respiratory symptoms zhao li, m.d.. common symptoms cough expectoration hemoptysis chest pain ...

Respiratory SymptomsRespiratory Symptoms

Zhao Li, M.D.Zhao Li, M.D.

Common symptomsCommon symptoms

Cough Expectoration Hemoptysis Chest pain Cyanosis Dyspnea

Cough Cough ((a protective reflexa protective reflex): ): causescauses

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

Cough : Cough : manifestationsmanifestations

Characteristics Dry cough (non-sputum: non-infectious) Productive cough (sputum: infectious, edema)

Attack Time season motivation

Tone Hoarseness High pitch Weak Brassy

Cough: Cough: accompany signsaccompany signs

Fever (infection) Chest pain (infection, tumor, pleurisy, pneumoth

orax, pulmo embolism) Dyspnea Hemoptysis (bronchietasis, tuberculosis, tumor) Bulk pus sputum (bronchietasis, lung abscess) Wheezing (asthma, foreign body) Clubbing fingers (bronchietasis, lung cancer, chr

onic lung abscess)

Sputum: Sputum: amountamount

Bulk frothy sputum Pulmo edema

Bulk serofluid sputum Alveolar carcinoma

Bulk pus sputum Bronchiectasis Lung abscess

Layeringupper: frothy, middle: mucoid or mucopus, lower: necrosis substance

Sputum: Sputum: consistencyconsistency

Mucoid sputum Bronchitis (without bacterial infection) Asthma Early stage of pneumonia

Serofluid sputum Pulmo edema

Pus sputum Any bacterial infection

Bloody sputum

Sputum: Sputum: colorcolor

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

Sputum: Sputum: foul odorfoul odor

anaerobic bacterium infection

Hemoptysis Hemoptysis

Bleeding from lower respiratory tract

The amount varies from blood-strained sputum to several hun

dreds 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

Distinguished hemoptysis from hematDistinguished hemoptysis from hematemesisemesis

Hemoptysis Hematemesis

Causes Pulmo or cardiac digestive system

Previous symptoms Cough, chest tightness Nausea, vomiting

Spit up Cough up Vomited

Color Bright red Dark red

Mixture Sputum, frothy Gastric contents

pH alkality acidity

Tarry stools - or + +

Post-bleeding Sputum with blood No sputum

Hemoptysis: Hemoptysis: causescauses

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）， epidemi

c hemorrhagic fever， endometriosis （子宫内膜异位症）

Hemoptysis: Hemoptysis: accompany signsaccompany 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 h

emorrhagic fever

Chest pain: Chest pain: causescauses

Chest wall herpes zoster, rib fracture

Cardiovascular angina pectoris, myocardial infarction, pericarditis, dissecting an

eurysm （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）

Chest pain: Chest pain: characteristicscharacteristics

location Referred pain Level or feature

Burning pain, pressing pain, bursting pain, pricking pain

Duration Influential factors

Exertional, respiration, foodintake, administration

Chest pain: Chest pain: accompany signsaccompany 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 ), lar

ge area pulmo embolism Dysphagia ( 吞咽困难 )

Esophageal disease

Cyanosis 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 )

Cyanosis: Cyanosis: classificationclassification

Central (warm) Deficient oxygenation Right-to-left shunt

Peripheral (cold) Reduced cardiac output Local vasoconstriction

Mixed Heart failure

Cyanosis: Cyanosis: accompany signsaccompany signs

Dyspnea Severe cardiac or respiratory disorder

Clubbing fingers Congenital heart disease Chronic respiratory disease

Unconsciousness Poisoning, shock, Severe cardiac or respiratory dis

order

Dyspnea: Dyspnea: causescauses 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 abdomin

al cavity Cardiovascular system

Heart failure Pulmo embolism

Poisoning ketoacidosis

Central nervous system cerebral tumor , trauma, abscess, hemorrhage, encephalitis, meningitis

hematological system Severe anemia

Respiratory DyspneaRespiratory Dyspnea Inspiratory dyspnea ____obstruction in large airway

Three depression sign depression in suprasternal fossa, supraclavicular fossa, intercostal spac

e 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

Cardiac dyspnea ____ Cardiac dyspnea ____ Heart failureHeart failure

Mechanism of left heart failure

Pulmo edema diffusion capacity decreased

Alveolar tension increased stimulating stretch recepto

r excitation of vagus nerve excitation of respirator

y center

Alveolar elasticity decreased vital capacity decreased

Increased pressure of pulmo circulation stimulating

respiratory center

Features of left heart failureFeatures of left heart failure

Underlying diseases

Mixed dyspnea

Position related dyspnea

Moist crackles or rhonchi in both lungs

Relief of symptoms after digitalis, diuretic, vasodila

tor agent used

Nocturnal paroxysmal dyspnea 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

Nocturnal paroxysmal dyspneaNocturnal paroxysmal dyspnea

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 decreased reaction aft

er obvious hypoxia

Poisoning dyspneaPoisoning dyspnea

Underlying diseases of metabolic acidosis (ure

mia, diabetic ketoacidosis )

deep breathing (Kussmaul breathing)

Dyspnea: Dyspnea: accompany signs (1)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

Dyspnea: Dyspnea: accompany signs (2)accompany signs (2)

Fever Infection

Cough and sputum COPD Infection Left heart failure

Unconsciousness CNS disorder Uremia diabetic ketoacidosis