16.signs and symptoms症状与体征.ppt

1、Chen Hong (陈虹),Symptoms Signs of respiratory diseases,Department of Pulmonary Diseases The First Affiliated Hospital of Chongqing Medical University,气囊,肺泡,细支气管,支气管,气管,Respiratory tract,differential respiratory diseases,Bronchi * Bronchial asthma * Chronic bronchitis Lungs * Consolidation * Hyperinfl

2、ation(emphysema) * Atelectasis(collapse) Pleura * Pleural effusion * Pneumothorax,*支气管哮喘 * 慢性支气管炎 *实变:肺炎,肺梗死 *过度充气(肺气肿) *肺不张(塌陷) * 胸腔积液 * 气胸,肋骨(rib) 肋间隙(intercostal space),intercostal space,Retraction in inspiration indicates the obstruction of airway . Bulging at any time indicates: the massive ple

3、ural effusion, pneumothorax , severe emphysema, thoracic tumor, enlargement of the heart ,Physical examination 查体,eye hand finger 听诊器 Respiratory movement Respiratory rate Respiratory depth Respiratory rhythm Shape of thoracic bulging retcaction 饱满 收缩,Palpation,Focus on: *areas of tenderness(pain,le

4、sions,bruises) *abnormalities in the skin(masses,sinus tracts) *thoracic expansion *fremitus(tactile fremitus, pleural friction fremitus) 触觉震颤 胸膜摩擦感,Percussion,Techniques : Mediate percussion (Indirect percussion) finger-finger detecting small, superficial changes and the border of organ Immediate p

5、ercussion (Direct percussion) detecting gross changes like pleural effusion and pneumothorax,Five percussion notes:,*resonance(清音): normal lung *tympany(鼓音): gastric air bubble *dullness(浊音): liver *flatness(实音): thigh(大腿) *hyperresonance(过清音): none normally You can practice the first four percussio

6、n notes on yourself,1. Lobar Pneumonia 大叶性肺炎,Lobar pneumonia is defined as an infection of lung parenchyma（肺实质） with a lobar distribution of consolidation. Its pathological changes could be divided into three stages, which include: congestion, consolidation, resolution. 充血 实变 消散,Lobar Pneumonia,Symp

7、toms Young adults with motivation, sudden onset. Chills, high fever, chest pain, cough, rusty sputum.,Lobar Pneumonia,General signs: Face of acute ill and fever, dyspnea (blue lips), herpes labialis疱疹 T, HR and RR BP may be low Special signs:,Lobar Pneumonia,Special signs: Inspection: decrease of re

8、spiratory movement Palpation: increase of vocal fremitus, trachea in middle position Percussion: dullness Auscultation: bronchial breath sound, pleural friction rub, rales.,Lobar Pneumonia,语音震颤,Crepitation bronchiorepiratory sound moist rales,respiratory movement vocal fremitus trachea in middle pos

9、ition,observe,touch,dullness,listen,dullness,kncok,congestion,consolidation,resolution,dyspnea，cynosis， herpes labialis,2、慢性支气管炎(chronic bronchitis) 慢性阻塞性肺气肿(chronic obstructive pulmonary emphysema),Chronic Obstructive Pulmonary Disease (COPD) 慢性阻塞性肺病,2. Chronic Obstructive Pulmonary Disease 慢性阻塞性肺病

10、 (COPD),COPD has been defined as a disease characterized by the presence of airflow obstruction caused by chronic bronchitis or emphysema. The airflow obstruction is partially reversible and generally progressive.,慢性支气管炎 慢性阻塞性肺气肿,Chronic Obstructive Pulmonary Disease,COPD,COPD,Symptoms Chronic produ

11、ctive cough whitish mucoid frothy sputum, yellowish sputum when complicated with infection. aggravation in the winter short of breath or dyspnea, wheezing, dyspnea with exertion.,白色黏液泡沫痰,COPD,Signs Inspection: barrel chest, decrease of respiratory movement Palpation: decrease of vocal fremitus. Perc

12、ussion: bilateral hyperresonance Auscultation: decrease of breath sounds and diffused rhonchi and rales 干罗音 湿罗音,Barrel chest 桶状胸,The diameter of AP : transverse like a barrel. Front ribs move up, intercostal space widen, infrasternal angle increases. It is common in older patients and those with emp

13、hysema.,signs 慢性支气管炎 并发肺气肿视 桶状胸 barrel chest触 呼吸动度减弱 语音震颤减弱叩 过清音 hyperresonance 肺下界下移、移动度减小 心浊音界缩小或消失 肝浊音界下移听散在干、湿罗音 呼吸音减弱 呼气音延长,Diffused ronchi and moist rales Wheezing喘鸣音,3.Bronchial Asthma 支气管哮喘,Bronchial asthma is a chronic inflammatory disorder of the airway in which many cells play a role. Thi

14、s chronic inflammation causes airway hyperresponsiveness and recurrent episodes of wheezing, breathlessness, and cough, particularly at night and/or in the early morning. These symptoms are reversible either spontaneously or with treatment.,These symptoms are reversible either spontaneously or with

15、treatment.,Bronchial Asthma,Symptoms Childhood or adolescence onset, recurrent attacks and seasonality. Contact of allergen, allergic rhinitis(鼻炎) Chest tightness, cough, expiratory dyspnea with wheezing Remission spontaneously or with treatment.,Bronchial Asthma,Signs Inspection: expiratory dyspnea

16、, forced sitting position, accessory respiratory muscle use, sweating, cyanosis, chest hyperinflation. Palpation: respiratory movement and fremitus Percussion: hyperresonant note Auscultation: diffused wheezes.,4. Pleural Effusion 胸腔积液,abnormal accumulation of fluid. Caused by : excess fluid product

17、ion or decreased absorption,Pleural space,The pleural space: potential space between the visceral and parietal pleura In the pleural space: Negative pressure No air - pneumothorax Little fluid (lubricate the surface of the pleurae) - pleural effusion,Pleural Effusion,Symptoms The symptoms are not ob

18、vious if the fluid is 300ml Dry cough, pleuritic chest pain, the pain will be palliated when the fluid increase short breath and chest tightness when the fluid is 500ml dyspnea and cyanosis when the fluid is large. symptoms of the basic disease.,Pleural Effusion,Signs Usually there is no signs if th

19、e fluid is 500ml Middle to large fluid Inspection: restriction of the respiratory movement on the affected side, bulging intercostals margins Palpation: shift of apex beat and trachea to the uninvolved side. Absent tactile fremitus over effusion Percussion: dullness on the effusion area. Auscultatio

20、n：Decreased or absent breath sounds over the effusion. Bronchial breath sounds could be heard above the pleural effusion. Pleural rub could be heard in dry or fibrinous pleurisy,Air in the pleural space,5. Pneumothorax 气胸,5. Pneumothorax,Air in the pleural space Can be classified as follows accordin

21、g to the causative factors spontaneous pneumothorax: COPD, Tuberculosis artificial pneumothorax traumatic pneumothorax Classified clinically as follows according to the pleural hole closed pneumothorax open pneumothorax tension pneumothorax.,Pneumothorax,Symptoms motivation (strenuous exertion) sudd

22、en onset with unilateral pleuritic pain and dyspnea. The degree of dyspnea varies according to the size of the pneumothorax the lungs healthy condition,Pneumothorax,Symptoms small closed pneumothorax with a good basic lung function, the initial dyspnea is slight and will improve after a few hours. l

23、arge tension pneumothorax will produce sever dyspnea and even respiratory or circulatory failure,Pneumothorax,Sign No obvious signs if pneumothorax is small Large pneumothorax Inspection: the affected thoracic is full and the respiratory movement is restricted. Palpation: tracheal and apex beat devi

24、ation, vocal fremitus diminished or disappeared. Percussion: hyper-resonance on percussion Auscultation: diminution of breath sounds.,6. Atelectasis 肺不张,Loss of alveolar volume Obstructive atelectasis foreign body, neoplasm, sputum plug, endobronchial tuberculosis Non-obstructive atelectasis Compressive , e.g. pneumothorax, pleural effusion,Atelectasis,Symptoms: Varies according to the extent and degree of atelectasis. dyspnea, cough, toxic symptom associated with secondary infection.,Atelectasis,Signs: Inspection: retraction of the