The document summarizes several basic clinical syndromes related to disorders of the respiratory organs. It describes the key symptoms, signs, and diagnostic findings for bronchial obstruction, infiltrative consolidation of the pulmonary tissue, atelectasis, pulmonary emphysema, fluid accumulation in the pleural cavity, pneumothorax, and respiratory failure syndrome. For each syndrome, it provides details on inspection, palpation, percussion, and auscultation findings, as well as results of supplementary diagnostic techniques like radiography and spirometry.

1. Basic Clinical Syndromes in
Disorders of the Respiratory
Organs

2. •That is
a symptom?

3. • Symptom is one of the signs of a
disease.

4. •That is
a syndrome?

5. • A syndrome is a combination of
symptoms, united by a common
mechanism of their
development (pathogenesis).
Syndrome
3 symptom
2 symptom
1 symptom

6. Basic Clinical Syndromes in Disorders of the
Respiratory Organs
Bronchial obstruction
Infiltrative consolidation of the pulmonary tissue
Atelectasis
Obstructive
Compression
The air cavity in the lung
Pulmonary emphysema
Fluid accumulation in the pleural cavity
Pneumothorax
Respiratory failure syndrome

7. Bronchial obstruction
• Bronchial obstruction is disorder in bronchial patency caused by
• a spasm of smooth muscles
• swelling of the mucous membrane
• bronchial obstruction with sputum
• as well
• cicatrice bronchial constriction
• external compression caused by a tumor.

8. • Asthma
• airway are inflamed due to irritation and
bronchioles constrict due to smooth muscle
spasms.
Well inflamed and thickened
Air trapped in alveoli
Smooth muscle
spasms

9. • Bronchitis
• airway are influenced due to infection
(acute) or due to an irritant (chronic).
• Coughing brings up mucus.

10. Bronchial obstruction

11. BRONCHIAL OBSTRUCTION
Dyspnea of an expiratory type, attacks of dyspnea, cough,
glassy mucus.
Tachypnea; diffuse cyanosis; forced position. The thorax is
expanded, the neck veins are swollen
No changes are detected, but maybe ↓Voice trembling
attenuation (asthma attacks)
No changes are detected, but maybe a bandbox sound
(asthma attacks)
harsh respiration, dry wheezing (Wheezes (asthma) or
Rhonchus (bronchitis))

12. Supplementary techniques of investigation
• Spirography shows reduced forced
VCL (FVCL) and MVL, VFE1 and
VFE1 / VCL (Tiffeneau’s Index).
• VCL - Vital capacity of the lungs - a sum
of the tidal volume, inspiratory and
expiratory reserve volumes.
• It equals to 3700 ml on average.
• FVCL - Forced vital capacity of the lungs
and the volume of forced expiratory
volume per 1 second (VFE1) during
Votchal – Tiffeneau test.
• MVL - maximum ventilation of the lungs.

13. Spirography
• Spirography is a method for
examination of the pulmonary
ventilation by measuring the
pulmonary tidal volumes.

14. • Pneumotachometry: decreased
peak expiratory flow rate.

15. • Radiography:
• enhanced pulmonary pattern.

16. Sputum examination
• Research can be macroscopic, microscopic and bacteriological.
• During macroscopic examination color, odor, character, consistency
of sputum, as well as various inclusions in it are determined.

17. Sputum examination
(Asthma)
• Macroscopic examination
• Glasses sputum
• Sputum has bronchus form

18. Sputum examination
(Asthma)
• Microscopic examination
• Kurschman’s spirals (detected
in asthma) are transparent fibers
of mucus with convoluted shiny
thread in the center coated with
eosinophils, columnar
epithelium and Charcot-Leuden
crystals (shiny smooth colorless
rhombs, consisting of protein
from disintegrated eosinophils).
Kurschman’s spirals
Charcot-Leuden
crystals
Eosinophils

19. Kurschman’s spirals
Charcot-Leuden crystals

20. Sputum examination
(bronchitis)
Macroscopic
• Mucopurulent
•
Microscopic
• The cylindrical ciliated epithelium is
specific for bronchitis

21. SYNDROME OF INFILTRATIVE CONSOLIDATION
OF THE PULMONARY TISSUE
• Pulmonary infiltration is a
pathological condition caused by
the accumulation of cellular
elements and of fluid in the
pulmonary tissue.
• Alveoli fill with a thick fluid,
leaking gas exchange difficult
• It is noted in pneumonia

22. Cross-sectional view of
alveolar consolidation in
pneumonia.
AC, Alveolar consolidation;
L, leukocyte;
M, macrophage;
RBC, red blood cell;
TI, type I cell.

23. INFILTRATIVE CONSOLIDATION OF THE PULMONARY TISSUE
dyspnea, cough, dry or with a mucopurulent sputum, hemoptysis,
chest pain
tachypnea, delay of the affected part of the thorax in an act of
breathing
increased voice trembling over the focus of consolidation
Dull or dulled percussion sound
Broncho-vesicular or Pathological bronchia respiration. Additional
respiratory sounds: moist and dry wheezing, pleural rub, crepitation.

24. Supplementary methods
• Thoracic radiography:
• infiltrative consolidation is
determined as a shadow of an
irregular shape with an obscure
contour.

25. • Spirography:
• restrictive type of disorder in
alveolar ventilation, with
decrease in VCL and MVL.

26. Sputum examination
Sputum should be collected into a clean container
in the morning when it is most rich in microflora.
Microbiological examination of sputum
(inoculation for nutrient medium) provides for
establishing etiology of disease and determination
of sensitivity of microorganisms to antibiotics.

27. Atelectasis
• Atelectasis is a pathological
condition of the lung or its part, in
which pulmonary alveoli contain no
air, and their walls collapse.
• In atelectasis respiratory surface
area of ​​the lung decreases, arterial
hypoxemia develops, which may
lead to respiratory failure.

28. • ATELECTASIS may be due to airway obstruction, or
compression of the lung.

29. Mechanisms of atelectasis
• A, Collapse of the lung in
pneumothorax (compression
atelectasis).
• B, Compression of the lung
by pleural fluid (compression
atelectasis).
• C, Resorption of the air from
alveoli distal to an obstructed
bronchus.
Obstructive atelectasis is
usually focal.

30. Obstructive atelectasis
• Obstructive atelectasis develops as a
result of obstruction of the bronchial
lumen by:
• mucus,
• viscous sputum,
• tumor
• a foreign body
• as well as of compression of bronchus
by
• a lymph gland
• scar tissue

32. Obstructive atelectasis
shortness of breath and persistent cough
puffy face, tachypnea, diffusive cyanosis, decreased the volume of
the affected part of the thorax and its delay in an act of breathing
Voice trembling is absent
Dull sound
Absent or decreased breath sounds

33. Compression atelectasis
• This syndrome develops due to
external compression of the
pulmonary tissue by a large
amount of fluid (hydrothorax)
or air (pneumothorax)
in the pleural cavity.

34. Compression atelectasis
dyspnea, palpitation
cyanosis, delay of the affected half of the thorax in an act
of breathing, flattening or bulging of the intercostal spaces
voice trembling over the area of atelectasis is increased
dull or dull-tympanic sound
pathological bronchial respiration

35. Supplementary techniques
In compression atelectasis: a) mediastinal organs are displaced to
the unaffected side; b) the cupula of the diaphragm is lowered on
the affected side.
a)
b)

38. Syndrome of the aerial cavity in the lung
• The aerial cavity in the lungs is a
local cavernous structure
resulting from destruction of the
pulmonary tissue.
• In some cases, this structure
communicates with a bronchus.

39. • Lung abscess.
• A, Cross-sectional view of lung abscess.
• B, Consolidation and
• (C) excessive bronchial secretions are common secondary anatomic alterations of
the lungs.
• AFC, Air-fluid cavity;
• EDA, early development of abscess;
• PM, pyogenic membrane;
• RB, ruptured bronchus
(and drainage
of the liquefied
contents of the cavity).

40. Syndrome of the air cavity in the lung
productive cough (sputum is expectorated in a large amount,
reaching 500 ml per day, with a putrid odor), hemoptysis
Delay of the affected part of the thorax in an act of breathing.
finger-clubbing
amplified voice trembling is determined
tympanic percussion sound
pathological bronchial respiration. sonorous and moist
medium - and large bubbling wheezing

41. • Radiography: the aerial
cavity is light-colored, the
fluid level and area
of perifocal infiltration
are seen.

42. Sputum examination
• During the microscopic examination the following components can be
determined:
• Dietrich’s corks (can be found in gangrene, pulmonary abscess,
bronchiectasis)
• white lumps of a millet grain size, consisting of bacteria, cellular
debris, and crystals of fatty acids, they produce malodor on crushing
them.

43. Dietrich’s corks
Macroscopy Microscopy
Elements Dietrich corks in the sputum
Drops of neutral fat
Needle fatty acids

44. • Elastic fibers occur in the decay
of the pulmonary tissue,
pulmonary abscess or gangrene.

45. PULMONARY EMPHYSEMA
• Increased airiness of the
pulmonary tissue, or
emphysema is a pathological
condition characterized by
expansion of the air spaces in
the lungs resulting from reduced
elastic properties of the
pulmonary tissue.

46. • Alveoli burst and fuse into enlarged air spaces.
• Surface area for gas exchange is reduced.

47. PULMONARY EMPHYSEMA
dyspnea and dry cough
cyanosis, expiratory dyspnea, barrel-shaped thorax
The thorax is rigid. Voice trembling is attenuated.
Bandbox sound. Increased widths of Kroenig’s fields. The inferior margin of
the lung is lowered, mobility of the lower pulmonary margin is reduced.
decreased breath sounds

48. Barrel-chest

49. Diagnostic techniques
• Radiography study:
• increased transparency of the
pulmonary fields, expansion of
the intercostal spaces, lowering
of the inferior margins of the
lungs, low mobility of the
diaphragm

50. • Spirography:
• decrease in the rate of forced expiration, in Tiffeneau
index, in VCL, and increase in residual volume.

51. SYNDROME OF FLUID ACCUMULATION
IN THE PLEURAL CAVITY
• A pleural effusion is an
excess fluid that
accumulates in the pleural
cavity.
• This excess can impair
breathing by limiting the
expansion of the lungs.
• ,

52. • Various kinds of pleural effusion,
depending on the nature of the
fluid are
• hydrothorax (serous fluid),
• hemothorax (blood),
• chylothorax (chyle),
• pyothorax (pus).

53. Hydrothorax (serous fluid) Hemothorax

54. Chylothorax
(chyle)
pyothorax (pus)

55. SYNDROME OF FLUID ACCUMULATION IN THE PLEURAL CAVITY
cough
delay chest expansion on the affected side, increased
respiratory rate, possible cyanosis
chest expansion decreased on the affected side, tactile
fremitus decreased or absent over the involved area
dull over affected area
breath sounds decreased or absent over involved area

56. Three zones can be identified in the affected side in the presence of
exudate in an objective study.
Line of Sokolov - Ellis – Damoiseau (2)
1. The first zone is the location area of
exudate (1)
2. The second zone has a triangular
shape and is called Garland’s triangle
(3) (Compression atelectasis).
3. The third zone is located over the
Garland’s triangle (4)

57. • If the fluid in
the pleural cavity
is transudate, only
two areas can be
determined -
transudate area
and area of the
lung over the fluid
level.
transudate area
area of the
lung over the
fluid level
Compression
atelectasis

58. Diagnostic techniques.
• Radiography: intensive uniform shadowing, with a
clear oblique superior margin corresponding to the line
of Sokolov - Ellis - Damoiseau (in pleural effusion) and
horizontal level (in transudate).
transudate
line of Sokolov - Ellis -
Damoiseau
exudate

60. Differential diagnostic distinctions between
pleural exudate and transudate
Signs Exsudate Transudate
Appearance of liquid Turbid,
frequent hemorrhagic, can
be purulent,
has a smell
Transparent,
slightly yellowish,
sometimes colorless,
has no smell
The protein content > greater than 30 g/l < less than 30 g/l
Density > greater than 1,018 kg/l < less than kg/l
Rivalt’s test Positive Negative
Amount of leukocytes in
pleural liquid
> greater than 1000 in 1
mm3
< less than in 1 mm3

61. AIR ACCUMULATION SYNDROME IN THE
PLEURAL CAVITY (pneumothorax)
• Pneumothorax is a pathological condition
characterized by accumulation of the air
between the visceral and parietal pleura.

64. SYNDROME OF AIR ACCUMULATION IN THE PLEURAL CAVITY
stabbing pain in the thorax, dyspnea, dry cough,
palpitations
On the affected side the volume of the thorax is increased.
The affected side of the chest retards in an act of breathing
voice trembling is attenuated
high tympanic sound
breath sounds decreased or absent over involved area

65. Diagnostics.
Radiography: parietal light color without the lung pattern is seen. The
mediastinal organs are displaced to the unaffected side and the cupula of the
diaphragm on the affected side is shifted inferiorly.

66. Syndrome Inspection Palpation Percussion Auscultation
Bronchial
obstruction
Tachypnea; diffuse cyanosis; forced
position
No changes are detected
/ ↓voice trembling
No changes /
bandbox sound
Harsh respiration, dry wheezing
Emphysema Cyanosis expiratory dyspnea
Barrel-shaped thorax
↓Voice trembling Bandbox sound Decreased breath sounds
Infiltrative
consolidation
Tachypnea
Delay of the affected part in an act of
breathing
Voice trembling is
increased
Dull or dulled
percussion
sound
Broncho-vesicular or Pathological
bronchia respiration, moist
wheezing, pleural rub crepitation
Obstructive
atelectasis
Decreased the volume of the affected
part and its delay in an act of
breathing
Voice trembling is absent Dull sound Absent or decreased breath sounds
Compression
atelectasis
Delay of the affected half in an act of
breathing
Voice trembling is
increased
Dull or dull-
tympanic sound
Pathological bronchial respiration
Air cavity in the
lung
Delay of the affected half in an act of
breathing
Voice trembling is
increased
Tympanic sound Pathological bronchial respiration.
moist medium - and large bubbling
wheezing
Hydrothorax Delay of the affected half in an act of
breathing
↓Voice trembling Dull sound Breath sounds decreased or absent
Pneumothorax Delay of the affected half in an act of
breathing
↓Voice trembling Tympanic sound Breath sounds decreased or absent

67. RESPIRATORY FAILURE SYNDROME
Respiratory failure is
a pathological condition of the body,
in which the respiratory system fails to support
the normal arterial blood gas level,
or it is achieved with the help of the
compensatory mechanisms of the external
breathing and the heart.

68. Causes of
respiratory
failure
Decreased
of alveolar ventilation
Decrease diffusion of
oxygen and carbon
dioxide through the
alveolar-capillary
membrane
Disorder blood flow in
pulmonary capillaries

69. Signs of
respiratory
insufficiency
Dyspnea
Cyanosis
Tachycardia

70. Three types of disorders in alveolar
ventilation
Obstructive Restrictive Combined

71. obstructive
restrictive
combined
normal bronchus

72. RESPIRATORY FAILURE
Acute Respiratory Failure
1 stage 2 stage 3 stage
Chronic Respiratory Failure
1 stage 2 stage 3 stage

73. Acute Respiratory Failure
Acute respiratory failure is a severe condition that results from the
inability to breathe enough or the inability of the lungs to diffuse
adequate amounts of oxygen into the blood, or a combination of
both.

74. Stages of acute respiratory failure
The 1st stage — initial.
It’s characterized by:
— The compelled position of the patient.
— Expressed cyanosis of skin and mucous membranes.
— Excitation, trouble, sometimes delirium, hallucinations.
— Accelerated respiration up to per 40 per minute.
— Participation of auxiliary respiratory muscles in the respiratory act.
— Tachycardia up to 120 per minute.
— Moderate arterial hypoxemia (Ра О2 — 60–70 mm of Hg) and
normocapnia (Ра СО2 — 35–45 mm of Hg).

75. Stages of acute respiratory
failure
The 2nd stage — deep hypoxemia.
It’s characterized by:
— The poorest condition of patients.
— Superficial respiration, patients convulsively suffice with a mouth air.
— The compelled position of the patient.
— Alternation of the periods of excitation with sleepiness periods.
— Frequency of breath exceeds 40 per minute.
— Frequency of cardiac contractions is above 120 per minute.
— Hypoxemia is revealed in blood (РаО2 — 50–60 mm of Hg)
and hypercapnia (Ра СО2 — 50–70 mm of Hg).

76. Stages of acute respiratory failure
The 3rd stage — hypercapnic coma.
It’s characterized by:
— Loss of consciousness.
— Expressed diffusive cyanosis.
— Cold sticky sweat.
— Pupils are expanded (mydriasis).
— Superficial, rare, often arrhythmic respiration — Chejn-Stoks type.
— Sharp hypoxemia is revealed in blood (РаО2 — 40–55mm of Hg) — and
expressed hypercapnia (Ра СО2 — 80–90 mm of Hg).

77. Chronic Respiratory Failure
• Chronic respiratory
failure is a result of
progressive pulmonary
disorders.

78. Symptoms of chronic respiratory failure often
include
•persistent cough
•dyspnea, especially with exertion
•diminished cognitive ability or confusion
•cyanosis
•fatigue
•edema (swelling, typically in the hands and feet)

79. Stages of chronic respiratory insufficiency
Stages
I
(compensated)
II
(subcompensated)
III
(decompensating)
Breathlessness On the severe physical
exertion
On daily exertion At rest
Cyanosis No Appears on exertion Diffusive constant
Participation of auxiliary
muscles in the respiratory act
Do not participate Participate on exertion Participate at rest
Frequency of respiration (per
minute)
May be norm More than 20 at rest More than 20 at rest
Ventilating disorder Decrease in indicators
up to 80–50 %
Decrease in indicators up
to 50–30 %
Decrease in indicators
below 30 %