3 en ausculation

7/30/2019 3 en Ausculation

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LectureAuscultation of the Lungs.

Vesicular and Bronchial

Breath Sounds.Added Breath Sounds.

Vocal Resonance and VocalFremitus.Assistant of propedeutic therapy and

clinical cardiology department R.Sh.Bragina


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AuscultationAuscultation (L(L auscul tareauscul tareto listen)to listen)

means listening to sounds inside themeans listening to sounds inside thebody. Auscultation isbody. Auscultation is immediateimmediate

(direct)(direct)when the examiner presses hiswhen the examiner presses his

ear to the pat ient bodyear to the pat ient bodyorormediatemediate( indirect,( indirect, or instrumental). Auscultationor instrumental). Auscultation

was first developed by the Frenchwas first developed by the French

physician Laennec in 1816 year.physician Laennec in 1816 year.


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Main Breath Sounds

Vesicular

Breath Sounds

Bronchial

Breath Sounds


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Vesicular (Alveolar)Vesicular (Alveolar)

Breath SoundsBreath SoundsMechanism of theMechanism of the

occurrenceoccurrence

* They arise due to* They arise due to

vibration of the alveolarvibration of the alveolar

walls during their fillingwalls during their filling

with air in inspiration.with air in inspiration.

*Summation of these*Summation of these

sounds gives long softsounds gives long soft

(blowing) sound.(blowing) sound.


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Alterations in

VesicularBreath Sounds

Quantitative

changes

Qualitative

changes


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Reasons Of Pathological DiminishedReasons Of Pathological Diminished

Vesicular Breath SoundsVesicular Breath Sounds

1.1. Emphysema (decreased elasticity of alveoli)Emphysema (decreased elasticity of alveoli)

2. Lobar pneumonia at I and III stages2. Lobar pneumonia at I and III stages

3. Oedema of the lungs (3. Oedema of the lungs ( swellingswelling of alveolarof alveolar

walls)walls)


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44. Accumulation of. Accumulation of

fluid in pleural cavityfluid in pleural cavity

( pleural effusion( pleural effusion--

hydrothorax,hydrothorax,exudative pleurisy)exudative pleurisy)

or air (pneumothorax)or air (pneumothorax)

5. Pneumofibrosis5. Pneumofibrosis

6.6. IncompleteIncomplete

obstructiveobstructive

atelectasisatelectasis

( by a tumour)( by a tumour)

7. Pleural thinking7. Pleural thinking

( adhesion)( adhesion)


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Reasons Of Pathological IncreasedReasons Of Pathological Increased

Vesicular Breath SoundsVesicular Breath Sounds

1.1. Vicarious emphysemaVicarious emphysema

2. Cheyne2. Cheyne Stokes, Kussmaul breathingStokes, Kussmaul breathing

3. Bronchitis ( harsh breathing)3. Bronchitis ( harsh breathing)


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Bronchial Breath SoundsBronchial Breath Sounds

Mechanism of OccurrenceMechanism of Occurrence::

** AriseArise at the larynx and the trachea when airat the larynx and the trachea when air

passes though the vocal slit ( another namepasses though the vocal slit ( another name

is laryngotracheal by site of its generation)is laryngotracheal by site of its generation)** During inspiration air passes though theDuring inspiration air passes though the

narrow vocal slit to enter wider trachea,narrow vocal slit to enter wider trachea,

where it is set in vortexwhere it is set in vortex

type motiontype motion

** During expiration, air also passes thoughDuring expiration, air also passes though

the vocal slit to enter wider space of larynxthe vocal slit to enter wider space of larynx

where it is set in a vortex motion.where it is set in a vortex motion.


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Conditions for Occurrence of PathologicalConditions for Occurrence of Pathological

Bronchial Breath SoundsBronchial Breath Sounds::

1. Free passage in1. Free passage inbronchibronchi

2. Consolidation of lung2. Consolidation of lungtissuetissue

or presence ofor presence ofpulmonary cavity whichpulmonary cavity whichis communicatedis communicated

with bronchus.with bronchus.

When region of lung hasWhen region of lung hasbecome firm or solidbecome firm or solidbronchial breath soundsbronchial breath soundsare transmitted fromare transmitted fromupper respiratory tract toupper respiratory tract to

this regionthis region


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Added Breath SoundsAdded Breath Sounds::

Types of

Added

Breath

Sounds

Rales(in bronchi

or cavities)

Crepitations(in alveoli)

Pleural rub(in pleural

cavity)


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Rales

Rhonchi Moist rales


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RhonchiRhonchi::

Mechanism of theirMechanism of theiroccurrenceoccurrence::

1. Swelling of the bronchial1. Swelling of the bronchialmucosamucosa

2.2. Accumulation of viscousAccumulation of viscoussputum in the bronchisputum in the bronchi

3.Constriction of lumen in3.Constriction of lumen inthe bronchithe bronchi

(spasm of sm ooth(spasm of sm oothmuscles of the bronchi )muscles of the bronchi )


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Rhonchi

Low- pitched

(sonoring)

in trachea,large and medium

bronchi

(bronchitis)

Medium

pitchedin medium bronchi

(bronchitis)

High pitched

(sibilantes)

When smallbronchi are narrow

(bronchial asthma,

obstructive

bronchitis)


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Features of RhonchiFeatures of Rhonchi::

* They are heard du ring insp irat ion and* They are heard du ring insp irat ion andexp irat ion but better du r ing exp irat ionexp irat ion but better du r ing exp irat ion

(exp irat ion is usual ly prolonged when(exp irat ion is usual ly prolonged whenrhonchi are present).rhonchi are present).

* Rhonch i are changeable ( after cough ing ,* Rhonch i are changeable ( after cough ing ,deep breathing, they can in tens i f ied ordeep breathing, they can in tens i f ied orweakened o r else dis appear)weakened o r else disappear)

* Musical sounds (di f ferent long sound )* Musical sounds (di f ferent long sound )


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Moist RalesMoist Rales::

MechanismMechanismof occu rrenceof occu rrence::

* Accum ulat ion of l iqu id* Accumulat ion of l iqu idsecret ion ( waterysecret ion ( watery

spu tum , pus , blood ) insputum , pus , blood ) inbron ch i or cavi tiesbronch i or cavi tiesthough wh ich air passesthough wh ich air passes

* Air bubbles pass* Air bubbles pass

though the f lu id andthough the f lu id andproduce speci f icproduce speci f iccrack ing sound oncrack ing sound onsu rface of a fluidsu rface of a fluid

If i t is cavi ty i t mustIf i t is cavi ty i t must

communicate wi thcommunicate wi thbronchusbronchus

D di th lib f b hiD di th lib f b hi


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Depending on the calibers of bronchiDepending on the calibers of bronchi

where rales are generated they arewhere rales are generated they are

classifiedclassified

Moist rales

Coarse

bubbling rales

Medium

bubbling rales

Fine

bubbling rales


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Moist rales are occurred inMoist rales are occurred in::

--pneumoniapneumonia

--tbstbs

--bronchi t isbronchi t is--bronchiectas isbronchiectas is

--cavern , abscesscavern , abscess

--congest ion o f the lung scongest ion o f the lung s


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CrepitationsCrepitations::

Crepitations originate in alveoli.Crepitations originate in alveoli.

They are heard only in the endThey are heard only in the end

of inspirationof inspiration

(height of inspiration)(height of inspiration)


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Crepitations are occurred inCrepitations are occurred in::

** Lobar pneumoniaLobar pneumonia (alveolar walls are imp regnated(alveolar walls are imp regnatedby exudate)by exudate)

(in the I(in the I--stst and IIIand IIIrd s tage)rd s tage)

** Pulmonary infarctionPulmonary infarction ( alveolar w alls are( alveolar w alls are

impregnated by blood)impregnated by blood)

** Onset of pu lmonary oedemaOnset of pu lmonary oedema

** Inf i l t rat ive pu lmonary tbsInf i l t rat ive pu lmonary tbs

** Compress ive atelectasisCompress ive atelectasis( not c ons tant)( not c ons tant)


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Pleural RubPleural Rub::

Mechanism ofMechanism ofoccurrenceoccurrence::

1. Fibrin is deposited in1. Fibrin is deposited ininflamed pleura toinflamed pleura to

make its surface roughmake its surface rough(dry pleurisy)(dry pleurisy)

2. Commissures , bands2. Commissures , bandsbetween pleural layersbetween pleural layers

3. Tubercles on layers in3. Tubercles on layers intbs, tumours,tbs, tumours,metastasis,metastasis,

carcinomatosiscarcinomatosis

of pleuraof pleura

4. Dryness of pleural4. Dryness of pleurallayers ( severelayers ( severe

dehydration)dehydration)

3 en ausculation

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