Symptoms of respiratory system diseases. Lection 2-3

Август 11, 2022

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Symptoms of respiratory system diseases. Lection 2-3

Содержание

2. Physical examination General inspection Cyanosis (diffuse, warm) – respiratory failure Hyperemia of the face and upper
3. 2. Examination of the chest 1)The shape of the chest normal (asthenic, normo- and hypersthenic) pathological
5. 4) The position of the clavicles, supra- and subclavian fossae, the state of the intercostal spaces:
7. 3. Palpation of the chest Objectives Assess pain Determine the resistance of the chest Study the
8. Voice vibration palpation sensation of chest vibration when pronouncing individual words containing the sound R-R (tractor)
10. Basic pathology of the lung
11. Pulmonary emphisema / Эмфизема легких - increased airiness of the lungs
12. Норма Эмфизема
13. Pneumonia -acute infection of respiratory part
15. Абсцесс легкого Abscess
18. Atelectasis - loss of airiness of the lung tissue Fluid Compression atelectasis Air
20. Obstructive atelectasis
21. Percussion of the lung
22. Comparative Percussion: Dullness or shortening of the percussion sound occurs when the lung tissue is compacted
23. Symbols Voice vibration Percussion tone
24. Lung auscultation АУСКУЛЬТАЦИЯ ЛЕГКИХ
25. History /История аускультации Hippocrates / Гиппократ – непосредственная аускультация ухом René-Théophile-Hyacinthe Laennec[ (1781 –1826) was a
28. Conditions for auscultation/ Условия проведения аускультации The patient in a sitting or standing position, breathing through
29. Purposes / Цели аускультации Recognize the basic breath sound / оценить основной дыхательный шум 2. Recognize
30. Basic breath sounds For lungs normal sound – vesicular sounds Origin: 1 step: sound is generated
31. Laryngotracheal Vesicular sounds sounds air
32. Vesicular sounds / Везикулярное дыхание Mechanism / Механизм образования: Larynx, trachea– rough turbulent noise / грубый
33. Vesicular sounds - normal for the lungs auscultation Laryngotracheal sounds – normal for the …. But
34. Auscultation depends on: 1. Upper respiratory tracts condition 2. Bronchial condition (patency) 3. Status alveoli 4.
35. Evaluation of the vesicular sound Vesicular breath sounds are soft and low pitched with a rustling
36. Evaluation of the vesicular sounds Attenuation / Ослабление А. Diffuse / Диффузное Reasons: - hyperinflation /
37. Laryngotracheal sounds ! Pathological laryngotracheal sound always local Reason – consolidation of lung tissue due to
38. Adventitious (additional) breathing sounds / Дополнительные дыхательные шумы Crackles - Fine crackles are brief, discontinuous, popping
39. Adventitious breath sounds - Coarse crackles are discontinuous, brief, popping lung sounds. Compared to fine crackles
40. Adventitious breath sounds Wheezes are lung sounds that are continuous with a musical quality. Wheezes can
41. Adventitious breath sounds Monophonic wheezes (rhonchi) are loud, continuous sounds occurring in inspiration, expiration or throughout
42. Adventitious breathing sounds Polyphonic wheezes are loud, musical and continuous. These breath sounds occur in expiration
43. Pleural rubs are discontinuous or continuous, creaking sounds. The sound has been described as similar to
44. Bronchophony Ask the patient to say "99" several times while auscultating the chest walls. Over healthy
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Physical examination
General inspection
Cyanosis (diffuse, warm) – respiratory failure
Hyperemia of

the face and upper half of the body – lung emphysema (EL)
Earthy color skin, dry skin – chronic bronchitis (CB)
Symptom of “drumsticks and watch glasses” – chronic hypoxia (CB and EL)
Smoker's tongue, smoker's fingers - (CB and EL)
Neck veins distension, ascites, edema in the legs - cor pulmonale (right ventricular failure)

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2. Examination of the chest
1)The shape of the chest normal

(asthenic, normo- and hypersthenic) pathological (emphysematous, paralytic, keeled, funnel-shaped, deformed with curvature of the spine)
2)Symmetry (determined visually or with a measuring tape):
asymmetry due to an increase in one half – hydrothorax (HT), pneumothorax (PT)
asymmetry due to a decrease in one half - pleural adhesions, atelectasis, removal of part of the lung
3) Participation of both halves of the chest in the act of breathing.
One part doesn’t participate – pleural pain, PT, after resection (surgery)

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4) The position of the clavicles, supra- and subclavian fossae, the

state of the intercostal spaces:
bilateral smoothness or bulging of pits and intercostal spaces - EL
unilateral smoothness of intercostal spaces - PT, HT
5) Respiratory rate (norm 16-20 per minute).
An increase in respiratory rate is a sign of damage to the bronchopulmonary system (not only) .
Type of breath, normal types: abdominal, thoracic, mixed, pathological types (distinguished based on the rhythm and depth of breathing)

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3. Palpation of the chest
Objectives
Assess pain
Determine the resistance

of the chest
Study the phenomenon of voice vibration

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Voice vibration
palpation sensation of chest vibration when pronouncing individual words containing

the sound R-R (tractor)
It is evaluated on symmetrical areas of the chest, starting from the front and top.
Conducting voice vibration depends on the timbre of the voice, gender, chest thickness.
Voice vibration symmetrically weakened - EL, obesity
locally weakened - HT, PT, obstructive atelectasis
local enhancement - compaction of lung tissue
(pneumonia, tumor, compression atelectasis)

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Basic pathology of the lung

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Pulmonary emphisema / Эмфизема легких
- increased airiness of the lungs

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Норма
Эмфизема

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Pneumonia
-acute infection of respiratory part

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Абсцесс легкого
Abscess

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Atelectasis - loss of airiness of the lung tissue
Fluid
Compression atelectasis
Air

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Obstructive atelectasis

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Percussion of the lung

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Comparative Percussion:
Dullness or shortening of the percussion sound occurs when

the lung tissue is compacted or there is fluid in the pleural cavity.
Total dullness – obesity local unilateral dullness - pneumonia, hydrothorax, atelectasis
Tympanitis occurs when the airiness of the lung tissue increases.
Symmetrical tympanitis – EL
Local unilateral tympanitis - cavity in the lungs, pneumothorax

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Symbols
Voice vibration
Percussion tone

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Lung auscultation АУСКУЛЬТАЦИЯ ЛЕГКИХ

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History /История аускультации
Hippocrates / Гиппократ – непосредственная аускультация ухом
René-Théophile-Hyacinthe Laennec[ (1781 –1826)

was a French physician and musician. His skill of carving his own wooden flutes led him to invent the stethoscope in 1816.
He pioneered its usage in diagnosing various chest conditions.

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Conditions for auscultation/ Условия проведения аускультации
The patient in a sitting

or standing position, breathing through the mouth, listen to 1-2 respiratory movements at one point. The doctor asks to breathe a little deeper, but not forcedly, and not too often. The sequence is like percussion. /
больной в положении сидя или стоя, дыхание ртом, выслушивают 1-2 дыхательных движения в одной точке. Просят дышать чуть глубже, но не форсированно, и не слишком часто. Последовательность - как при перкуссии.

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Purposes / Цели аускультации

Recognize the basic breath sound /

оценить основной дыхательный шум
2. Recognize adventitious (additional) breath sounds/
оценить наличие побочных дыхательных шумов
3. Check the voice conduction (bronchophony) / оценить проведение голоса на грудную стенку

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Basic breath sounds
For lungs normal sound – vesicular sounds
Origin: 1 step:

sound is generated when air passes through the glottis of the larynx and trachea
We can hear rough noise like: h-h-h-h-h larynx/грубый шум
2 step: in the lungs, this noise is softened by air in the alveoli f-f-f-f-f-f

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Laryngotracheal Vesicular sounds
sounds
air

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Vesicular sounds / Везикулярное дыхание
Mechanism / Механизм образования:
Larynx, trachea– rough turbulent noise

/ грубый тубулярный шум
high frequency
alveoli
low frequency

air

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Vesicular sounds - normal for the lungs auscultation
Laryngotracheal sounds –

normal for the ….
But it`s sign of pathology if you hear this sound over lungs

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Auscultation depends on:
1. Upper respiratory tracts condition
2. Bronchial condition

(patency)
3. Status alveoli
4. Condition of the interstitium
5. Pleural condition

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Evaluation of the vesicular sound
Vesicular breath sounds are soft and

low pitched with a rustling quality during inspiration and are even softer during expiration. These are the most commonly auscultated breath sounds, normally heard over most of the lung surface.
They have an inspiration/expiratory ratio of 3 to 1 or I:E of 3:1.

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Evaluation of the vesicular sounds
Attenuation / Ослабление
А. Diffuse / Диффузное
Reasons:

- hyperinflation / эмфизема легких
- obesity / ожирение
- shallow breathing / поверхностное дыхание
Б. Local
Reasons: : - obturation of the bronchus / обтурация бронха
- HT and PT

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Laryngotracheal sounds
! Pathological laryngotracheal sound always local
Reason – consolidation

of lung tissue due to filling of alveoli with exudate or their compression (pneumonia, hydrothorax with compression atelectasis)
Amphoric sound is a variety of laryngotracheal sound
Reason - lung cavity connected with bronchus

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Adventitious (additional) breathing sounds / Дополнительные дыхательные шумы
Crackles
- Fine crackles

are brief, discontinuous, popping lung sounds that are high-pitched. Fine crackles are also similar to the sound of wood burning in a fireplace, or hook and loop fasteners being pulled apart or cellophane being crumpled.
Late inspiratory crackles (fine) may mean pneumonia, CHF, or atelectasis.

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Adventitious breath sounds
- Coarse crackles
are discontinuous, brief, popping lung

sounds. Compared to fine crackles they are louder, lower in pitch and last longer. They have also been described as a bubbling sound.
Early inspiratory and expiratory crackles (usually coarse) are the hallmark of chronic bronchitis. A patient's cough may decrease or clear these lung sounds.
Early inspiratory crackles suggest decreased FEV1 capacity and are characteristic of COPD.

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Adventitious breath sounds
Wheezes
are lung sounds that are continuous with a

musical quality. Wheezes can be high or low pitched.
-High pitched wheezes may have an auscultation sound similar to squeaking (писк).
Lower pitched wheezes have a snoring (храп)
Origin- airway vibration in the place of obstruction
The proportion of the respiratory cycle occupied by the wheeze roughly corresponds to the degree of airway obstruction.

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Adventitious breath sounds
Monophonic wheezes (rhonchi) are loud, continuous sounds occurring in

inspiration, expiration or throughout the respiratory cycle.
The constant pitch of these sounds creates a musical tone. The tone is lower in pitch compared to other adventitious breath sounds. The single tone suggests the narrowing of a larger airway.

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Adventitious breathing sounds
Polyphonic wheezes are loud, musical and continuous. These breath

sounds occur in expiration and inspiration and are heard over anterior, posterior and lateral chest walls. These sounds are associated with COPD and more severe asthma.

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Pleural rubs
are discontinuous or continuous, creaking sounds.
The sound has

been described as similar to walking on fresh snow or a leather-on-leather type of sound.
Coughing will not alter the sound.
They are produced because two inflamed surfaces are sliding by one another, such as in pleurisy.
Pleural rubs stop when the patient holds her breath. If the rubbing sound continues while the patient holds a breath, it may be a pericardial friction rub.

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Bronchophony
Ask the patient to say "99" several times while auscultating the

chest walls. Over healthy lung areas, "99" is not understandable. This is because sound is impeded in normal lungs.
Over consolidated areas "99" is understandable
Egophony: ask the patient to say "Eeee" several times and auscultate the chest walls. Over healthy lung areas, the sound is understandable as an "E". Over consolidated lung areas, the sound is heard as an "A" (aaay).

Symptoms of respiratory system diseases. Lection 2-3

Содержание

Physical examinationGeneral inspection Cyanosis (diffuse, warm) – respiratory failure Hyperemia of

2. Examination of the chest 1)The shape of the chest normal

4) The position of the clavicles, supra- and subclavian fossae, the

3. Palpation of the chest Objectives Assess pain Determine the resistance

Voice vibrationpalpation sensation of chest vibration when pronouncing individual words containing

Basic pathology of the lung

Pulmonary emphisema / Эмфизема легких - increased airiness of the lungs

НормаЭмфизема

Pneumonia-acute infection of respiratory part

Абсцесс легкогоAbscess

Atelectasis - loss of airiness of the lung tissueFluidCompression atelectasisAir

Obstructive atelectasis

Percussion of the lung

Comparative Percussion:Dullness or shortening of the percussion sound occurs when

SymbolsVoice vibration Percussion tone

Lung auscultation АУСКУЛЬТАЦИЯ ЛЕГКИХ

History /История аускультацииHippocrates / Гиппократ – непосредственная аускультация ухомRené-Théophile-Hyacinthe Laennec[ (1781 –1826)

Conditions for auscultation/ Условия проведения аускультации The patient in a sitting

Purposes / Цели аускультации Recognize the basic breath sound /

Basic breath soundsFor lungs normal sound – vesicular soundsOrigin: 1 step:

Laryngotracheal Vesicular sounds sounds air

Vesicular sounds / Везикулярное дыхание Mechanism / Механизм образования:Larynx, trachea– rough turbulent noise

Vesicular sounds - normal for the lungs auscultation Laryngotracheal sounds –

Auscultation depends on: 1. Upper respiratory tracts condition 2. Bronchial condition

Evaluation of the vesicular sound Vesicular breath sounds are soft and

Evaluation of the vesicular sounds Attenuation / ОслаблениеА. Diffuse / ДиффузноеReasons:

Laryngotracheal sounds ! Pathological laryngotracheal sound always local Reason – consolidation

Adventitious (additional) breathing sounds / Дополнительные дыхательные шумыCrackles - Fine crackles

Adventitious breath sounds- Coarse crackles are discontinuous, brief, popping lung

Adventitious breath soundsWheezes are lung sounds that are continuous with a

Adventitious breath soundsMonophonic wheezes (rhonchi) are loud, continuous sounds occurring in

Adventitious breathing soundsPolyphonic wheezes are loud, musical and continuous. These breath

Pleural rubs are discontinuous or continuous, creaking sounds. The sound has

Bronchophony Ask the patient to say "99" several times while auscultating the

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