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- 1. Respiratory System Analysis & Diagnosis Assessment 1 Arul Selvan.S (Via Physiological Aspects) Third Professional Bachelor of Siddha Medicine & Surgery Government Siddha Medical College
- 3. Symptoms • Cough • Dyspnea • Chest Pain • Hemoptysis (Coughing up blood) • Wheeze / Stridor(High pitched breath sound) • Hoarseness of voice 3
- 4. Cough • 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? 4
- 5. Acute cough <3 week's • URI - Upper Respiratory Infection (URI or Common Cold) • Pneumonia • Pulmonary embolism 5
- 6. Subacute cough (3- 8 weeks) • 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 6
- 7. Chronic cough >8 weeks • 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 7
- 8. Nocturnal cough • Post nasal drip. • GERD • Chronic brochitis. • Bronchial asthma. • Obstructive sleep apnea 8
- 9. Sputum • Consistency • Amount • Color • Postural variation • Smell 9
- 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 necr debris or fluid caused by microbial infection. Necrotizing pneumonia (characterized by rapid progression consolidation to necrosis and cavitation which may lead to pulmon gangrene) Alveolar cell CA Empyema rupturing into bronchus Postural variation Lung Abscess & Bronchiectasis 11
- 12. Color of sputum 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. 12
- 13. • Foul Smell — Lung abscess Bronchiectasis Anaerobic bacterial infection. 13
- 14. Dyspnea • Within minutes Pneumothorax Pulmonary embolism Inhalation of foreign body Larnygeal edema 14
- 15. Dyspnea • Hours to Days ARDS (Acute respiratory distress syndrome) Bronchial Asthma Pneumoia 15
- 16. Dyspnea • 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 16
- 17. Haemoptysis Causes-- • Infection— TB Lung Abscess Bronchiectasis Pneumonia Fungal infection (aspergillosis, blastomycosis - inhali Blastomyces dermatitidis spores ) • Neoplasm--- Bronchogenic CA Bronchial adenoma Metastatic tumour 17
- 18. Causes-- • CVS - Cardiovascular system; MS (multiple sclerosis) PHT (pulmonary hypertension) Pulmonary embolism Arteriovenous malformations (abnormal connection betwee arteries and veins, usually in the brain or spine) • Collagen vascular disorder; Vasculitis Wegener’ s granulomatosis (Granulomatosis with polyangiitis can affect the lungs, Blood flow organs and tissues may be reduced, causing damage.) Goodpastures’s syndrome (anti-glomerular basement membrane disease, is rare autoimmune disease) • Traumatic; • Iatrogenic & Bleeding Disorders 18
- 19. Chest Pain • Site • Character • Aggravating/Relieving factor 19
- 20. • Retrosternal Pain :- • Upper • Tracheatis • Mid and Lower • Mediastinitis • Mediastinal tumor • GERD • Achalasia cardia (severe spasm of circular muscles of lower end in oesophagus) 20
- 21. 21 Examination
- 22. General condition-- • Built • Nourishment • Tripod position • Purse lip breathing 22
- 23. Pulse : • Bradycardia - Hypoxia. • Tachycardia - Pneumonia , Pulmonary Embolism, ARDS • Pulsus Paradoxus – Acquired severe asthma, COPD • Collapsing /bounding pulse — CO2 narcosis. 23
- 24. Respiratory Rate & Breathing Pattern-- • Tachypnoea > 20/min • Causes Pneumonia Acute pulmonary odema Pulmonary embolism ARDS Metabolic acidosis • Others causes • Fever , hypoxia, excitation, nervousness 24
- 25. Respiratory Failure Hypoxia • Irritability • Disorientation/ Confusion • Somnolence (feeling of drowsiness) • Bradycardia • Cyanosis • Seizures Hypercapnea • Anxiety • Delirium • Confused • Somonolence • Flapping tremors/ Asterixis • Thready or bounding pulse • Papillodema • Seizures 25 (Asterixis)
- 26. Anemia : • Chronic Infections – TB • Chronic inflammatory disorders – ILD • Malignancies. 26
- 27. Cyanosis Respiratory disorders • Acute severe Asthma • Tension Pneumothorax • Pulmonary AV malformations • Acute laryngeal oedema • ARDS 27
- 28. Lymphadenopathy • Sites • Number • Tender/Non-tender • Consistency • Fixed/Mobile • Overlying skin • Sinus 28
- 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 • 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. 31
- 32. Symmetry of chest-- • 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. 32
- 34. Manish Chandra Prabhakar 34 Rachitic Rosary
- 37. Symmetry of chest-- • Spinal deformity — Kyphosis , Scoliosis. • 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. 37
- 38. 38
- 39. 39 Scar
- 40. Dilated Veins 40
- 41. Palpation • Temperature • Tenderness • Position of trachea and apex beat • Movement of chest • Chest expansion • Tactile vocal fremitus • Others – flow in dilated veins, subcutaneous emphysema. 41
- 42. Local pain / tenderness • Empyema • Infiltration of chest wall by tumor • Osteomyelitis • Costochondritis • Herpes zoster 42
- 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 Asymmetrical expansion • Pleural effusion • Pneumothorex • Consolidation • Collapse • Fibrosis 44
- 45. Percussion • Position of Patient : Sitting • Anterior – Hands by the side • Posterior – Hands over opposite shoulders • Lateral – Hands over head. 45
- 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, Discontinuous Nonmusical 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—Arise from alveoli Coarse—Arise from bronchus & Bronchioles. 51
- 52. Wheeze ASTHMA BRONCHITIS VOCAL CORD DYSFUNCTION FOREIGN BODY ASPIRATION INFECTIONS – CROUP LARYNGITIS CONGESTIVE HEART FAILURE COPD CYSTIC FIBROSIS ILD FIBROSING ALVELOLITIS NOT ALL THAT WHEEZES IS ASTHMA 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 tion Midline Dull ↑ Bronchial (tubular) Crackles+ Rub+/- Fibrosis Same side Impaired ↑/↓, Bronchial Crackles+ Collapse (Major bronchus obstructio n) Same side Dull ↓ Vesicular None Collapse (Patent bronchus) Same side Dull ↑ Bronchial tubular Early – None Late – Coarse crackles 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