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Manifestations of respiratory system dysfunctions

Manifestations of respiratory system dysfunctions

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Manifestations of respiratory system dysfunctions

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  1. Manifestations of respiratory system dysfunctions M. Tatar, J. Hanacek

  2. Cardinal respiratory symptoms and signs cough sputum dyspnea wheezing cyanosis chest discomfort chest pain

  3. Disorders of lung mechanics

  4. Disorders of the lung mechanics • Airway obstruction • nasal cavity: nasal congestion • pharynx: collapse during sleep • larynx: suffocation • central aw: • trachea: stridor • main bronchi: dyspnea, wheezing • lobar bronchi: asymptomatic or minor dyspnea • peripheral aw: dyspnea • Lung parenchyma ( or compliance): dyspnea • Chest wall (abnormalities): dyspnea • Respiratory muscles (fatigue): dyspnea

  5. Disorders of airway defence mechanisms

  6. Disorders of airways defence mechanisms • Nasal cavity • sneezing • nasal dyscharge • Airways • Cough: acute respiratory infections, foreign body aspiration, chronic bronchitis, chronic cough • Expectoration - Sputum • mucoid (mainly macrophages) • purulent (neutrophils) • Pneumococcus - bloody or rust-colored • Pseudomonas, Haemophilus - green sputum

  7. Hyperplasia and hypertrophy of submucosal glands

  8. Disorders of gas exchange

  9. Disorders of gas exchange Respiratory insufficiency (failure) • Hypoxemic • Decreased ventilation/perfusion ratio • Venous admixture • Diffusion impairment • Hypercapnic • Overall alveolar hypoventilation • Limits for hyperventilatory compensation of decreased ventilation/perfusion ratio

  10. Vznik hypoxémie vplyvom zníženia V/Q pomeru

  11. Kompenzačné mechanizmy pri hyperkapnii

  12. Disturbed regulation of breathing Cheyne-Stokes respiration Sleep apnea Hyperventilation Gasping Hypopnea Shortness of breath

  13. Cheyne-Stokes breathing

  14. General body responses Fever Weakness, fatigue Decreased exercise tolerance Immunity: eosinophilia Weight loss: advanced disease

  15. Cough • Physiologic reflex • Pathologic reflex • Acute cough • Chronic cough • Rhinitis/sinusitis • Asthma • Gastroesophageal reflux disease

  16. Dyspnea • Air hunger, chest tighness • Subject´s feelings – needs for increased ventilatory activity • Tachypnoea with either shallow or deep breathing • Increased workload of respiratory muscles – normal gas exchange cannot be achieved without increased ventilatory effort

  17. Pathophysiology of dyspnea • Hyperventilation – acute hypoxemia • Relative hyperventilation - decreased ventilatory surfice (atelectasis, pleural effusion, lung congestion, pneumotorax) • Disordered lung mechanics (most frequent cause) - Upper airways stenosis - Increased arways resistence = obstruction of peripheral airways (asthma, COPD, heart failure) - Decreased muscle force (polyomyelitis, diaphragm paralysis, myastenia gravis) - Limited chest movements (kyphoscoliosis) • !!! acute or chronic state; rest or physical activity

  18. Causes of dyspnea  oxygen content in atmosphere  oxygen consumption during physical activity Lung function disorders Heart function disorders Decreased hemoglobin content (during exercise) Respiratory center dysfunction (Cheyne-Stokes, acidosis) Stimulation of airway and lung nerve-endings (pneumonia, lung congestion) Obesity Emotive factors (chronic hyperventilatory syndrom) Brain dysorders Metabolic dysorders – hyperthyreosis

  19. Hypoxemia Tachycardia, tachypnea, dyspnea, mental status changes Secondary polycythemia ( hematocrit) Cyanosis threshold for central cyanosis is a capillary reduced hemoglobin content of 5 g/dL !!! ancillary nonspecific signs

  20. Relation between SaO2 and arterial Hb

  21. Cyanosis • Central • hemiglobin – methemoglobin, sulphhemoglobin • hemoglobin -  content of reduced Hb • Heart disorders – lung congestion • Lung disorders • acute: pneumonia, lung edema • chronic: COPD, severe lung fibrosis • Peripheral • local perfusion disorders • False • pigmentation (silver)

  22. Peripheral and central cyanosis Central Peripheral

  23. Hypercapnia Morning headaches Papilledema, dilated conjunctival and superficial facial blood vessels CO2 narcosis: anxiety may progress to delirium and somnolency

  24. Primary respiratory disorders can significantly affect the function of other systems Most frequently CVS Cor pulmonale elevated jugular venous pulse, peripheral edema Massive pulmonary embolism and tension pneumothorax circulatory shock – hypotension, weakness, pale, sweaty, oliguric, and develops impaired mentation OSAS daytime sleepiness, right heart failure, systemic arterial hypertension