2015/12/9 باطنية / د.فاخر

Objectives 1-to enumerate the main respiratory features . 2-to discuss each one of them . 3-to make approach of diagnosis .

باطنية / د.فاخر 2015/12/9 Respiratory diseases share the same manifestation from simple diseases like flu to the more serious disease like bronchiogenic carcinoma. So we have to concentrate on these manifestation to differentiate between them.

1- cough 2- sputum 3- haemoptysis 4-chest pain 5- dyspnea 6-cyanosis باطنية / د.فاخر 2015/12/9 1- cough 2- sputum 3- haemoptysis 4-chest pain 5- dyspnea 6-cyanosis 7-clubbing

cough *Dry or productive: Dry bronchitis باطنية / د.فاخر 2015/12/9 cough *Dry or productive: Dry bronchitis Productive smoker, chronic bronchitis *Painful or painless: change in the pattern of cough example from normal to bovine and the patient has horsiness of voice . If the cough persists for more time 2-3weeks the patient should be send to the chest x-ray (CXR).

2015/12/9 باطنية / د.فاخر

sputum expectorated secretions which are produced out by coughing. باطنية / د.فاخر 2015/12/9 sputum expectorated secretions which are produced out by coughing. *quantity: small or large. *quality: thin or thick(purulent). *color: white , yellow (mean there is infection) or green (must serious one). If the sputum mixed with blood called Haemoptysis. How we deal with sputum? 1.Gross examination. 2. Microscopical examination.

1. Gram stain: for bacterial examination. باطنية / د.فاخر 2015/12/9 Investigation: 1. Gram stain: for bacterial examination. 2.AFB(acid fast bacillus) :for tuberculosis. 3.Cytology: for bronchiogenic carcinoma.

باطنية / د.فاخر 2015/12/9 Haemoptysis it is coughing of blood whether mixed with the sputum or pure. It may be small in amounts or large in amounts. The causes of large amounts of haemoptysis: 1. Bronchiectasis. 2. Lung abscess. 3. Tuberculosis.

باطنية / د.فاخر 2015/12/9 CHEST PAIN Chest pain is a frequent manifestation of both cardiac and respiratory disease and is considered in detail on. Pleural or chest wall involvement by lung disease gives rise to peripheral chest pain which is exacerbated by deep breathing or coughing.peluritic pain). Central chest pain suggests heart disease but occurs with tumours affecting the mediastinum, oesophageal disease) or disease of the thoracic aorta).

باطنية / د.فاخر 2015/12/9 Massive pulmonary embolus may cause ischaemic cardiac pain as well as severe breathlessness. Tracheitis produces raw upper retrosternal pain which is worse on coughing. Musculoskeletal chest wall pain is usually exacerbated by movement and associated with local tenderness

Central :angina pectoris Peripheral :pneumonia باطنية / د.فاخر 2015/12/9 Chest pain : Cardiac Lung Esophagus Aorta Central :angina pectoris Peripheral :pneumonia

Connective tissue disorders باطنية / د.فاخر 2015/12/9 Lungs/pleura Pulmonary infarct Pneumonia Pneumothorax Malignancy Tuberculosis Connective tissue disorders

Costochondritis (Tietze's Rib fracture/injury syndrome) باطنية / د.فاخر 2015/12/9 Musculoskeletal2 Osteoarthritis Costochondritis (Tietze's Rib fracture/injury syndrome) Intercostal muscle injury Epidemic myalgia (Bornholm disease) Neurological Prolapsed intervertebral disc Herpes zoster Thoracic outlet syndrome

Breathlessness or dyspnoea باطنية / د.فاخر 2015/12/9 Breathlessness or dyspnoea can be defined as the feeling of an uncomfortable need to breathe. It is unusual among sensations in having no defined receptors, no localised representation in the brain, and multiple causes both in health (e.g. exercise) and in diseases of the lungs, heart or muscles.

Dysponea : shortness of breath Heart failure Respiratory failure باطنية / د.فاخر 2015/12/9 Dysponea : shortness of breath Heart failure Respiratory failure Pneumonia Asthma Metabolic :diabetic ketoacidosis –renal failure

2015/12/9 باطنية / د.فاخر

باطنية / د.فاخر 2015/12/9 Asthma Dyspnoea in asthma is associated with episodes of wheeze or chest tightness, varying in severity over time, but usually worse in the morning and often waking the patient overnight. There may be a history of childhood wheeze, or of wheeze or rhinitis provoked by pollens, dusts, household pets or occupational allergens.

باطنية / د.فاخر 2015/12/9 Heart disease Impaired left ventricular function can cause exertional dyspnoea. Orthopnoea, cough and wheeze may also be present, as in lung disease. A history of angina or hypertension may be useful in implicating a cardiac cause. On examination, an increase in heart size as judged by a displaced apex beat, a raised JVP and cardiac murmurs may indicate cardiac disease .

باطنية / د.فاخر 2015/12/9 Cyanosis is an abnormal bluish discoloration of the skin resulting from an increase in the level of reduced hemoglobin in the blood, and, in general, reflects an arterial oxygen saturation of 85% or less (normal arterial oxygen saturation ≥95%). Central cyanosis presents as cyanosis of the lips or trunk and reflects right-to-left shunting of blood owing to structural cardiac abnormalities (e.g., atrial or ventricular septal defects) or pulmonary parenchymal or vascular disease (e.g., chronic obstructive pulmonary disease, pulmonary embolism,

باطنية / د.فاخر 2015/12/9 Peripheral cyanosis may occur because of systemic vasoconstriction in the setting of poor cardiac output or may be a localized phenomenon resulting from venous or arterial occlusive or vasospastic disease (e.g., venous or arterial thrombosis, arterial embolic disease, Raynaud's disease). When cyanosis presents in childhood, it usually reflects congenital heart disease with right-to-left shunting of blood.

2015/12/9 باطنية / د.فاخر

clubbing:- loss of the angle between the nail and nail bed. باطنية / د.فاخر 2015/12/9 clubbing:- loss of the angle between the nail and nail bed. normally the angle 175 (less than 180 ) and becomes 180 and more in clubbing. So clubbing characterized by : 1. Increase curvature of the nail. 2. Swelling of the terminal phalanges (drumstick). Causes of the clubbing: 1. Lung abscess. 2. Fibrosing alveoli. 3. Bronchiogenic carcinoma.