呼吸系统教学课件：Respiratory Symptom

RespiratorySymptom2023/3/142ClinicalDiagnosisdiagnosisSymptom(medicalhistory)Physicalsignstestexamination2023/3/143symptomCharacterDurationPatternrhythm

causeAccompaniedAbnormalitiesClinicalscenarios

coughirritating

coughirritatingcough,blood-streakedsputum

irritating

cough

associatedwithfeverofblood-streakedsputumirritating

cough,2months

oflowthermal,blood-streakedsputum50yearold

male,2monthsof

irritatingcoughassociatedwithfeverandblood-streakedsputumCoughExpectorationHemoptysisChestpain2023/3/145要求掌握常见呼吸系统症状（咳嗽、咳痰、咯血、胸痛）的概念、主要表现、临床特征及鉴别。熟悉常见呼吸系统症状出现的原因、发生机制及临

床意义。了解

常见呼吸系统症状的问诊

2023/3/147

COUGH2023/3/148咳嗽是为防止异物进入气道、清除气道内潴留的分泌物的一系列防御性反射。CONCEPTCleanexcessivesecretion&foreignmaterialInitiatedbymiscellaneousstimuliorbyvoluntaryexertionSeverecoughisaseriousclinicalproblemAprotectivereflexactThemostcommonrespiratorysymptomEtiologyRespiratoryDiseases-mostcommonStimulatingplacestimulatingfactorPleural&chestwalldisordersCardiovascularabnormalitiesCentralnervoussystemfactorsOthercausesEtiologyInflammationcancerforeignbodyautonomouscontrol2023/3/1411

EtiologyRespiratoryDiseases-mostcommonAirwayfactors:Bronchitis,bronchiectasis,asthma,tumor,pharyngitis,endobronchialtuberculosisLungfactors:Infection,edema,fibrosis,tumor2023/3/1412EtiologyPleural&chestwalldisordersPleurisy,pneumothorax,mesotheliomaofpleuraCardiovascularabnormalitiesCardiacedema,pulmonaryembolismGERDOthercausesCentralnervoussystemfactorsPsychiatriccough2023/3/1414CoughReflexAfferentinformfromLarynx,trachea,bifurcationofthebronchiIrritanttypeMechanical,chemical,(inflammationforexample)Afferentfibersareinthenervecoughcenter.

呼吸道粘膜其他器官延髓咳嗽中枢迷走N舌咽N三叉N喉下N膈N脊N咽肌声门膈肌其他呼吸肌咳嗽动作皮肤的感觉N咳嗽发生机制

coughreflexmechanism2023/3/1416CoughReflexEfferentsignalsLarynx,musclesofdiaphragm,chestwall,abdomenmusclesAcoordinatedseriesofmovementcompletedthecough.DeepinspirationeffortwithglottisclosedExpiration,GlottisopenabruptlyHighvelocityofairflowbringsoutsecretionsfromairways.2023/3/1419

ExpectorationThemorbidphenomenon____dischargingthepathologicalsecretionfromrespiratorytracttooralbythemovementofcoughing.

Expectoration

stimulatingfactorMicrobiology,physics,chemistry,allergicfactorspositionthroat,tracheaandbronchusmucousmembrane,alveolarconsequenceCongestion,edemaandcapillarypermeabilityincrease,glandshypersecretioncomponentInhalationofdust、tissuenecrosiscellcomposition、microorganismandmovablematerialinairway,themixtureofmucusandserousmaterialTheproductionofsputumHowtomakesuretheclinicalsignificanceofcough?2023/3/1421

Outbreakcharacteristicsofcough

ClassificationAcuteChronicoracuteonchronicCoughrhythmParoxysmAcutelaryngitis,foreignbodies,whoopingcough,asthma,bronchialendometrialtuberculosisChronicChronicbronchitisandbronchiectasis,pulmonarytuberculosis,lungabscess,etcToneQualityHoarsenessChorditis，laryngealTB,laryngealcancer,laryngealrecurrentnerveparalysisBrassymediastinaltumors,aorticaneurysm,bronchiallungcanceroppresstheairway,Highpitchwhoopingcough,epiglottis,laryngealdiseasesandairwaycompressionWeakSevereemphysema,vocalcordparalysis,extremelyweak2023/3/1425CharacterofCoughDrycoughNon-sputumProductivecoughSputum:infectious,edema

CharacterofCoughContributingfactorsdaystartChronicbronchitis,Bronchiectasis,lungabscess,paranasalsinusinfections,nighttimecoughvariantasthma,tuberculosis,leftheartfailure,SeasonalSpecialfactorposition,motion,suction,contact

Sputumspecialties

Layering:BronchiectasisLungabscessupper:frothysubstance,middle:mucoidormucopus,Lower:necrosissubstance2023/3/1427

thecharacterandvolumeofsputumvolumeMore:alveolarcellcarcinomaLess:

traitsstick:fungismelly:Anaerobicbacteriatough：fibrousbronchitisTenaciousstickymucoidsputum,occasionallywithbronchialcasts,：iscommonlynotedinasthmatics.

2023/3/1430Sputum:ColorWhiteMucoidorserofluidsputumYellowGeneralbacterialinfectionGreenAeruginosus-bacillusinfectionGreyorblackDustinhalationRustyLobarpneumoniaPinkCardiacedemaRedHemoptysis2023/3/1431Sputum:ClassificationSerofluidsputumPulmoedema,EchinococcosisMucoidsputumBronchitis(withoutbacterialinfection)Asthma，partofpneumoniaPussputumBronchiectasis,Lungabscess,Bronchitiswithbacteriainfection,partofpneumoniaBloodysputumTuberculosis,Carcinoma,Bronchiectasis2023/3/14serofluidsputummucoidsputumpussputumBloodysputumAccompaniedAbnormalities2023/3/1433Fever(acuteoractiveinfectionintherespiratorysystem)Chestpain(heartdiseaseandcoronaryheartdiseasepneumonia,tumor,pleurisy,pulmoembolism,pneumothorax,)Dyspnea(edemaandtumoroflarynx;COPD;TB;pneumothorax;severepneumonia;massivepleuraleffusion;pulmonarycongestion,Hemoptysis(bronchiectasis,tuberculosis,lungtumor,Bronchiectasis,Lungabscess,Mitralstenosis:)2023/3/1434AccompaniedAbnormalitiesWheezing：

asthma,foreignbody，COPD，cardiacedema,etal.Clubbingfinger：bronchiectasis,lungcancer,lungabscess,pyothoraxBulkpussputum：bronchiectasis,lungabscess,bronchi-pleuralfistula.GERD：gastroesophagealrefluxdiseasePNDs：postnasaldripsyndromeBronchiectasis2023/3/1436ClubbingfingerGeneralsituationchildren:Foreignbody,tracheobronchiallymphnodeenlargementyoung

adults:Coughforalongtimeforbronchiectasis,pulmonarytuberculosis,>40岁smokerslungcancer,chronicbronchitis,emphysemacontacts

smokeranddustcontact,SummaryPathogenesis:medullaoblongatacoughcenterisstimulated,nervereflexEtiology:respiratoryandcardiovascular,pleura,central,andotherClinicalmanifestation:properties,inducement,rhythm,timbre,sputumcolorandquantityAccompanyingsymptomsfever,pain,haemoptysis,sputum,dyspneaandwheezingsound,fingerclubbingComplementphysicianvisitsGender,age,occupation,smokinghistory,responsetodrugtreatment病例患者，女，46岁。反复咳嗽、咳黄痰40年，伴间断咯血10年入院。40年前麻疹史，后每遇受凉后咳嗽、咳黄痰，痰静置后可分层，晨起症状较明显，咳痰无明显季节性，病程中无胸闷、气喘、胸痛。10年前始，咳痰发作时常伴咯血，予抗感染、化痰、止血治疗可缓解。既往无其它慢性病史，无过敏史，家族中无类似疾病史。Clinicalscenarios咳痰；咳黄痰；咳黄色分层痰；晨起明显的咳黄色分层痰；晨起为主的咳黄色分层痰约40年；季节性不明显晨起为主的咳黄色分层痰约40年；季节性不明显的晨起为主的咳黄色分层痰约40年，伴间断咯血；46岁患者，季节性不明显的晨起为主的咳黄色分层痰约30年，伴间断咯血。Clinicalscenarios咳嗽；干性咳嗽；突发干咳；突发干咳伴胸闷、气急；突发干咳伴胸闷、气急，吸气时可加剧的胸痛，举重物后突发干咳伴胸闷、气急，吸气时可加剧的胸痛。2023/3/1444思考题１.阐述各种性状咳嗽咳痰病因分类？２.咳嗽咳痰的临床特点？2023/3/1446ChapterThree:HEMOPTYSISBleedingbelowthelevelofthelarynx

thatbeingcoughedout.Degrees:fromblood-tingedsputumtomassivegrossblood,evenleadingtoairwayocclusion(dyspnea)&shock.Thelatterismuchlessseen.2023/3/1447Differentiatingfrom

UpperAirwayBleedingPostnasalbleedingMouthandpharynxmembranebleedingByintensiveinvestigationandexamination喉2023/3/1449DifferentiatingfromHematemesisHemoptysisHematemesisHistoryofcoughing,Gastric,liverdiseasePrecededbystimulatingcough,chestpainandsoonPrecedednausea,vomiting,UpperabdomenpainCoughedup&frothyVomitedwithoutfrothyBrightredDarkredorbrownMixedwithsputumMixedwithfoodalkalineacidBlood-tingedsputumTarrystoolwithoutTarrystoolWithoutblood-tingedsputumThemostcommoncausePulmoTBTumorBronchiectasis2023/3/1450BronchiectasisTuberculosis

右上肺癌性空洞CommonCauses2023/3/1454BronchialDisordersBronchiectasisBronchogeniccarcinomaEndobronchialTBChronicBronchitisPulmoDiscordersPulmoTBPeumoniaLungabscessPulmoembolismTumorOthersHematologicdisease,),leptospirosis(钩端螺旋体病EpidemicHemorrhagicfever,endometriosisCardiovascularDisordersAcuteleftheartfailureMitralstenosis:capillaries,veinsPulmonaryhypertensionPulembolismPneumonia病例CardiovascularDisorders二尖瓣狭窄2023/3/1458HemoptysisAgeTheyoungTheoldTheamountvariesfromblood-strainedsputumtoseveralhundredsmilliliterpurebloodMild:<100ml/dModerate:100-500ml/dSevere:>500ml/d,or>100ml/timeColorandcharacter2023/3/1459AccompanySignsFeverInfectionChestpainInfectionPulmoembolismCarcinomaPussputumBronchie-ctasisLungabscessClubbingfingersBronchi-ectasisLungabscessCarcinomaHemorrha-gicspotsHematologicdiseaseLeptospirosisEpidemicHemorrhagicfeverJaundicepneumoniaLeptospiro-sis(钩端螺旋体病Pulmoinfarct2023/3/1460Investigation

Ifcoughedoutorvomittedout[文本】Age,sex,colourVolume:howmuchTimedurationAnyaccompaniedappearances思考题1．咯血和呕血如何鉴别?2．咯血的病因可分哪几类？3.咯血的定义？2023/3/1462ChapterFour:Chestpain2023/3/1463CommonCausesChestwallHerpeszosterRibfracturecostalchondritis,chestwalltumors.Cardiovas-cularAngina(心绞痛）

MyocardialinfarctionPericarditisDissectinganeurysmRespirato-ryPleuraldisordersPneumotho-raxCarcinomaPneumoniaMediastin-alMediastinitisMediastinalemphysemaMediastinaltumorEsophageallesionsHiatalhernia(食管裂孔疝OthersLivercarcinomaLiverabscessSubdiaph-ragmaticabsessSpleeninfartPainReflex2023/3/1465SensorynerveofchestIntercostalnervesOrgansandsympatheticnerveofaortaVagusnerveoftracheaandbronchusSensoryfiberofphrenicnerveVariousstimulersubstancePaincentrumofbrain2023/3/1466Definition

RadiatingpainorReferredpainWhenaninternalorganlesions,patientsfeelpainnotonlyfromthesickorgans,butalso

from

thepartsofthebodysurfaceordeeptissue

wellaway

fromthesickorgansin

Internallesionandthedistributionofbodysurfaceafferentnerveintothespinalcordtothesamesegment,andinthecontactAngle,Sofromvisceralnociceptiveimpulsesdirectlystimulatethespinalcordsurfacesensoryneurons,causingcorrespondingpainofbodysurfacearea.

anginacholecystitis7-8thoracicspinalcordsegment2023/3/1469ClinicalManifestationLocalization:herpeszosteralongtheintercostalnervechondritiswithlocaltendernessanginawithprecordialdistress.CharacteristicsBurningpainPressingpainBurstingpainPrickingpainDurationParoxysmPersistenceInfluentialfactorsExerciseRespirationFoodintakeAdministration(responsetotrentment)2023/3/1470ClinicalManifestationPayAttentionRelationwithrespiratory2023/3/1471AccompaniedSignsCough,sputumand/orfeverRespiratorydiseaseDyspneaSeverepneumoniaPneumotho-raxpleurisyPulmo-embolismHemoptysisCarcinomaPulmo-embolismPneumoniaShockMyocarialinfarctionDissectinganeurysm(rupture)Largeareapulmo-embolismEatingrelated(Dysphagia)Esophagealdisease2023/3/1473AssistantExamiantionCarefulphysicalexammingSerumD-dimerSerumCreatineKinase,CK-MB,CardiacTroponinIArterialbloodgasElectrocardiogramChestRadiology:X-Ray,CT-scanChestpaindiagnosiswayofthinking

Professional,age;inducement,onsetvelocity,Localization,scope,presenceofradiation;characteristicofpain,thedurationof,thereliefway;accompanysymptoms;auxiliaryexamin