istrumental & laboratory methods of respiratory system examination

7/24/2019 Istrumental & Laboratory Methods of Respiratory System Examination

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Kursk State MedicalKursk State Medical

UniversityUniversity

Propaedeutics of InternalPropaedeutics of Internal

Diseases DepartmentDiseases Department

Instrumental & LaboratoryInstrumental & Laboratory

Methods of RespiratoryMethods of RespiratorySystem !aminationSystem !amination



Laboratory studiesLaboratory studiesSputum e!aminationSputum e!amination

"ypothesis of"ypothesis of patholo#y

Type of sputumType of sputum Suggested diseaseSuggested disease

Mucoid colourlessMucoid colourless Acute bronchitis Acute bronchitisSerous colourless (or blood-Serous colourless (or blood-stained) liquid foamystained) liquid foamy

Pulmonary edemaPulmonary edema

Mucopurulent yellow/greenMucopurulent yellow/greentenacioustenacious

Chronic bronchitisChronic bronchitistuberculosistuberculosis

Mucopurulent with strea! ofMucopurulent with strea! ofbloodblood

"ronchiectasis"ronchiectasis



Laboratory studiesLaboratory studiesSputum examination - Hypothesis of pathology


Mucous bloodyMucous bloody #ung infarction#ung infarction

"loody purulent"loody purulent #ung abscess#ung abscess //gangrenegangrene

$usty$usty #obar pneumonia#obar pneumonia

%hree-layer sputum (on%hree-layer sputum (onstanding) with foul odor&standing) with foul odor&upper'mucopurulentupper'mucopurulentmiddle'serousmiddle'serous lower'puslower'pus

Chronic purulent processChronic purulent process(lung abscess/gangrene/(lung abscess/gangrene/purulent bronchiectasis)purulent bronchiectasis)




Type of sputumType of sputum Suggested diseaseSuggested diseaseittrich s plugs (lenticularittrich s plugs (lenticularformations with offensi*e odorformations with offensi*e odoron pressing)on pressing)

Chronic purulent processChronic purulent process(lung abscess/gangrene/(lung abscess/gangrene/purulent bronchiectasis)purulent bronchiectasis)

#ime grains#ime grains ecomposition of oldecomposition of oldtuberculotic focustuberculotic focus

Curschmann spirals (smallCurschmann spirals (smalldense twisted mucous threads&dense twisted mucous threads&central filament + spiral mantlecentral filament + spiral mantlewith leucocytes (eosinophils) +with leucocytes (eosinophils) +Charcot-#eyden crystals -Charcot-#eyden crystals -colorless eosinophilscolorless eosinophils octahedraoctahedra

"rochospasm"rochospasm(bronchial asthma chronic(bronchial asthma chronic

obstructi*e bronchitis)obstructi*e bronchitis)





Malignant cellsMalignant cells "ronchial carcinoma"ronchial carcinoma

,lastic fibres,lastic fibres ecomposition of lung tissueecomposition of lung tissue(lung abscess/gangrene/ purulent(lung abscess/gangrene/ purulentbronchiectasis/tuberculosis/broncbronchiectasis/tuberculosis/bronchial carcinoma)hial carcinoma)

ematoidin crystalsematoidin crystals(rhombic or needle-(rhombic or needle-shaped brown-yellowshaped brown-yellowformations)formations)

Pulmonary hemorrhagePulmonary hemorrhage



Laboratory syndromesLaboratory syndromesof sputum examination:of sputum examination:

Syndrome of inflammationSyndrome of inflammation ' columnar ciliated ' columnar ciliatedepithelium leucocytes erythrocytes al*eolarepithelium leucocytes erythrocytes al*eolarmacrophagesmacrophages

"ronchoobstructi*e syndrome"ronchoobstructi*e syndrome ' Curschmann ' Curschmannspirals al*eolar macrophages with lipids inclusionspirals al*eolar macrophages with lipids inclusion

Allergic syndrome Allergic syndrome ' eosinophils Charcot-#eyden ' eosinophils Charcot-#eyden

crystalscrystalsSyndrome of lung tissue destructionSyndrome of lung tissue destruction ' elastic ' elasticfibres erythrocytesfibres erythrocytes



Examination of pleural fluidExamination of pleural fluidHypothesis of pathologyHypothesis of pathology

Type of cells inType of cells inpleural exudatepleural exudate

Suggested diseaseSuggested disease

Red cellsRed cells Bronchial carcinomaBronchial carcinoma

PusPus EmpyemaEmpyema

LymphocytesLymphocytes TuberculosisTuberculosis

Fat globules (chylousFat globules (chylouseffusioneffusion

Thoracic ductThoracic ductobstructionobstruction



Ri!alta"s reactionRi!alta"s reaction

.ater with a few drops of acetic acid.ater with a few drops of acetic acid 0-1 drops of pleural fluid 0-1 drops of pleural fluidPositi*e (cloudy trace) ' e2udatePositi*e (cloudy trace) ' e2udate3egati*e ' trasudate3egati*e ' trasudate



Lucaerini testLucaerini test

#$ % & ml H&'& on glass )*& drops ofpleural fluidPositi!e (opalescence % exudate+egati!e % trasudate

Ri!alta"s , Lucaerini tests %positi!e - seromucin(mucopolisaccharide complex



Pulmonary function tests.Pulmonary function tests.

/entilation of the lungs/entilation of the lungs

0as exchange in the lungs0as exchange in the lungs



1ethods of functional diagnosis1ethods of functional diagnosisLung !olume measurementsLung !olume measurements

$%$% otal lun# capacity ' otal lun# capacity ' TLCTLC ( ) the volume of( ) the volume of#as contained in the lun#s after a#as contained in the lun#s after ama!imal inspirationma!imal inspiration

*%*%Residual volume 'Residual volume ' RVRV ( ) the volume of #as( ) the volume of #asremainin# in the lun#s at the end of aremainin# in the lun#s at the end of ama!imal e!pirationma!imal e!piration

+%+%,ital capacity ',ital capacity ' VCVC ( ) the volume of #as( ) the volume of #as

that is e!haled from the lun#s-that is e!haled from the lun#s- TLC – RVTLC – RV .%.%/unctional residual capacity '/unctional residual capacity ' FRCFRC ( ) the( ) the

volume of #as in the lun#s at the end of avolume of #as in the lun#s at the end of anormal e!halationnormal e!halation



Lungs !entilation measurementsLungs !entilation measurementsSpirometrySpirometry

#ung si4e (*ital capacity)#ung si4e (*ital capacity)Patency of airways (forced e2piratoryPatency of airways (forced e2piratory

*olume)*olume) Amount of air for lung *entilation during Amount of air for lung *entilation duringnormal breathing at rest + on e2ercisenormal breathing at rest + on e2ercise

(minute + al*eolar *entilation)(minute + al*eolar *entilation)



0as exchange0as exchange ' measurement of ' measurement ofo2ygen + carbon dio2ide tensions ino2ygen + carbon dio2ide tensions in

arterial blood calculating the gasarterial blood calculating the gastransfer factor or diffusing capacitytransfer factor or diffusing capacityusing carbon mono2ide upta!eusing carbon mono2ide upta!e

techniquetechnique



2linical lung !olume measurements of2linical lung !olume measurements ofairflo3 % patient inspires to TL2 ,airflo3 % patient inspires to TL2 ,forcibly exhales to R/ (exhaledforcibly exhales to R/ (exhaled!olume !ersus time!olume !ersus time



Spirography

0505 6orced e2piratory *olume in 0 sec5 (6,70) '6orced e2piratory *olume in 0 sec5 (6,70) 'the *olume of gas e2haled during the firstthe *olume of gas e2haled during the firstsecond of e2pirationsecond of e2piration

15 6orced *ital capacity (67C) '15 6orced *ital capacity (67C) ' the total e2haled *olumethe total e2haled *olume85 6orced e2piratory flow between 19 + :9;85 6orced e2piratory flow between 19 + :9;

ofof7C (6,6 19-:9;) ' ma2imal7C (6,6 19-:9;) ' ma2imal

mide2piratory flow rate (MM6$) ' themide2piratory flow rate (MM6$) ' thea*erage e2piratory flow rate during thea*erage e2piratory flow rate during the

middle 9<; of 7Cmiddle 9<; of 7C



TL2TL2 & ma2imal force applied by the& ma2imal force applied by the

inspiratory muscles to e2pand the lungs 'inspiratory muscles to e2pand the lungs '*s'inward recoil of the lungs5*s'inward recoil of the lungs5%#C determinants& stiffness of the lungs '%#C determinants& stiffness of the lungs '

*s' inspiratory lung strength*s' inspiratory lung strength%he lungs become stiffer (less compliant) '%he lungs become stiffer (less compliant) '%#C is decresed%#C is decresed

%he lungs become less stiff (more%he lungs become less stiff (morecompliant) ' %#C is increasedcompliant) ' %#C is increased



R/R/ ' the influence of 1 factors& ' the influence of 1 factors&

0505 patient s ability to e2ert a prolongedpatient s ability to e2ert a prolongede2piratory effort (muscle strength +e2piratory effort (muscle strength +ability to o*ercome sensory stimuli fromability to o*ercome sensory stimuli from

the chest wall)the chest wall)1515 lung s ability to empty to a small *olumelung s ability to empty to a small *olume,le*ated $7&,le*ated $7&

wea! e2piratory muscleswea! e2piratory musclesintrinsic airways diseaseintrinsic airways disease



1easurement of1easurement of

!entilation function!entilation functionStatic % lung !olumesStatic % lung !olumes

4ynamic % forced expiratory flo3 rates4ynamic % forced expiratory flo3 rates



Static % lung !olumesStatic % lung !olumes

A)5 7C e2piratory reser*e *olume e2piratory A)5 7C e2piratory reser*e *olume e2piratorycapacity 'capacity ' spirometric methods (spirometric methods ( breathe into +breathe into +

out of spirometer)out of spirometer)")5 $7 6$C %#C ' measurement of the gas")5 $7 6$C %#C ' measurement of the gas*olume after ma2imal e2piration&*olume after ma2imal e2piration&

0505 helium delution method (breathe into + out fromhelium delution method (breathe into + out froma reser*oir with a !nown *olume of gasa reser*oir with a !nown *olume of gascontaining a trace amount of helium)containing a trace amount of helium)

1515 body plethysmographybody plethysmography



4ynamic %4ynamic %forced expiratory flo3 ratesforced expiratory flo3 rates

Forced expiratory flo3 rates against timeForced expiratory flo3 rates against time

Forced expiratory flo3 rates against lungForced expiratory flo3 rates against lung!olume (flo3*!olume cur!e5 flo3*!olume!olume (flo3*!olume cur!e5 flo3*!olumelooploop



Pulmonary function testsPulmonary function tests

Spirometric *entilation testsSpirometric *entilation tests %est%est efinitionefinition 3orm3orm ConditionsConditions

7ital7italcapacitycapacity(7C)(7C)

%he *olume of%he *olume ofair which canair which canbe e2pelledbe e2pelledafter a ma2imalafter a ma2imalinspirationinspiration

8 ' 9 #8 ' 9 # ecreased 'ecreased ' restricting lungsrestricting lungse2pansion&e2pansion&thoracic cagethoracic cage

deformitydeformitypleural effusionpleural effusionlung fibrosislung fibrosis





Ma2imumMa2imum*oluntary*oluntary*entilation*entilation(M77)(M77)

%he amount of%he amount ofair which canair which canbe shifted in 0be shifted in 0min5 bymin5 byma2imalma2imalrespirationrespiration

01<'01<'0=< #0=< #perpermin5min5

ecreased 'ecreased 'diffuse airwaysdiffuse airwaysobstruction&obstruction& Asthma Asthma

"ronchitis"ronchitis,mphysema,mphysema





6orced6orcede2piratorye2piratory*olume '*olume 'in 0 sec5in 0 sec5

(6,70)(6,70)

%he amount of%he amount ofair which canair which canbe e2pelled inbe e2pelled in0 second after0 second aftera ma2imala ma2imalinspirationinspiration

:9; of:9; of*ital*italcapacitycapacity

ecreased 'ecreased 'diffuse airwaysdiffuse airwaysobstruction&obstruction& Asthma Asthma

"ronchitis"ronchitis,mphysema,mphysema



Pulmonary function testsPulmonary function testsSpirometric *entilation testsSpirometric *entilation tests

%est%est efinitionefinition 3orm3orm ConditionsConditions MinuteMinute*entilation*entilation

%he amount of air%he amount of airbreathed in 0breathed in 0min5 duringmin5 during

normalnormalrespiration > tidalrespiration > tidal*olume*olume 66 respiratory raterespiratory rate

='? #='? #perpermin5min5

@ncreased&@ncreased&lung diseases 'lung diseases '

pneumoniapneumoniametabolic disordersmetabolic disorders

-acidosis-acidosis thyroto2icosisthyroto2icosisecreased&ecreased&cerebral +cerebral +

neuromuscularneuromusculardiseases - narcoticdiseases - narcoticdrugs poliomyelitisdrugs poliomyelitis



Pulmonary function testsPulmonary function testsSpirometric *entilation testsSpirometric *entilation tests

%est%est efinitionefinition 3orm3orm ConditionsConditions Al*eolar Al*eolar *entilation*entilation

%he amount of air%he amount of air*entilating the*entilating theal*eoli in 0 min5al*eoli in 0 min5

during normalduring normalrespiration >respiration >(tidal *olume(tidal *olumeminus anatomicalminus anatomicaldead space)dead space) 66 respiratory raterespiratory rate

'= #'= #perpermin5min5

@ncreased&@ncreased&lung diseases 'lung diseases '

pneumoniapneumoniametabolic disordersmetabolic disorders

-acidosis-acidosis thyroto2icosisthyroto2icosisecreased&ecreased&cerebral +cerebral +

neuromuscularneuromusculardiseases - narcoticdiseases - narcoticdrugs poliomyelitisdrugs poliomyelitis



Pulmonary function testsPulmonary function tests%ests of gas e2change%ests of gas e2change

%est%est efinitionefinition 3orm3orm ConditionsConditions

Arterial Arterial

o2ygeno2ygensaturationsaturation

%he o2ygen%he o2ygencontent ofcontent ofarterialarterialhemoglobin ashemoglobin asa percentagea percentageof the contentof the contentwhen blood iswhen blood ise2posed to air e2posed to air

B: ;B: ; ecreased 'ecreased 'hypo*entilationhypo*entilation

(cerebral +(cerebral +neuromuscularneuromuscular

disorders)disorders)





Arterial Arterial

C 1C 1 tensiontension(PaC 1)(PaC 1)

%he partial%he partialpressure ofpressure ofC 1C 1 ininarterial bloodarterial blood

< mm< mmgg

ecreased 'ecreased 'hypo*entilationhypo*entilation





7lterations in !entilatory function7lterations in !entilatory function

PatternPattern %#C%#C $7$7 7C7C 6,70/67C6,70/67C

'bstructi!e'bstructi!e 3 to3 to 88 DD 99



7lterations in !entilatory function7lterations in !entilatory functionRestricti!eRestricti!e


PulmonaryPulmonaryparenchymalparenchymal

DD DD DD + to+ to EE





,2tra-,2tra-parenchymalparenchymal

' inspiratory ' inspiratory

DD + to+ to DD DD ++





,2tra-,2tra-parenchymalparenchymal

' 'inspiratory einspiratory e2piratory2piratory

DD DD DD 7ariable7ariable



'bstructi!e pattern'bstructi!e pattern % % hallmar!&hallmar!& decreasedecreasein e2piratory flow ratesin e2piratory flow rates

Restricti!eRestricti!e patternpattern ' hallmar!& ' hallmar!& decrease indecrease inlung *olumes (%#C + 7C)lung *olumes (%#C + 7C)



'bstructi!e disorders'bstructi!e disorders

Asthma Asthma

C P (chronic bronchitis lungC P (chronic bronchitis lungemphysema)emphysema)"ronchiectasis"ronchiectasis

Cystic fibrosisCystic fibrosis"ronchiolitis"ronchiolitis



Restricti!e disorders % parenchymalRestricti!e disorders % parenchymal

SarcoidosisSarcoidosis@diopatic pulmonary fibrosis@diopatic pulmonary fibrosis

PneumosclerosisPneumosclerosisrug- or radiation-induced interstitial lungrug- or radiation-induced interstitial lungdiseasesdiseases



Restricti!e disorders % extraparenchymalRestricti!e disorders % extraparenchymal

3euromuscular&3euromuscular& ' iaphragmatic wea!ness / paralysisiaphragmatic wea!ness / paralysis ' Myasthenia gra*isMyasthenia gra*is

' Fuillain-"arre syndromeFuillain-"arre syndrome ' Muscular dystrophiesMuscular dystrophies ' Cer*ical spine inGuryCer*ical spine inGury

Chest wall&Chest wall& ' HyphoscoliosisHyphoscoliosis ' besitybesity ' An!ylosing spondylitis An!ylosing spondylitis





Arterial Arterial

o2ygeno2ygentensiontension(Pa 1)(Pa 1)

%he partial%he partialpressure ofpressure ofo2ygen ino2ygen inarterial bloodarterial blood

0<<0<<mm gmm g

ecreased 'ecreased 'hypo*entilationhypo*entilation



istrumental & laboratory methods of respiratory system examination

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