Some Clinical PresentationsSome Clinical Presentations in Respiratory System Diseasesin Respiratory System Diseases

• Respiratory distress.

• Cough.

• Haemoptysis.

• Cyanosis

((11 ) )RESPIRATORY DISTRESSRESPIRATORY DISTRESS

SubjectiveSubjective)Symptoms()Symptoms(

ObjectiveObjective)Signs()Signs(

• Exertional dyspnoea

• Orthopnoea

• Tachypnoea )> 20 /min(

• Inspiratory Retractions

• Active accessory muscles of respiration

• Adventitious sounds

Dyspnoea: subjective feeling of difficulty in breathing due to increased respiratory effort.

Exertional: provoked or increased by physical activity

Types Physiologic: with more than usual daily activity

Pathologic- Psychogenic: mainly at rest, with frequent sighing

- Organic

Grades• Provoked by more than usual daily activity

• Provoked by usual daily activity• Provoked by less than usual daily activity

• Present at rest

Progression to Grade 4 may occur over: Minutes )Acute Dyspnoea(: foreign body aspiration, bronchial asthma, pulmonary embolism Days: rapidly accumulating pleural effusion Months: interstitial lung disease Years: emphysema

OrthopnoeaIt is dyspnoea produced or aggravated on lying down,relieved )partially or completely( in the upright position.It may result from abdominal distension pushing the diaphragm upwards.

Normal Breathing

Cheyne Stokes Breathing

Acidotic )Kussmaul( Breathing

Suprasternal, Supraclavicular Retractions

Epigastric Retractions

Inetrcostal Retractions

Active Accessory Muscles of Respiration

Breath Sounds

Adventitious Sounds • Wheezes

• Crepitations

• Croup

((22 ) )COUGHCOUGH

It is forced expiratory effort against a closed glottis which then suddenly opens with a jet of air expelled out, possibly along with secretions.

Types Dry )Irritant( Cough: The irritant stimulus may be obvious )smoke, dust, pharyngitis( and may not. Two common "concealed" causes of resistant

dry cough are post- nasal discharge and GERD )gastro-oesophageal reflux disease(.

• Wet )Productive( Cough:

Frothy Pink: pulmonary oedema Mucoid: bronchial asthma, chronic bronchitis Mucopurulent, Purulent )yellowish, thick(: infections Rusty: lobar pneumonia Greenish/Bluish: Gram negative infection Foul Smelling: anaerobic infection Blackish: smoker, coal workers

((33 ) )HAEMOPTYSISHAEMOPTYSIS

It is coughing of blood or blood tinged sputum due to bleeding from the respiratory tract below the vocal cords.

Bleeding originating above vocal cords )nose, mouth, larynx( may produce false haemoptysis.

HaemoptysisHaemoptysisHaematemesisHaematemesis

It isIt isCoughing of bloodCoughing of bloodVomiting of Vomiting of bloodblood

ColorColorBright redBright redDark redDark red

OdorOdor------soursour

ReactionReactionalkalinealkalineacidicacidic

Mixed Mixed withwith

Sputum, air (frothy)Sputum, air (frothy)foodfood

SputumSputumBlood tinged for 12 – 24 Blood tinged for 12 – 24 h after the attackh after the attack

normalnormal

StoolStoolnormalnormalmelenamelena

((44 ) )CYANOSISCYANOSIS

Cyanosis bluish discoloration of skin, mucous membranes due to presence of:

- > 5 gm deoxy Hb /100 mL blood Or - abnormal Hb )met or sulph Hb(

in surface capillaries.

Normal level of deoxy Hb /100 mL blood:- Arterial: 0.75 gm- Capillary 2.25 gm- Venous 3.75 gm

Central CyanosisCentral Cyanosis1

23

4

1( Hypoventilation- alveolar PO2: eg, high altitude

- Obstructive lung diseases- Restrictive lung diseases

2( Shunt- Cardiac Rt to Lt shunt )congenital

cyanotic heart disease(: eg, Fallot tetralogy

- Pulmonary: pulmonary AV fistula

3( Diffusion Defect )Alveolo-Capillary Block(- Pulmonary fibrosis- Pulmonary oedema

4( Ventilation Perfusion )V/Q( Mismatch- Pulmonary embolism )ventilation > perfusion = dead space effect(

- Atelectasis/collapse )perfusion > ventilation = shunt effect(- Most pulmonary disorders produce hypoxia by more than one

mechanism. V/Q mismatch is the most common.

Peripheral CyanosisPeripheral Cyanosis1( Generalized

stagnation )low COP(

i. HF

ii. Shock

2( Localized stagnation

i. Arterial

ii. Venous

Chemical CyanosisChemical Cyanosis

1( Met-haemoglobin

2( Sulph-haemoglobin

Central CyanosisPeripheral Cyanosis

Cause O2 saturation of core

arterial blood ( O2

loading by cardiopulmonary circulation)

Stagnant circulation - peripheral arterial flow- O2 extraction by tissues

DistributionWarm areas (tongue, interior of lips), all over

Cold areas: tip of nose, lobule of ear, fingers, toes

TemperatureWarm Cold

Clubbing+-

Polycythaemia+-

Effect of- Exercise- Warming- Oxygen

May No effect

to variable extent, maximal in low atmospheric PO2 and minimal in shunt

No effect

Hypoxia Low Oxygen Tension

Hypoxia TypeCyanosis

Hypoxic HypoxiaCentral

Stagnant HypoxiaPeripheral

Anaemic Hypoxia---

Histotoxic Hypoxia---