Download Respiratory System

Respiratory System
Anatomy
• The respiratory system starts from the
nose, mouth, larynx, trachea, and the
two lungs.
• Within the lungs, the bronchi transport air
with oxygen to the alveoli on inspiration and
carry waste gases (e.g. carbon dioxide) away
on expiration.
• The acinus is the gas exchange unit of the
lung and consists of branching respiratory
bronchioles leading to clusters of alveoli.
• Alveoli are tiny air sacs lined by flattened
epithelial cells and covered in capillaries
where gas exchanges occur
• The alveoli and capillaries have
extremely thin walls and come into very
close contact (the alveolar capillary
membrane) so gases can rapidly
diffuse between them. There are
approximately 300 million alveoli in
each lung for gas exchange with a total
surface area of 40-80 meter square.
• The lungs has two blood supplies:
1) the bronchial arteries which arise from
the aorta and supply oxygenated blood
to the bronchial walls.
2) The pulmonary arteries which deliver
deoxygenated blood to the capillaries
surrounding the alveoli
Symptoms
1) Cough
2) Sputum production
3) Hemoptysis
4) Chest pain
5) Breathlessness
Symptoms
1 )Cough:
Is a forced expulsive maneuver against an
initially closed glottis. Causing
characteristic sound.
Can be acute (less than 3 weeks) or chronic
(more then 8 weeks)
The most common cause is acute viral
infections of the upper airway system
• Cough (features)
Prolonged wheezy coughing: asthma,
COPD.
Feeble non-explosive (bovine): lung
cancer (paralysis of vocal cords),
neuromsucular disease causing
respiratory muscle weakness
Moist cough: secretions from infection,
bronchiectasis, chronic bronchitis.
Noctunral cough: asthma
Cough (causes)
Chronic
Acute:
Viral respiratory
tract infection
Bronchitis
Inhaled foreign
body
Inhalation of irritant
dusts or fumes
Pneumonia
Acute extrinsic
allergic alveolitis
Gastroesophageal reflux disease
(GERD)
Asthma
Post bronchial hyper-activity
Rhinitis/sinusitis
Cigarette smoking
Drugs, ACE inhibitors
Irritant dusts/fumes
Lung tumors
TB, Interstitial lung disease
Bronchiectasis
Symptoms
2) sputum production
• Amount
• Colour
• Taste or smell
Examples:
 COPD and chronic bronchitis: clear mucoid sputum
if there is no infection
 Lower respiratory tract infection: yellowish sputum
(presence of live neutrophils)
 Ashtma: yellowish sputum (eosinophils)
 Bronchiectasis: large volumes of purulent sputum
varying with posture
 Pulmonary edema: watery sputum with a pink tinge
Symptoms
3) Hemoptysis
Amount and appearance
Duraion and frequency
intermittent with recurrent infections
over years: bronchiectasis
Daily for a short periods (weeks) lung
cancer, TB, abscess
Single episodes with chest pain: pulmonary
infarction.
Hemoptysis (causes)
Infection:
Bronchiectais, Tuberculosis, lung abscess, cystic
fibrosis
Tumours:
Lung cancer, endobronchial metastasis, bronchial
carcninoid.
Vascular:
Pulmonary infarction, arteriovenous malformation
Vasculitis.
Trauma
Foreign body, iatrogenic
Hemoptysis (causes)
Cardiac:
Mitral Valve disease, acute left ventricular failure
Hematological:
Bleeding tendencies, anticoagulation
Symptoms
4) Chest pain:
 Pleural chest pain
 Chest wall pain
 Mediastinal chest pain
Pleural chest pain
• Is a sharp, stabbing pain and is intendified
by inspiration or coughing caused by
irritation of the parietal pleura.
• Causes:
Infection: pneumonia, bronchiectasis
Pneumothorax
Pulmonary infarction
Connective tissue disease
Chest wall pain
Causes:
Chornic cough/breathlessness
Muscular pain
Rib fractures
Bony metastasis
Thoracis shingles (herpes zoster)
Mediastinal chest pain
• Mediastinal chest pain is central, retrosternal
and unrelated to respiration or cough.
• Causes:
Massive pulmonary embolism
Acute myocardial infarction
Aortic dissection
Infection, irritant dusts
Eshophagitis
Mediastinitis
Lymphadenopathy
Symptoms
5) Breathlessness
 Shortness of breath, difficulty getting
enough air.
 Mode of onset
Minutes: pulmonary thromboembolism,
pneumothorax, asthma, inhaled forein body
Hours to days: pneumonia, asthma.
Weeks to months: Anemia, Pleural effuion,
neruomuscular disease.
Months to years: COPD, pulmonary fibrosis,
TB, Heart failure.
Breathlessness
Causes:
Non cardio-respiratory:
Anemia, Obesity, Psychogenic, Metabolic acidosis.
Cardiac:
Heart failure, mitral valve disease, pericarditis,
pericaridal effusion
Respiratory:
Foreign body, Ashtma, COPD, Bronchiectasis, Lung
cancer, pulomnary fibrosis, Pneumonia,
Tuberculosis, pulmonary thromboembolism,
pulmonary hypertension, pneumothorax,
kyphoscholiosis.
Neumuscular disease.
Physical Examination of the respiratory system
General Examination
Respiratory rate
Accessory muscles
Breathing pattern
Examination of the thorax
Inspection
Stridor
Palpation
Hoarseness
Blood pressure
Hands
Shape of chest
Cyanosis
Skin Appearances
Percussion
Neck
Ascultation
Physical Examination of the respiratory system
General Examination
Respiratory rate
Examination of the thorax
Respiratory rate
Average: 14 breath per minute
Normal 12-20 breth per minute
Tachypnea:
Increased ventilatory drive:
Fever
Acute asthma, COPD exacerbation
Reduced ventilatory capacity:
Pneumonia, Pulmonary edema, interstitial
lung disease.
Decreased respiratory rate
Physical Examination of the respiratory system
General Examination
Respiratory rate
Breathing pattern
Examination of the thorax
Breathing Patterns
Periodic breathing (Cheyne-Stokes
respiration)
Hyperventilation
Anxiety/emotional stress
Metabolic acidosis (Kussmaul
respiration)
Physical Examination of the respiratory system
General Examination
Respiratory rate
Accessory muscles
Breathing pattern
Stridor
Examination of the thorax
Stridor
A harsh, rasping or croaking inspiratory noise
resulting from turbulent airflow in the upper
airway, aggravated by coughing.
Should always be investigated, can be an
emergency
Causes
foreign body or tumour partially occluding
larynx, trachea or main bronchus
epiglottitis
Air way edema
Physical Examination of the respiratory system
General Examination
Respiratory rate
Accessory muscles
Hoarseness
Breathing pattern
Stridor
Cyanosis
Examination of the thorax
Cyanosis
Is a bluish discoloration of the skin and
mucous membranes
Can be Central of Peripheral
Physical Examination of the respiratory system
General Examination
Respiratory rate
Accessory muscles
Hoarseness
Blood pressure
Hands
Breathing pattern
Stridor
Cyanosis
Skin Appearances
Examination of the thorax
Hands
Clubbing
(mild , moderate , gross )
Causes
Familial
Thoracic
Non-Thoracic
Thoracic
Non Thoracic
Lung cancer
Mesothelioma
Pleural fibroma
Liver cirrhosis
Esophageal cancer
Celiac disease
Thymoma
Ulcerative colitis
Atrial myxoma
Crohn’s disease
IPF
Bronchiectasis, lung abscess
Empyema
CF
Bacterial Endocarditis
Cyanotic congenital heart
disease
Lung AV malformation
Hands
Hypertrophic Pulmonary Osteoarthropathy
(combination of clubbing and thickening of
periosteum (connective tissue lining of the
bones) and synovium)
Discoloration of the finger and nails
Tremor
Fine tremor
Coarse flapping tremor (asterixis)
Causes of flapping tremor
Respiratory failure/ CO2 retention
Liver failure
Renal failure
Electrolyte disturbance
Hypoglycemia
Hypokalemia
Hypomagensemia
Wilson’s disease
CNS
Intracerebral hemorrhage
subdural hematoma
subarachnoid hemorrhage
cerebral ischemia
cerebral lymphoma
Drugs
barbiturates
alcohol
sodium valproate
phenytoin
carbamazaepine
metoclopramide
gabapentin
ceftazidime
opioids
Physical Examination of the respiratory system
General Examination
Respiratory rate
Accessory muscles
Hoarseness
Blood pressure
Hands
Breathing pattern
Stridor
Cyanosis
Skin Appearances
Neck
Examination of the thorax
Neck
JVP
Neck Nodes
will see you soon next year
Thank you