Respiratory Symptoms

1. Respiratory Symptoms GuoYing The respiratory department of the first affiliated hospital of liaoning medical college

2. Common symptoms • Cough • Expectoration • Hemoptysis • Chest pain • Dyspnea • Cyanosis

3. Cough A cough is a sudden, forceful, noisy expulsion of air from the lungs. It is a protective reflex，but excessive coughing is harmful to human’s body.

4. larynx, trachea, bronchi,pleura andexternal acoustic meatus Mechanism of cough from Stimuli vagus nerve afferent nerve fiber coughing centre （in oblongata） efferent nerve fiber laryngeal nerve diaphragmatic nerve spinal nerves deep breath glottal closure intrathoracic pressure increase sudden glottal opening outward blast of air

5. Cough : manifestations • Characteristics • Unproductive /Dry cough (non-sputum: non-infectious) • Productive cough (sputum: infectious, edema) • Attack • Time (single/paroxysmal /nocturnal) • Season (chronic) • motivation • Tone • Hoarseness • High pitch/brassy cough • Weak

6. Cough : Clinical Occurrence • Respiratory diseases___ the most common causes • Airway agents • Bronchitis, bronchiectasis, asthma, endobronchial tuberculosis, tumor, pharyngitis， tracheoesophageal fistula，foreign bodys • Lung agents • Infection, edema, fibrosis, tumor • Pleural agents • Pleurisy, pneumothorax, mesothelioma of pleura

7. Cardiovascular diseases • Cardiogenesis edema/ congestive heart failure, • pulmonary embolism and infarction • _vasculitis : Wegener, Churg-Straus syndrome , • Goodpasture syndrome. • _aortic aneurysm, pulmonary hemorrhage. • Central nervous system agents • Initiative cough, encephalitis, meningitis

8. Chronic unexplained coughs are most commonly related to one or a combination of : chronic post-nasal drip; gastroesophageal reflux; cough-variant asthma; drugs (angiotensin converting enzyme inhibitors)

10. Cough: accompany signs • Fever (infection) • Chest pain (infection, tumor, pleurisy, pneumothorax, pulmo embolism) • Hemoptysis (bronchiectasis, tuberculosis, tumor) • Bulk pus sputum (bronchiectasis, lung abscess) • Wheezing (asthma, foreign body) • Clubbing fingers (bronchiectasis, lung cancer, chronic lung abscess)

11. Common symptoms • Cough • Expectoration • Chest pain • Hemoptysis • Dyspnea • Cyanosis

12. Expectoration The attributes of sputum Bloody Sputum (Hemoptysis,next class ) Bloody gelatinous sputum Rusty Sputum Purulent Sputum Stringy Mucoid Sputum Frothy Sputum Broncholiths

13. Bloody gelatinous sputum （Currant-jelly sputum ） Copious quantities of tenacious ,bloody sputum are almost pathognomonic for pneumonia caused by klebsiella pneumoniae or streptococcus pneumoniae

14. Rusty Sputum ( Prune-juice Sputum) Purulent sputum containing changed blood pigment is typical of pneumococcal pneumonia but it is frequently preceded by small amounts of frank blood. Stringy Mucoid Sputum Increased mucous production and formation of mucous plugs occur in asthma; during resolution of an acute attack, retained mucous is mobilized. Frothy Sputum ( Pulmonary Edema) Fluid from the pulmonary capillaries enters the alveoli and is expectorated. A thin secretion containing air bubbles, frequently colored with hemoglobin , is typical of pulmonary edema. Both acute lung injury and left ventricular failure produce this sign.

15. Purulent Sputum Inflammatory cells, predominately polymorphonuclear leukocytes, enter the airways and alveoli in response to lower airway infection. Colour:yellow (general bacterial), green (aeruginosus Bacillus), or Grey or black (dust inhalation). Amounts:Small amounts ：acute bronchitis, pneumonia during resolution, small tuberculous cavities or lung abscess. Copious purulent sputum suggests lung abscess, bronchiectasis, or bronchopleural fistula communicating with an empyema. Many lung abscesses do not yield much sputum because their bronchial communications are inadequate for complete drainage Odor :Fetid sputum suggests anaerobic infection and/or lung abscess. Bronchiectasis:200 to 500 ml/d. On standing, bronchiectatic sputum typically separates into three layers,with mucus on top separated by clear fluid from pus on the bottom. (or upper: frothy, middle: serofluid or serofluid pus,lower: necrosis substance) bronchopleural fistula :Copious sputum from a patient with signs of pleural effusion suggests

16. Broncholiths Occasionally, calcified particles are found in the sputum either by the patient or the physician. These are usually broncholiths, derived from calcified lymph nodes eroding the bronchi or from calcareous granulomas in silicosis, tuberculosis, or histoplasmosis. Their discovery may explain the source of pulmonary hemorrhage

17. Common symptoms • Cough • Expectoration • Hemoptysis • Chest pain • Dyspnea • Cyanosis

18. Hemoptysis • Definition: Spitting or coughing of blood is hemoptysis. • The blooding region: anywhere from the nose to the lungs . • The amount varies from blood-strained sputum to several hundreds ml pure blood • Mild: 100ml/d • Moderate: 100-500ml/d • Severe: >500ml/d, or 100-500/time

19. Hemoptysis • Differential diagnosis • Bleeding from upper respiratory tract Expectorated blood usually comes from the upper respiratory tract while blood in the bronchial tree induces coughing. However, the patient may not be able to distinguish which of the two is occurring, so both upper and lower respiratory tract disorders must be considered. • Hematemesis

20. Distinguished hemoptysis from hematemesis

21. Hemoptysis: causes • Bronchial disorders • Bronchiectasis • Bronchogenic carcinoma • endobronchial TB • Chronic bronchitis

22. Hemoptysis: causes • Pulmo Disorders • Pulmo TB • Pneumonia • Lung abscess • Pulmo embolism

23. Hemoptysis: causes • Cardiovascular disorders • Acute left heart failure • Mitral stenosis

24. Hemoptysis: causes • Others • Hematologic disease, leptospirosis （钩端螺旋体病），epidemic hemorrhagic fever，endometriosis （子宫内膜异位症）

25. Bloody Sputum • Blood in the sputum usually impresses patients enough to bring them to the physician. The first problem is to identify the anatomic site of hemorrhage. • Blood-Streaked Sputum is usually caused by inflammation in the nose, nasopharynx, gums, larynx, or bronchi. Sometimes it occurs only after severe paroxysms of coughing and may be attributed to trauma. • Pink Sputum usually results from blood mixing with secretions in the alveoli or smaller bronchioles; it most frequently occurs in pneumonia or pulmonary edema.

26. Massive bleeding occurs with erosion of a bronchial artery by cavitary pulmonary tuberculosis, aspergilloma, lung abscess, bronchiectasis, pulmonary infarction, pulmonary embolism, bronchogenic carcinoma or a broncholith. • Goodpasture syndrome Alveolar Hemorrhage, does not produce bloody sputum in all cases. • mitral stenosis. Not infrequently,frank bleeding from the lungs occurs in

27. Hemoptysis: accompany symptoms • Fever • Infection or carcinoma • Chest pain • Infection， Pulmo Embolism，Carcinoma • Pus sputum • Bronchiectasis，Lung abscess • Clubbing fingers • Bronchiectasis，Lung abscess，Carcinoma • Hemorrhagic spots • Hematologic disease, leptospirosis, epidemic hemorrhagic fever

28. Clubbing fingers

29. Clinical occurrence 1.Upper Respiratory Tract bleeding from : nasopharynx, oropharynx, gums, laryngitis, laryngeal carcinoma, hereditary hemorrhagic telangiectasia.

30. 2.Bronchial Tree bronchiectasis, bronchial carcinoma, acute and chronic bronchitis, trauma from coughing, broncholiths, foreign body aspiration, erosion by aortic aneurysms. bronchiectasis foreign body broncholiths carcinoma

31. 3 Lungs infections ( pneumonia, especially caused by Klebsiella, lung abscess, tuberculosis,fungal infections, amebiasis, hydatid cyst) , pulmonary embolism with infarction, trauma, pulmonary hemorrhage ( vasculitis especially Wegener, Goodpasture syndrome ) , idiopathic pulmonary hemo-siderosis, lipoid pneumonia. 4 Cardiovascular diseases Mitral stenosis, congestive heart failure, arteriovenous fistula, anomalous pulmonary artery, hypertension. 5 Hematologic diseases thrombocytopenia, leukemia, hemophilia

32. lobar pneumonia Lung abscess Pulmo TB