobin
– hemoglobin -  content of reduced Hb
• Heart disorders – lung congestion
• Lung disorders
– acute: pneumonia, lung edema
– chronic: COPD, severe lung fibrosis
• Peripheral
– local perfusion disorders
• False
– pigmentation (silver)

22. Peripheral and central cyanosis
Peripheral Central

23. Hypercapnia
Morning headaches
Papilledema, dilated conjunctival and superficial facial
blood vessels
CO2 narcosis: anxiety may progress to delirium and
somnolency

24. Primary respiratory disorders can significantly affect the
function of other systems
Most frequently CVS
Cor pulmonale
elevated jugular venous pulse, peripheral edema
Massive pulmonary embolism and tension pneumothorax
circulatory shock – hypotension, weakness, pale, sweaty,
oliguric, and develops impaired mentation
OSAS
daytime sleepiness, right heart failure, systemic arterial
hypertension