Signs and Symptoms of Respiratory Diseases
Signs and Symptoms of Respiratory Diseases
Cough
A sudden audible expulsion of air from the lungs. Coughing is proceeded by inspiration, the glottis is partially closed and the accessory muscles of expiration contract to expel the air forcibly from the respiratory passages. Coughing is a essential protective response that serves to clear the lungs.Bronchi or trachea of irritants and secretions or to prevent aspiration of foreign material into the lungs. Material coughed up from the lungs and expectorated through the mouth. It contains mucus, cellular derbis or microorganisms and it may content blood or pus.The amount, colour and constituents of the sputum are important in the diagnose of many illness.
An image of Coughing Women
Dry Cough – Pleuritis, ILD
Productive Cough -Chronic bronchitis ,Suppurative lung disease, Tuberculosis.
Brassy Cough – Trachea 1 compression
Bovine Cough -Recurrent laryngeal palsy, laryngitis
Nocturenal Cough -Chronic bronchitis, Bronchial asthma,Aspiration, Tropical eosinophilia, Left sided heart failure.
Cough syncope
It is due to raised intrathoracic pressure with reduced venous return to heart, reduced cardiac output and cerebral ischaemia.
A Cartoon image for Cough syncope
Picture of a person fall on floor due to Syncope
Aetiology
1. In resp. tract
Pharyngeal (and Laryngeal): Infection
Pulmonary : Pneumonia , TB, etc.
Pleural effusion: Pneumothorax
Pressure : Mediastinal growth, aneurysm
2. Outside respiratory tract
Auditory : Wax or inflammation
Abscess: Liver, subphrenic
Anxiety
Types
Asthmatic: Mostly nocturnal
Bovine : Vocal cord paralysis
Croupy: Laryngeal infection
Dry : TB
Expectorant: Bronchitis, brotichiectasis
Foetid: Anaerobic infection
Gander (metallic): Mediastinal compression
Hacking: Postnasal drip
Intermittent (Staccato): Whooping cough
Cardiac
Cyanotic congenital heart disease
Infective endocarditis
Extra-thoracic
Endocrine: Thyroid acropachy
Familial or idiopathic
Gastro-intestinal disease: Crohn’s disease
Hepatic disease: Cirrhosis
Sputum
Yellow thick/Green thick – Bacterial infections
Rusty – Pneumococcal pneumonia
Red currant jelly – sticky – Klebsiella pneumonia
Pink frothy – Pulmonary edema
Blood tinged – Bronchitis, bronehiectasis, bronchial adenoma, tuberculosis, malignancy
Ancovy sauce -Ruptured amoebic liver abscess
Copious colourless -Alveolar cell carcinoma
Copious-purulent – Lung abscess, bronchiectasis necrotising pneumonia.
Foul smelling sputum
Abscess, Anaerobic lung abscess
Bronchiectasis, Bronchiectasis,
Carcinoma (breaking down)
Diaphragmatic abscess (bursting into lung)
Empyema (bursting into lung)
Foetid bronchitis
Gangrene lung
Difficulty in Breathing
Dyspnoea
It is defined as undue awareness of respiratory effort or of the need to increase the effort as in thickened pleura, pleural effusion, pneumothorax, hypoxia, anaemia, acidosis etc. J receptors in alveoli stretch receptors of thoracic cage, chemoreceptors in carotid arteries are all involved.
A cartoon image of dyspnoea
Causes
Within minutes, Pneumothorax, Pulmonary edema, Pulmonary embolism, Laryngeal edema, Foreign body,
Within hours-days, Asthma, Pneumonia, Allergic alveolitis. Massive consolidation, ARDS collapse
Within weeks-months, Pleural effusion, Fibrosing alveolitis,Emphysema,Pneumoconiosis, Pleural fibrosis, Anaemia.
Orthopnoea
Orthopnoea defines dyspnoea on recumbency.
A comfort posture for orthopnoea person
Causes of orthopnoea
LV failure, pericardial effusion.
Bronchial asthma, bilateral diaphragmatic palsy.
Large ascites, GERD, obstructive sleep apnoea.
Platypnoea
It is dyspnoea worse on upright position, commonly due to a-v malformation at lung bases.
Breathing Patterns
I. Regular abnormal
Cheyne Stokes – hyperpnoea followed by apnoeic as in cardiac failure, narcotic over dose, raised ICP
Kussmaul’s – Increase in rate and depth as in metabolic acidosis and pontine lesions.
II. Irregular abnormal
Biot’s – Shallow or deep breaths with apneic spells as in meningitis.
Ataxic – Deep and shallow breaths occurring randomly as in brain stem lesion.
Apneustic – Pause after inspiration and expiration as in pontine lesions.
Cogwheel – Interrupted breathing in anxiety
Pursed lip – Emphysema.
Chest Expansion
Normal 5-8 cm
General restriction – Emphysema, ankylosing spondylitis, interstitial lung disease
Asymmetrical restriction – Fibrosis, collapse, pneumothorax, pleural effusion, pneumonia
Percussion Note
A 3D image of Percussion
Tympanitis – Hollow viscus
Skodiac – Above level of pleural effusion
Hyper resonant – Pneumothorax
Resonant – Normal lung
Impaired – Pulmonary fibrosis, thick walled cavity
Dull – Consolidation, collapse, thickened pleura
Stony dull – Pleural effusion
Impaired or Dull note
Abscess
Bronchogenic Ca
Collapse, Consolidation
Diaphragm raised (uncommon)
Effusion (and thickened pleura)
Fibrosisof Jung
Obliteration of Traube’s space occurs in left sided pleural effusion, massive splenomegaly, massive percicardial effusion,
Upward shift ofTraube’s space, occurs in left lower lobe fibrosis, left diaphragmatic palsy.
Hyper-resonant note
Airinpleural cavity
Bulla
Cavity
Cyst
Distension of stomach
Diaphragmatic eventration
Diaphragmatic hernia
Emphysema
Breath sounds
Diminished – Thickened pleura, emphysema, collapsed lung with occluded bronchus, tumor.
Absent – Massive pleural effusion, pneumothorax, severe asthma.
Bronchial Breathing Sounds
Tubular breathing is high pitched heard over consolidation, collapsed lung with patent bronchus and above level of pleural effusion (a partially collapsed lung with patent bronchus).
Amphoric breathing is of low pitched metallic quality heard over large superficial cavity, tension pneumothorax, bronchopleural fistula
Cavernous breathing is low pitched heard over thick walled cavity with a communicating bronchus.
Type Causes
Cavernous Consoldiation
Amphoric Cavity
Tubular Collapse
Vocal Resonance
Increased: Consolidation
Cavity (superficial)
Decreased : Air in pleural cavity
Bronchial obstruction
Collapse
Diaphragmatic hernia
Effusion, emphysema
Fibrosis
Crackles (Rales)
Fine crackles are high pitched, short duration and arise from alveoli. Coarse crackles are low pitched and arise from bronchus and bronchioles. Early inspiratory crackles occur in chronic bronchitis, mid inspiratory in bronchiectasis and late inspiratory in pneumonitis, ILD, pulmonary edema, pulmonary fibrosis. Expiratory crackles occur in chronic bronchitis and pulmonary edema.
Abscess, ARDS
Bronchi ectas is
Consolidation
Decompensation
Edema
Fibrosis
Wheezes (Rhonchi)
Polyphonic Monophonic
More expiratory Insp. or expiratory
Large number Single or few
Not widely heard Wide conduction
Loud. Can be heard with Cannot be heard with unaided car (except stridor)
Causes
Congestion or thickening of mucous lining
Constriction of smooth ms. of bronchi
Chronic bronchitis, emphysema
If single wheeze on inspiration – Stenosis or FB or lymphnode or
Ca obstructing principalbronchus.
Pleural Rub
Audible during both phases of respiration
Better heard on increased pressure of stethoscope.
Cough does not change rub
Defined area (Localised)
Eliminated by holding breath
Frequently associated with localised pain and tenderness
Grating in character
Differentiation between pleural rub and crackle
Rub Crackle
Continuous Discontinuous
Superficial loud Deep
Usually localised May be diffuse
Unaffected by cough Intensified or abolished by cough
Pressure with stethoscope No effect Increased intensity
Pain and tenderness No pain or tenderness
Succussion Splash
Obstruction of the Pyloric outlet can be checked by succussion splash.Simultaneously listening in the epigastrium and shaking the upper abdomen from side to side.
An image of Succussion Splash
Hydropneumothorax
Herniation of stomach or colon into thorax
Huge cavity with fluid and air
