SIGNS AND SYMPTOMS OF RESPIRATORY DISEASES
LEARNING OBJECTIVES:
By the end of this session, students should be able to:
· Enumerate the various symptoms of respiratory disorders.
· Enumerate the different signs ellicitied after a clinical examination of a patient with respiratory disorders.
· Correlate the symptoms with the signs of respiratory distress.
· Determine the cause of respiratory distress in a patient with particular sign or symptom
SYMPTOM:
• Patient’s subjective assessment of disease or physical disturbance
• Problems the patient complains about or seeks relief from.
SIGN:
• Objective evidence of the presence of a disease or disorder, as elicited by the doctor
Symptoms
• Cough
• Breathlessness / dysnea
• Chest pain
• Hemoptysis
• Syncope
• Palpitations
• Weight loss
• Fatigue
SIGNS
• Tachypnea
• Tachycardia
• Cachexia
• Wheezing
• Sputum
• Use of accessory muscles of respiration
• Decreased chest expansion
• Vocal Resonance
• Decreased breath sounds
• crepitations
COUGH
• To expel air suddenly and noisily from the lungs through the glottis, either as the result of an involuntary muscular spasm in the throat or to clear the air passages
Causes:
• Asthma
• Allergies
• COPD (chronic obstructive pulmonary disease)
• GERD (gastroesophageal reflux disease)
• Smoking
• Throat disorders, such as croup in young children
• Some medicines
SPUTUM
Sputum is matter that is expectorated from the respiratory tract, such as mucus or phlegm, mixed with saliva
Types and causes:
– Serous e.g., Pulmonary edema
– Mucous e.g., chronic bronchitis, COPD, asthma
– Mucopurulent (brown, yellow, green) e.g., Infection
– Rusty e.g., pneumococcal pneumonia
BREATHLESSNESS
n Shortness of breath; difficult or labored breathing.
n Associated sign:
Tachypnea (increased respiratory rate)
o Normal: 12/min
Causes: increased ventilatory drive and decreased ventilatory capacity
Dyspnea with CVS patholgy:
Ischemic heart Disease
Dyspnea with Respiratory pathology:
Asthma
COPD
Emphysema
Infections (pneumonia and T.B.)
Hypoxia
Acidosis/ metablic disorders
Disorder
/Acute cause of dyspnea
/Chronic cause of dyspnea
/Association with exercise
Asthma
/Acute on chronic
/yes
/Increased (exercise induced)
COPD
/No
/Yes
/Increased
Emphysema
/Maybe
/Yes
/Increased
Lung Infections
/Yes (pneumonia)
/Yes (T.B.)
/Increased
Hypoxia
/Yes
/Yes (COPD)
/Increased
Acidosis
/Yes
/Yes
/Increased
CHEST PAIN
• Chest pain is a manifestation of a number of serious conditions and is generally considered a medical emergency.
• Associated sign:
– Tenderness on palpation (bone or muscular pathology)
– Decreased chest expansion (respiratory or cardiovascular pathology)
CAUSES:
CENTRAL: CVS pathology, e.g, IHD
PERIPHERAL: Respiratory pathology e.g.,
• Pneumothorax
• pulmonary embolism
• Pleurisy
• lung cancer
HEMOPTYSIS
• Spitting or coughing up blood or bloody-stained sputum
Causes:
• T.B.
• Lung carcinoma
• Pneumonia
SYNCOPE
• Temporary loss of consciousness due to generalized cerebral ischemia
Causes:
• Pulmonary embolism
• Emphysema
• Internal bleeding
• High grade fever
• Vasovagal shock
PALPITATIONS and TACHYCARDIA
• TACHYCARDIA: A rapid heart rate, usually defined as greater than 100 beats per minute.
• PALPITATIONS: A sensation in which a person is aware of an irregular, hard, or rapid heartbeat.
WEIGHT LOSS
• A reduction in body mass characterized by a loss of adipose tissue (body fat) and skeletal muscle
• Associated sign:
– Cachexia
Causes:
• T.B.
• Lung carcinoma
• Chronic diseases e.g., COPD, asthma etc
FATIGUE
Fatigue is physical and/or mental exhaustion that can be triggered by stress, medication, overwork, or mental and physical illness or disease.
CAUSES:
• Infection
• Inflammation
• Trauma
• malignancy
• chronic disease e.g., COPD
• autoimmune diseases
TRACHEAL DEVIATION
Towards the side of lesion:
• Lung collapse (with or without pneumothorax on opposite side)
• Fibrosis e.g., in bronhiectasis or cavitation
Away from the side of lesion:
• Space occupying lesion
• Fluid in the space: plueral effusion or empyema
• Air in the space: pneumothorax
USE OF ACCESSORY MUSCLES OF RESPIRATION
ACCESSORY MUSCLES OF RESPIRATION:
• Scalene muscles
• Sternocleidomastoid
• Trapezius
• Serratius anterior
• Pectoralis major and minor
• Latissimus dorsi
Causes:
• COPD
• Decreased vital capacity (Emphysema)
• Spinal cord injury (cervical)
DECREASED CHEST EXPANSION
• Consolidation
• Lung collapse
• Fibrosis
• Cavitation
• Pleural effusion
• Empyema
• pneumothorax
PERCUSSION NOTE
• DULL:
• Consolidation
• Collapse
• Pleural effusion (stony dull)
• IMPAIRED:
• Fibrosis
• Cavitation
• Bronchopneumonia
• HYPER-RESONANT (presence of air):
• Pneumothorax
• emphysema
VOCAL RESONANCE
The prolongation and intensification of sound produced by transmission of its vibrations to a cavity
• Increased:
Air present in the alveoli/ consolidation/ fibrosis in the lung parenchyma e.g, Pneumonia, bronhiectasis
• Decreased:
Fluid or air present in pleural space e.g, pleural effusion, pneumothorax
BREATH SOUNDS
Increased:
• Consolidation
• Interstitial lung disease (prolonged expiration)
Decreased:
• Collapse
• Local fibrosis
• Pleural effusion or empyema
Vesicular (prolonged expiration):
• Bronchitis
• Asthma
• Pneumonia
• emphysema
WHEEZING
• Wheezing is a high-pitched whistling sound during breathing.
• It occurs when air flows through narrowed breathing tubes
Inspiratory wheeze:
• Bronchitis
• Pneumonia
Expiratory wheeze:
• Asthma
• Emphysema
CREPITATIONS
A noise produced by pressure upon tissues containing abnormal amounts of air, the rubbing of fractured ends of bones, and by cracking joints
Causes:
• Consolidation
• Localized fibrosis
• Cavitation
• Pneumothorax
• Pneumonia
REFERENCES
• Davidson’s Principles and Practice of Medicine
• Hutchison’s Clinical Methods
• Medlineplus.com
• Britannica online dictionary
• Merriam-Webster dictionary