(钩端螺旋体病).ppt

RespiratorySymptoms,ZhaoLi,M.D.,Commonsymptoms,CoughExpectorationHemoptysisChestpainCyanosisDyspnea,Cough(aprotectivereflex):causes,Respiratorydiseases_themostcommoncausesAirwayagentsBronchitis,bronchiectasis,asthma,endobronchialtuberculosis,tumor,pharyngitisLungagentsInfection,edema,fibrosis,tumorPleuralagentsPleurisy,pneumothorax,mesotheliomaofpleura,Cough(aprotectivereflex):causes,CardiovasculardiseasesCardiogenesisedema,pulmonaryembolismCentralnervoussystemagentsInitiativecough,encephalitis,meningitis,Cough:manifestations,CharacteristicsDrycough(non-sputum)Productivecough(sputum:infectious,edema)AttackTime(morning,midnight,earlymorning)Season(spring,summer,falland/orwinter)Motivation(fumeinhalation,exertion)ToneHoarsenessHighpitchWeakBrassy,Cough:accompanysigns,Fever(infection)Chestpain(infection,tumor,pleurisy,pneumothorax,pulmoembolism)DyspneaHemoptysis(bronchietasis,tuberculosis,tumor)Bulkpussputum(bronchietasis,lungabscess)Wheezing(asthma,foreignbody)Clubbingfingers(bronchietasis,lungcancer,chroniclungabscess),Sputum:amount,BulkfrothysputumPulmoedemaBulkserofluidsputumAlveolarcellcarcinomaBulkpussputumBronchiectasisLungabscessLayeringupper:frothy,middle:mucoidormucopus,lower:necrosissubstance,Sputum:consistency,MucoidsputumBronchitis(withoutbacterialinfection)AsthmaEarlystageofpneumoniaSerofluidsputumPulmoedemaPussputumAnybacterialinfectionBloodysputum,Sputum:color,WhitemucoidorserofluidsputumYellowgeneralbacterialinfectionGreenaeruginosusBacillusinfectionGreyorblackdustinhalationRustyLobarpneumoniaPinkcardiacedemaRedhemoptysis,Greyorblack,Sputum:foulodor,anaerobicbacteriuminfection,Hemoptysis,BleedingfromlowerrespiratorytractTheamountvariesfromblood-strainedsputumtoseveralhundredsmlpurebloodMild:100ml/dModerate:100-500/dSevere:500ml/d,or100-500ml/timeDifferentialdiagnosisBleedingfromupperrespiratorytractHematemesis,Distinguishedhemoptysisfromhematemesis,Hemoptysis:causes,BronchialdisordersBronchiectasisBronchogeniccarcinomaendobronchialTBChronicbronchitisPulmoDisordersPulmoTBPeumoniaLungabscessPulmoembolism,Hemoptysis:causes,CardiovasculardisordersAcuteleftheartfailureMitralstenosisOthersHematologicdisease,leptospirosis（钩端螺旋体病），epidemichemorrhagicfever，endometriosis（子宫内膜异位症）,Hemoptysis:accompanysigns,FeverInfectionorcarcinomaChestpainInfection，PulmoEmbolism，CarcinomaPussputumBronchiectasis，LungabscessClubbingfingersBronchiectasis，Lungabscess，CarcinomaHemorrhagicspotsHematologicdisease,leptospirosis,epidemichemorrhagicfever,Chestpain:causes,Chestwallherpeszoster,ribfractureCardiovascularanginapectoris,myocardialinfarction,pericarditis,dissectinganeurysm（夹层动脉瘤）RespiratoryPleuraldisorders,pneumothorax,carcinomaMediastinalMediastinitis,mediastinalemphysema,mediastinaltumorOthersesophagealcarcinoma,liverabscess,subdiaphragmaticabscess,hiatalhernia（食道裂孔疝）,Chestpain:characteristics,locationReferredpainfeatureBurningpain,pressingpain,burstingpain,prickingpainDurationInfluentialfactorsExertional,respiration,foodintake,administration,Chestpain:accompanysigns,Cough,sputumand/orfeverRespiratorydiseaseDyspneaSeverepneumonia,pneumothorax,pleurisy,pulmoembolismHemoptysisCarcinoma,pulmoembolismShockmyocardialinfarction,dissectinganeurysm(rupture),largeareapulmoembolismDysphagia(吞咽困难)Esophagealdisease,Cyanosis,Anexcessofdesaturatedhemoglobincausesabluecolorationoftheskinormucosae.methemoglobinemia(高铁血红蛋白血症）Poisoningbynitrite,Cyanosis:classification,Central(warm)DeficientoxygenationRight-to-leftshuntPeripheral(cold)ReducedcardiacoutputLocalvasoconstrictionMixedHeartfailure,Cyanosis:accompanysigns,DyspneaSeverecardiacorrespiratorydisorderClubbingfingersCongenitalheartdiseaseChronicrespiratorydiseaseUnconsciousnessPoisoning,shock,Severecardiacorrespiratorydisorder,Dyspnea:causes,RespiratorysystemObstruction:asthma,COPD,tumorPulmoDiseases:pneumonia,interstitiallungdisease,Chestwallorpleura:pleurisy,pneumothorax,traumaneuro-muscles:poliomyelitis(脊髓灰质炎),myastheniagravis(重症肌无力)Diaphragmamovementdisorder:obviouslyelevatedpressureinabdominalcavity,Dyspnea:causes,CardiovascularsystemHeartfailurePulmoembolismPoisoningketoacidosisCentralnervoussystemcerebraltumor,trauma,abscess,hemorrhage,encephalitis,meningitishematologicalsystemSevereanemia,RespiratoryDyspnea,Inspiratorydyspnea_obstructioninlargeairwayThreedepressionsigndepressioninsuprasternalfossa,supraclavicularfossa,intercostalspaceExpiratorydyspnea_obstructioninsmallairwayoralveolarelasticitydecreasedProlongedexpiratorytimeExpiratoryrhonchiMixeddyspnea_deficientgasexchangeRespiratoryrateincreasedShallowbreathing,Cardiacdyspnea_Heartfailure,Featuresofleftheartfailure,UnderlyingdiseasesMixeddyspneaPositionrelateddyspneaMoistcracklesorrhonchiinbothlungsReliefofsymptomsafterdigitalis,diuretic,vasodilatoragentused,Nocturnalparoxysmaldyspnea,CharacteristicsAwokenduetochesttightnessordyspneaForcedsittingpositionororthopneaSeveresweatTachycardiaMoistcracklesorrhonchiinbothlungsPinkfrothysputum,Nocturnalparoxysmaldyspnea,Poisoningdyspnea,Underlyingdiseasesofmetabolicacidosis(uremia,diabeticketoacidosis)deepbreathing(Kussmaulbreathing),Dyspnea:accompanysigns(1),RhonchiAsthmaAcuteleftheartfailure(cardiacasthma)