Respiratory Symptoms

1. Respiratory Symptoms Zhao Li, M.D.

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

3. Cough (a protective reflex): causes • Respiratory diseases___ the most common causes • Airway agents • Bronchitis, bronchiectasis, asthma, endobronchial tuberculosis, tumor, pharyngitis • Lung agents • Infection, edema, fibrosis, tumor • Pleural agents • Pleurisy, pneumothorax, mesothelioma of pleura • Cardiovascular diseases • Cardiogenesis edema, pulmonary embolism • Central nervous system agents • Initiative cough, encephalitis, meningitis

4. Cough : manifestations • Characteristics • Dry cough (non-sputum: non-infectious) • Productive cough (sputum: infectious, edema) • Attack • Time • season • motivation • Tone • Hoarseness • High pitch • Weak • Brassy

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

6. Sputum: amount • Bulk frothy sputum • Pulmo edema • Bulk serofluid sputum • Alveolar carcinoma • Bulk pus sputum • Bronchiectasis • Lung abscess Layering upper: frothy, middle: mucoid or mucopus, lower: necrosis substance

7. Sputum: consistency • Mucoid sputum • Bronchitis (without bacterial infection) • Asthma • Early stage of pneumonia • Serofluid sputum • Pulmo edema • Pus sputum • Any bacterial infection • Bloody sputum

8. Sputum: color • White • mucoid or serofluid sputum • Yellow • general bacterial infection • Green • aeruginosus Bacillus infection • Grey or black • dust inhalation • Rusty • Lobar pneumonia • Pink • cardiac edema • Red • hemoptysis Grey or black

9. Sputum: foul odor • anaerobic bacterium infection

10. Hemoptysis • Bleeding from lower respiratory tract • The amount varies from blood-strained sputum to several hundreds ml pure blood • Mild: 100ml/d • Moderate: 100-500/d • Severe: >500ml/d, or 100-500/time • Differential diagnosis • Bleeding from upper respiratory tract • Hematemesis

11. Distinguished hemoptysis from hematemesis

12. Hemoptysis: causes • Bronchial disorders • Bronchiectasis • Bronchogenic carcinoma • endobronchial TB • Chronic bronchitis • Pulmo Disorders • Pulmo TB • Peumonia • Lung abscess • Pulmo embolism • Cardiovascular disorders • Acute left heart failure • Mitral stenosis • Others • Hematologic disease, leptospirosis （钩端螺旋体病），epidemic hemorrhagic fever，endometriosis （子宫内膜异位症）

13. Hemoptysis: accompany signs • 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

14. Chest pain: causes • Chest wall • herpes zoster, rib fracture • Cardiovascular • angina pectoris, myocardial infarction, pericarditis, dissecting aneurysm （夹层动脉瘤） • Respiratory • Pleural disorders, pneumothorax, carcinoma • Mediastinal • Mediastinitis, mediastinal emphysema, mediastinal tumor • Others • esophageal carcinoma, liver abscess, subdiaphragmatic abscess, hiatal hernia （食道裂孔疝）

15. Chest pain: characteristics • location • Referred pain • Level or feature • Burning pain, pressing pain, bursting pain, pricking pain • Duration • Influential factors • Exertional, respiration, foodintake, administration

16. Chest pain: accompany signs • Cough, sputum and/or fever • Respiratory disease • Dyspnea • Severe pneumonia, pneumothorax, pleurisy, pulmo embolism • Hemoptysis • Carcinoma, pulmo embolism • Shock • myocardial infarction, dissecting aneurysm (rupture ), large area pulmo embolism • Dysphagia (吞咽困难) • Esophageal disease

17. Cyanosis • An excess of desaturated hemoglobin causes a blue coloration of the skin or mucosae. • methemoglobinemia (高铁血红蛋白血症） • Poisoning by nitrite (Methylthioninium Chloride iv, 亚甲兰)

18. Cyanosis: classification • Central (warm) • Deficient oxygenation • Right-to-left shunt • Peripheral (cold) • Reduced cardiac output • Local vasoconstriction • Mixed • Heart failure

19. Cyanosis: accompany signs • Dyspnea • Severe cardiac or respiratory disorder • Clubbing fingers • Congenital heart disease • Chronic respiratory disease • Unconsciousness • Poisoning, shock, Severe cardiac or respiratory disorder

20. Dyspnea: causes • Respiratory system • Obstruction: asthma, COPD, tumor • Pulmo Diseases: pneumonia, interstitial lung disease, • Chest wall or pleura: pleurisy, pneumothorax, trauma • neuro-muscles: poliomyelitis ( 脊髓灰质炎), myasthenia gravis (重症肌无力) • Diaphragma movement disorder: obviously elevated pressure in abdominal cavity • Cardiovascular system • Heart failure • Pulmo embolism • Poisoning • ketoacidosis • Central nervous system • cerebral tumor , trauma, abscess, hemorrhage, encephalitis, meningitis • hematological system • Severe anemia

21. Respiratory Dyspnea • Inspiratory dyspnea ____obstruction in large airway • Three depression sign • depression in suprasternal fossa, supraclavicular fossa, intercostal space • Expiratory dyspnea ____obstruction in small airway or alveolar elasticity decreased • Prolonged expiratory time • Expiratory rhonchi • Mixed dyspnea ____deficient gas exchange • Respiratory rate increased • Shallow breathing

22. Mechanism of left heart failure • Pulmo edema diffusion capacity decreased • Alveolar tension increased stimulating stretch receptor excitation of vagus nerve excitation of respiratory center • Alveolar elasticity decreased vital capacity decreased • Increased pressure of pulmo circulation stimulating respiratory center Cardiac dyspnea ____ Heart failure

23. Features of left heart failure • Underlying diseases • Mixed dyspnea • Position related dyspnea • Moist crackles or rhonchi in both lungs • Relief of symptoms after digitalis, diuretic, vasodilator agent used

24. Nocturnal paroxysmal dyspnea Characteristics • Awoken due to chest tightness or dyspnea • Forced sitting position or orthopnea • Severe sweat • Tachycardia • Moist crackles or rhonchi in both lungs • Pink frothy sputum

25. Mechanism • Elevated excitation of vagus nerve • Contraction of coronary artery myocardium ischemia • Contraction of bronchiole decreased alveolar ventilation • Vital capacity decreased in supine position • Returned blood volume increased pulmo edema • Sensitivity of respiratory center decreasedreaction after obvious hypoxia Nocturnal paroxysmal dyspnea

26. Poisoning dyspnea • Underlying diseases of metabolic acidosis (uremia, diabetic ketoacidosis ) • deep breathing (Kussmaul breathing)

27. Dyspnea: accompany signs (1) • Rhonchi • Asthma • Acute left heart failure (cardiac asthma) • Foreign body in large airway • Acute laryngeal edema • Chest pain • Infection • Pneumothorax • Pulmo embolism • Lung cancer • Acute myocardial infarct

28. Dyspnea: accompany signs (2) • Fever • Infection • Cough and sputum • COPD • Infection • Left heart failure • Unconsciousness • CNS disorder • Uremia • diabetic ketoacidosis