1. Respiratory System

2. Anatomy
The respiratory system starts from the nose, mouth, larynx, trachea, and the two lungs.

7. Within the lungs, the bronchi transport air with oxygen to the alveoli on inspiration and carry waste gases (e.g. carbon dioxide) away on expiration.
The acinus is the gas exchange unit of the lung and consists of branching respiratory bronchioles leading to clusters of alveoli.
Alveoli are tiny air sacs lined by flattened epithelial cells and covered in capillaries where gas exchanges occur

8. The alveoli and capillaries have extremely thin walls and come into very close contact (the alveolar capillary membrane) so gases can rapidly diffuse between them. There are approximately 300 million alveoli in each lung for gas exchange with a total surface area of meter square.

9. The lungs has two blood supplies:
1) the bronchial arteries which arise from the aorta and supply oxygenated blood to the bronchial walls.
2) The pulmonary arteries which deliver deoxygenated blood to the capillaries surrounding the alveoli

11. Symptoms 1) Cough 2) Sputum production 3) Hemoptysis 4) Chest pain
5) Breathlessness

12. Symptoms
1 )Cough:
Is a forced expulsive maneuver against an initially closed glottis. Causing characteristic sound.
Can be acute (less than 3 weeks) or chronic (more then 8 weeks)
The most common cause is acute viral infections of the upper airway system

13. Cough (features)
Prolonged wheezy coughing: asthma, COPD.
Feeble non-explosive (bovine): lung cancer (paralysis of vocal cords), neuromsucular disease causing respiratory muscle weakness
Moist cough: secretions from infection, bronchiectasis, chronic bronchitis.
Noctunral cough: asthma

14. Cough (causes) Acute: Viral respiratory tract infection Bronchitis
Chronic
Gastroesophageal reflux disease (GERD)
Asthma
Post bronchial hyper-activity
Rhinitis/sinusitis
Cigarette smoking
Drugs, ACE inhibitors
Irritant dusts/fumes
Lung tumors
TB, Interstitial lung disease
Bronchiectasis
Acute:
Viral respiratory tract infection
Bronchitis
Inhaled foreign body
Inhalation of irritant dusts or fumes
Pneumonia
Acute extrinsic allergic alveolitis

15. Symptoms 2) sputum production Amount Colour Taste or smell Examples:
COPD and chronic bronchitis: clear mucoid sputum if there is no infection
Lower respiratory tract infection: yellowish sputum (presence of live neutrophils)
Ashtma: yellowish sputum (eosinophils)
Bronchiectasis: large volumes of purulent sputum varying with posture
Pulmonary edema: watery sputum with a pink tinge

16. Symptoms 3) Hemoptysis Amount and appearance Duraion and frequency
intermittent with recurrent infections
over years: bronchiectasis
Daily for a short periods (weeks) lung
cancer, TB, abscess
Single episodes with chest pain: pulmonary
infarction.

17. Hemoptysis (causes) Infection:
Bronchiectais, Tuberculosis, lung abscess, cystic fibrosis
Tumours:
Lung cancer, endobronchial metastasis, bronchial carcninoid.
Vascular:
Pulmonary infarction, arteriovenous malformation
Vasculitis.
Trauma
Foreign body, iatrogenic

18. Hemoptysis (causes) Cardiac:
Mitral Valve disease, acute left ventricular failure
Hematological:
Bleeding tendencies, anticoagulation

19. Symptoms 4) Chest pain: Pleural chest pain Chest wall pain
Mediastinal chest pain

20. Pleural chest pain
Is a sharp, stabbing pain and is intendified by inspiration or coughing caused by irritation of the parietal pleura.
Causes:
Infection: pneumonia, bronchiectasis
Pneumothorax
Pulmonary infarction
Connective tissue disease

21. Chest wall pain Causes: Chornic cough/breathlessness Muscular pain
Rib fractures
Bony metastasis
Thoracis shingles (herpes zoster)

22. Mediastinal chest pain
Mediastinal chest pain is central, retrosternal and unrelated to respiration or cough.
Causes:
Massive pulmonary embolism
Acute myocardial infarction
Aortic dissection
Infection, irritant dusts
Eshophagitis
Mediastinitis
Lymphadenopathy

23. Symptoms 5) Breathlessness
Shortness of breath, difficulty getting enough air.
Mode of onset
Minutes: pulmonary thromboembolism, pneumothorax, asthma, inhaled forein body
Hours to days: pneumonia, asthma.
Weeks to months: Anemia, Pleural effuion, neruomuscular disease.
Months to years: COPD, pulmonary fibrosis, TB, Heart failure.

24. Breathlessness Causes: Non cardio-respiratory:
Anemia, Obesity, Psychogenic, Metabolic acidosis.
Cardiac:
Heart failure, mitral valve disease, pericarditis, pericaridal effusion
Respiratory:
Foreign body, Ashtma, COPD, Bronchiectasis, Lung cancer, pulomnary fibrosis, Pneumonia, Tuberculosis, pulmonary thromboembolism, pulmonary hypertension, pneumothorax, kyphoscholiosis.
Neumuscular disease.

25. Physical Examination of the respiratory system
General Examination
Examination of the thorax
Respiratory rate
Breathing pattern
Inspection
Accessory muscles
Stridor
Palpation
Hoarseness
Cyanosis
Blood pressure
Skin Appearances
Percussion
Hands
Neck
Ascultation
Shape of chest

26. Physical Examination of the respiratory system
General Examination
Examination of the thorax
Respiratory rate

27. Respiratory rate Average: 14 breath per minute
Normal breth per minute
Tachypnea:
Increased ventilatory drive:
Fever
Acute asthma, COPD exacerbation
Reduced ventilatory capacity:
Pneumonia, Pulmonary edema, interstitial
lung disease.
Decreased respiratory rate

28. Physical Examination of the respiratory system
General Examination
Examination of the thorax
Respiratory rate
Breathing pattern

29. Breathing Patterns Periodic breathing (Cheyne-Stokes respiration)
Hyperventilation
Anxiety/emotional stress
Metabolic acidosis (Kussmaul
respiration)

30. Physical Examination of the respiratory system
General Examination
Examination of the thorax
Respiratory rate
Breathing pattern
Accessory muscles
Stridor

31. Stridor
A harsh, rasping or croaking inspiratory noise resulting from turbulent airflow in the upper airway, aggravated by coughing.
Should always be investigated, can be an emergency
Causes
foreign body or tumour partially occluding larynx, trachea or main bronchus
epiglottitis
Air way edema

32. Physical Examination of the respiratory system
General Examination
Examination of the thorax
Respiratory rate
Breathing pattern
Accessory muscles
Stridor
Hoarseness
Cyanosis

33. Cyanosis Is a bluish discoloration of the skin and mucous membranes
Can be Central of Peripheral

34. Physical Examination of the respiratory system
General Examination
Examination of the thorax
Respiratory rate
Breathing pattern
Accessory muscles
Stridor
Hoarseness
Cyanosis
Blood pressure
Skin Appearances
Hands

35. Hands Clubbing (mild , moderate , gross ) Causes Familial Thoracic
Non-Thoracic

37. Thoracic Non Thoracic Lung cancer Mesothelioma Pleural fibroma
Esophageal cancer
Thymoma
Atrial myxoma
IPF
Bronchiectasis, lung abscess
Empyema CF
Bacterial Endocarditis
Cyanotic congenital heart disease
Lung AV malformation
Non Thoracic
Liver cirrhosis
Celiac disease
Ulcerative colitis
Crohn’s disease

38. Hands Hypertrophic Pulmonary Osteoarthropathy
(combination of clubbing and thickening of periosteum (connective tissue lining of the bones) and synovium)
Discoloration of the finger and nails
Tremor
Fine tremor
Coarse flapping tremor (asterixis)

39. Causes of flapping tremor
Respiratory failure/ CO2 retention
Liver failure
Renal failure
Electrolyte disturbance
Hypoglycemia
Hypokalemia
Hypomagensemia
Wilson’s disease
CNS
Intracerebral hemorrhage
subdural hematoma
subarachnoid hemorrhage
cerebral ischemia
cerebral lymphoma
Drugs
barbiturates
alcohol
sodium valproate
phenytoin
carbamazaepine
metoclopramide
gabapentin
ceftazidime
opioids

40. Physical Examination of the respiratory system
General Examination
Examination of the thorax
Respiratory rate
Breathing pattern
Accessory muscles
Stridor
Hoarseness
Cyanosis
Blood pressure
Skin Appearances
Hands
Neck

41. Neck
JVP
Neck Nodes

42. will see you soon next year Thank you