呼吸系统课件：呼吸症状学

RESPIRATORYSYPTOMSRESPIRATORYSYPTOMSSymptomsofRespiratoryDiseasesSymptomsofRespiratoryDiseasCoughandSputumCoughandSputumCoughCoughisadeepinspirationfollowedbyastrongexpirationagainstaclosedglottis,whichthenopenswithanexpulsiveflowofair,followedbyarestorativeinspiration;thesearetheinspiratory,compressive,expulsive(expiratoryorexplosive),andrecoveryphasesofcoughCoughCoughisadeepinspiratiThestimulithatcanelicitacoughinhaledparticles,Mucusontheliningoftheairways,Inflammatoryexudateinairwaysorparenchyma,anewgrowthorforeignbodyinanairway,pressureontheexternalwallofthebronchus.ThestimulithatcanelicitaCOUGHItisaprotectivereflexwhichremovessecretionsorinhaledsolidmaterial,provokedbyphysicalorchemicalstimulationofirritantreceptorsinthelarynx,tracheaorbronchialtree.COUGHItisaprotectivereflexClassificationAcute<3wksSubacute:3-8wksChronic:>8wksdryorproductive(sputumproduction)ClassificationAcute<3wksCough(aprotectivereflex):causesRespiratorydiseases___themostcommoncausesAirwayagentsBronchitis,bronchiectasis,asthma,endobronchialtuberculosis,tumor,pharyngitisLungagentsInfection,edema,fibrosis,tumorPleuralagentsPleurisy,pneumothorax,mesotheliomaofpleuraCardiovasculardiseasesCardiogenesisedema,pulmonaryembolismCentralnervoussystemagentsInitiativecough,encephalitis,meningitisCough(aprotectivereflex):cCough:accompanysignsFever(infection)Chestpain(infection,tumor,pleurisy,pneumothorax,pulmoembolism)DyspneaHemoptysis(bronchietasis,tuberculosis,tumor)Bulkpussputum(bronchietasis,lungabscess)Wheezing(asthma,foreignbody)Clubbingfingers(bronchietasis,lungcancer,chroniclungabscess)Cough:accompanysignsFever(iSputum:consistency

MucoidsputumBronchitis(withoutbacterialinfection)AsthmaEarlystageofpneumoniaSeroussputumPulmoedemaPussputumAnybacterialinfectionBloodysputumSputum:consistencyMucoidspuCoughrhythm

咳嗽的节律Paroxysm发作性咳嗽急性咽喉炎、异物、百日咳、哮喘、支气管内膜结核等Chronic慢性咳嗽慢支、支扩、肺脓肿、肺结核等Coughrhythm

咳嗽的节律Paroxysm急性咽喉ToneQuality

咳嗽的音色Hoarseness嘶哑声带炎、喉结核、喉癌、喉返神经麻痹等Brassy金属音调纵隔肿瘤、主动脉瘤、支气管癌等压迫气管Highpitch鸡鸣样咳嗽百日咳，会咽、喉部疾患及气管受压Weak低微或无声极度衰弱、严重肺气肿、声带麻痹等ToneQuality

咳嗽的音色Hoarseness嘶哑CharacterofCoughDrycoughNon-sputumProductivecoughSputum:infectious,edemaCharacterofCoughDrycoughNon

(sputum:Quantity,traits)

痰量及性状量quantity多：肺泡细胞癌(alveolarcellcarcinoma)少:性状traits粘：真菌(fungi)臭：厌氧(Anaerobicbacteria)韧：纤维性支气管炎

(sputum:Quantity,traits)

痰量Sputum:ColorWhiteMucoidorserofluidsputumYellowGeneralbacterialinfectionGreenAeruginosus-bacillusinfectionGreyorblackDustinhalationRustyLobarpneumoniaPinkCardiacedemaRedHemoptysisSputum:ColorWhiteMucoidorsSYMPTOMSANDSIGNS--sputumColor,quantity,consistencyandunusualodorColorlessandtransparent:mildinflammationandnormalProductiveandpurulent-bacterialinfectionasbronchitispneumonia,lungabscess,bronchiectasisBloodstreaked-cancer,tuberculosis,lunginfarctionBloodfoamy-congestiveheartfailureRust-colored–pneumococalpneumoniaLargequantity-lungabscess,bronchiectasis,lungcancerPurulentwithfoulodor-streptococcusandanaerobeinlungabscessSYMPTOMSANDSIGNS--sputumColoAcuteCoughViralinfectionsRhinoviruses,coronaviruses,andrespiratorysyncytialvirusinfluenza,parainfluenza,andadenovirusesAllergicrhinitisExacerbationsofCOPDStreptococcuspneumoniae,Haemophilusinfluenzae,andMoraxellacatarrhalisBordetellapertussisinfectionAcuteCoughViralinfectionsChronicCoughUpperairwaycoughsyndrome(Postnasaldrip)AsthmaGastroesophagealreflux(GERD)EosinophilicbronchitisACEinhibitorsChronicbronchitisBronchiectasisInterstitialLungDiseaseLungCancerCongestiveHeartFailurePsychogenicCoughChronicCoughUpperairwaycougComplicationsofcoughpainfromintercostalmusclestraincoughfracturecoughsyncopecough-inducedincontinencepneumothorax,pneumomediastiniumComplicationsofcoughpainfroHaemoptysisHaemoptysisSYMPTOMSANDSIGNS--haemoptysisThecoughupofbloodistermedhaemoptysisBloodtingedsputumtopurebloodDifferentiation:upperairway,uppergastrointestinaltract(hematemesis-vomitingblood)Haemoptysis—bloodisbrightredmixedwithfrothysputum,alkalineHematemesis—dark,acidic,foodparticleSYMPTOMSANDSIGNS--haemoptysiBronchialcirculationmassivePulmonarycirculationairwaysPulmonaryparenchyma.VasculardisordersOriginanddisordersBronchialcirculationmassivHemoptysisBleedingfromlowerrespiratorytractTheamountvariesfromblood-strainedsputumtoseveralhundredsmlpurebloodMild:100ml/dModerate:100-500/dSevere:>500ml/d,or100-500/timeDifferentialdiagnosisBleedingfromupperrespiratorytractHematemesisHemoptysisBleedingfromlowerDistinguishedhemoptysisfromhematemesisDistinguishedhemoptysisfromCommonCausesBronchialDisordersBronchiectasisBronchogeniccarcinomaEndobronchialTBChronicBronchitisPulmoDiscordersPulmoTBPeumoniaLungabscessPulmoembolismTumorOthersHematologicdisease,),leptospirosis(钩端螺旋体病EpidemicHemorrhagicfever,endometriosisCardiovascularDisordersAcuteleftheartfailureMitralstenosis:capillaries,veinsPulmonaryhypertensionPulembolismCommonCausesBronchialDisordeAccompanySignsFeverInfectionChestpainInfectionPulmoembolismCarcinomaPussputumBronchie-ctasisLungabscessClubbingfingersBronchi-ectasisLungabscessCarcinomaHemorrha-gicspotsHematologicdiseaseLeptospirosisEpidemicHemorrhagicfeverJaundicepneumoniaLeptospiro-sis(钩端螺旋体病PulmoinfarctAccompanySignsFeverInfectionCSYMPTOMSANDSIGNS--haemoptysisTuberculosis,bronchiectasis,lungcancerParallelsymptoms-intermittent,purulent—bronchiectasisParallelsymptoms-older,longhistoryofsmoking,chestpain—lungcancerParallelsymptoms-suddenonset,chestpain,dyspnea—pulmonaryembolismParallelsymptoms-menstrationcycle—endometriosisParallelsymptoms-oliguria—GoodpastersyndromeParallelsymptoms-epidemiologicalhistory—parasiteinfectionSYMPTOMSANDSIGNS--haemoptysiSomeCommonCausesofHemoptysisInfectionsBronchitisTuberculosisFungalinfectionsPneumoniaLungabscessBronchiectasisNeoplasmsBronchogeniccarcinomaBronchialadenomaCardiovasculardisordersPulmonaryinfarctionfromthromboembolismMitralstenosisTraumaForeignbodyHematologic/immunologicBlooddyscrasiaGoodpasture’ssyndromeSomeCommonCausesofHemoptysDIFFERENTIALDIAGNOSISTracheobronchialsourceNeoplasm(bronchogeniccarcinoma,endobronchialmetastatictumor,Kaposi’ssarcoma,bronchialcarcinoid)Bronchitis(acuteorchronic)BronchiectasisBroncholithiasisAirwaytraumaForeignbodyPulmonaryparenchymalsourceLungabscessPneumoniaTuberculosisMycetoma(“fungusball”)Goodpasture’ssyndromeIdiopathicpulmonaryhemosiderosisWegener’sgranulomatosisLupuspneumonitisLungcontusionPrimaryvascularsourceArteriovenousmalformationPulmonaryembolismElevatedpulmonaryvenouspressure(especiallymitralstenosis)Pulmonaryarteryrupturesecondarytoballoon-tippulmonaryarterycathetermanipulationMiscellaneousandrarecausesPulmonaryendometriosis(catamenialhemoptysis)SystemiccoagulopathyoruseofanticoagulantsorthrombolyticagentsDIFFERENTIALDIAGNOSISTracheoNeoplasm40-60ageLonghistoryofsmokingTroublesomecoughandchestpainthatprecedeandacompanyhemoptysisNeoplasm40-60ageInfectionStaphylococcus—rusty-looking,grosslybloodStaphylococcus—bloodmixedwithpusKlebsiella—currantjellyBrisk(浓味道)bleeding—bloodmixedwithcopiousamountoffoul-smellingpusInfectionStaphylococcus—rusty-2023/9/832Investigation

Ifcoughedoutorvomittedout[文本】Age,sex,colourVolume:howmuchTimedurationAnyaccompaniedappearances2023/8/332Investigation

IfcouChestPainChestPainSYMPTOMSANDSIGNS—chestpainPleuritis,lunginfection,lungtumor,lunginfarctionarethemajorcauses.Pleuriticchestpain—respirationSuddenonsetwithdyspnae–pneomothorax,lunginfarctionSuperficialpainofchestwall—intercostalneuropathy,viralinfectionPericardialandpoststernal-myocardialinfarction--substernal"pressure,""constriction,"or"squeezing",neckorbotharms.

SYMPTOMSANDSIGNS—chestpainPPleuriticPainPulmonaryPainChestWallPainCardiacPainPleuriticPainCommonCausesChestwallHerpeszosterRibfractureCardiovas-cularAngina(心绞痛）

MyocardialinfarctionPericarditisDissectinganeurysmRespirato-ryPleuraldisordersPneumotho-raxCarcinomaPneumoniaMediastin-alMediastinitisMediastinalemphysemaMediastinaltumorEsophageallesionsHiatalhernia(食管裂孔疝OthersLivercarcinomaLiverabscessSubdiaph-ragmaticabsessSpleeninfartCommonCausesChestwallHerpesChestwallpainPersistentcoughorbreathlessnessMuscularstrainsIntercostalmyositisThoracicherpeszosterCoxsackieBinfectionThoracicdisclesionornervecompressionIntercostalnervecompressionorinfiltrationRibfractureRibtumour:primaryormetastaticTietze’ssyndromeSlippingribsyndromePleuralpainInfectivepleurisyPneumothoraxAutoimmunediseaseAsbestospleuralfibrosisMesotheliomaMetastatictumourAirwaypainTracheitisInhalationofirritantgasIntubationCentralbronchialcarcinomaMediastinalpainCardiacischaemia/infarctionMassivepulmonaryembolismOesophagitisPericarditisSarcoidadenopathyLymphomaMediastinitisAorticdissectionAorticaneurysmChestwallpainPleuralpainMedClinicalManifestationAgeTheyoungTheoldCharacteristicsBurningpainPressingpainBurstingpainPrickingpainDurationParoxysmPersistenceInfluentialfactorsExerciseRespirationFoodintakeAdministration(responsetotrentment)ClinicalManifestationAgeTheyAccompaniedSignsCough,sputumand/orfeverRespiratorydiseaseDyspneaSeverepneumoniaPneumotho-raxpleurisyPulmo-embolismHemoptysisCarcinomaPulmo-embolismPneumoniaShockMyocarialinfarctionDissectinganeurysm(rupture)Largeareapulmo-embolismEatingrelated(Dysphagia)EsophagealdiseaseAccompaniedSignsCough,sputum2023/9/840AssistantExamiantionCarefulphysicalexammingSerumD-dimerSerumCreatineKinase,CK-MB,CardiacTroponinIArterialbloodgasElectrocardiogramChestRadiology:X-Ray,CT-scan2023/8/340AssistantExamiantioDspneaorBreathlessnessDspneaorBreathlessnessSYMPTOMSANDSIGNS—dyspneaMedicaltermforbreathlessnessorshortnessofbreathcausedbyairhungerwithaccessoryrespiratorymusclejoininginrespiration.ThistermisusedtodesignateavarietyofsensationsthatrangefromanawarenessofbreathingtorespiratorydistressChangesinrespiratoryrateandrhythmKussmaulbreathing--acidosisCheyne-Strokerespiration(Tidalbreathing)--Unchanged-hypercapnia,narcotics,PsychogenicSYMPTOMSANDSIGNS—dyspneaMediSOMEDESCRIPTIONSANDPATHOPHYSIOLOGICMECHANISMSOFSHORTNESSOFBREATHSOMEDESCRIPTIONSANDPATHOPHYDYSPNEAPATHOPHYSIOLOGYDYSPNEAPATHOPHYSIOLOGYSYMPTOMSANDSIGNS—dyspneaAcute,chronicandrecurrentLunginfarction—acutewithchestpainNocturnalorthoradoxdyspnea—congestiveheartfailureandasthmaProgressive(afewwkstomonths)–pleuraleffusionChronicprogressive–interstitiallungdiseaseRucurrentandseasonal—asthmaInspirational—largeairwayobstructionExpiratory–distalairwayasasthma,bronchitisSYMPTOMSANDSIGNS—dyspneaAcutRespiratorycausesofbreathlessnesstheairways---airflowobstruction;thelungparenchyma---progressivetypeofbreathlessnesswitharestrictivepatternoflungfunction.thepulmonarycirculation---progressivedyspnoeaoftenwithverysevereexerciselimitationthepleura---Thechestwall.RespiratorycausesofbreathleSomecausesofbreathlessness.AirwaysdiseaseChronicbronchiolitisandemphysemaAsthmaBronchiectasisandcysticfibrosisLaryngealorpharyngealtumourBilateralcordpalsyCricoarytenoidrheumatoidTrachealobstructionTracheomalaciaAmyloidofairwaysParenchymaldiseaseAllergicalveolitisSarcoidosisFibrosesanddiffusealveolitisObliterativebronchiolitisPneumoniasandtoxicpneumonitisDiffuseinfectionsRespiratorydistresssyndromeInfiltrativeandmetastatictumourPneumothoraxPulmonarycirculationPulmonaryembolismandhypertensionPulmonaryarteritisandthrombosisChestwallandpleuraEffusionorpleuralfibrosisFracturedribsAnkylosingspondylitisKyphoscoliosisNeuromuscular,bilateraldiaphragmparalysisSomecausesofbreathlessness.Somecausesofbreathlessness.CardiacLeftventricularfailureMitralvalvediseaseCardiomyopathyPericardialeffusionorconstrictionNon-cardiorespiratoryPsychogenicAnaemiaHaemorrhageAcidosisHypothalamiclesionsSomecausesofbreathlessness.CausesofAcuteandChronicDyspneaAcutePulmonaryedemaAsthmaInjurytochestwallandintrathoracicstructuresSpontaneouspneumothoraxPulmonaryembolismPneumoniaAdultrespiratorydistresssyndromePleuraleffusionPulmonaryhemorrhageChronic,progressiveChronicobstructivepulmonarydiseaseLeftventricularfailureDiffuseinterstitialfibrosisAsthmaPleuraleffusionsPulmonarythromboembolicdiseasePulmonaryvasculardiseasePsychogenicdyspneaAnemia,severePostintubationtrachealstenosisHypersensitivitydisordersCausesofAcuteandChronicDy呼吸系统课件：呼吸症状学Dyspnea:causesRespiratorysystemObstruction:asthma,COPD,tumorPulmoDiseases:pneumonia,interstitiallungdisease,Chestwallorpleura:pleurisy,pneumothorax,traumaneuro-muscles:poliomyelitis(脊髓灰质炎),myastheniagravis(重症肌无力)Diaphragmamovementdisorder:obviouslyelevatedpressureinabdominalcavityCardiovascularsystemHeartfailurePulmoembolismPoisoningketoacidosisCentralnervoussystemcerebraltumor,trauma,abscess,hemorrhage,encephalitis,meningitishematologicalsystemSevereanemiaDyspnea:causesRespiratorysyRespiratoryDyspneaInspiratorydyspnea____obstructioninlargeairway

Threedepressionsigndepressioninsuprasternalfossa,supraclavicularfossa,intercostalspaceExpiratorydyspnea____obstructioninsmallairwayoralveolarelasticitydecreased

ProlongedexpiratorytimeExpiratoryrhonchiMixeddyspnea____deficientgasexchange

RespiratoryrateincreasedShallowbreathingRespiratoryDyspneaInspiratoryFeaturesofleftheartfailureUnderlyingdiseasesMixeddyspneaPositionrelateddyspneaMoistcracklesorrhonchiinbothlungsReliefofsymptomsafterdigitalis,diuretic,vasodilatoragentused

FeaturesofleftheartfailureNocturnalparoxysmaldyspneaCharacteristicsAwokenduetochesttightnessordyspneaForcedsittingpositionororthopneaSeveresweatTachycardiaMoistcracklesorrhonchiinbothlungsPinkfrothysputum

NocturnalparoxysmaldyspneaCPoisoningdyspneaUnderlyingdiseasesofmetabolicacidosis(uremia,diabeticketoacidosis)deepbreathing(Kussmaulbreathing)PoisoningdyspneaUnderlyingdiDyspnea:accompanysigns(1)RhonchiAsthmaAcuteleftheartfailure(cardiacasthma)ForeignbodyinlargeairwayAcutelaryngealedema

ChestpainInfectionPneumothoraxPulmoembolism