Respiratory disease by: Dr. EzyanIntroduction Respiratory diseases are quite common in day to day practise and are significant causes of morbidity and mortality all over the world. It may present in the form of symptoms or as an abnormality on the chest radiograph General symptoms Hypoxemia and Hypercapnia Hyperventilation Cardiac failure Infection and Malignancy Finger clubbing and Osteoarthropathy

Hypoxia and HypercapniaHypoxia: Cyanosis Tacchycardia/Bradycardia, irritablity,and mental confusionHypercapnia: Headache ,confusion,flapping tremors,warm moist skin,full volume pulse,suffused conjunctiva and papilloedema

Cardiac failure Physical signs of right ventricular hypertrophy: Left parasternal heave,thirdheart sound over the rt. Ventricle,enlarged JVP with V waves,hepatomegaly and dependent oedema.Hyperventilation Leads to respiratory alkalosis and producing paraesthesiae in the lips and extremities,tetanic cramps in the hands and variety of discomfort in the chest

Effect of Infection and Malignancy Fever and loss of weight Effects of metastasis:lymoh node, brain,bone , liver or other organs Secretion of hormones by tumours leadind to Cushings syndrome,SIADH etc Mediastinal obstruction,compression of SVC(non pulsatile JVP),chest oedema etc Horners syndrome

Clubbing and Pulmonary osteoarthropathy Asoociated with Broncogenic carcinoma, fibrosing alveolitis,pulmonary fibrosis,empyema,lung abscess, bronchiectasis. Increased periosteal growth of long bones give rise to hypertrophic pulmonary osteoarthropathy producing painfull tender swelling around ankles,knees and wristsSymptom Chief complaintsDyspnea Cough withSputumHemoptysis Chest pain Fever PastTBAsthmaDiabetesCOPDPersonal historySmokingOccupationPromiscuityApproach to respiratory diseasesDYSPNEA

ACUTEAc.AsthmaPneumothoraxPulmonary emboAc.pulm. oedema SUBACUTECOPDPleural diseasePCP pneumoniaWegenersCHRONICCOPDILDFibrosisCCFBREATHLESSNESS

Cough with expectoration Suggests airway disease or parenchymal diseases. With mild sputum- Asthma,Pneumonia With moderate amt.- Chr.Bronchitis With large amount- Bronchiectasis,lung abscess(ask for odour?) Dry cough- Pleurisy,early stage of pneumonia and atypical pneumoniaAIRWAYSAc/chr.BroncBronchiectasisCystic fibrosis Broncogenic CaCarcinoid tumourVASCULATUREPulm.thromboembo.AV malformationsPARENCHYMAPneumoniaLung abscess TuberculosisAspergillosisGoodpasturesHEMOPTYSISHEMOPTYSISCHEST PAIN Causes: Pleurisy Pneumonia Pulmonary infarction Invasive malignancy

Additional history Smoking:Active/Passive Exposure to inhaled agents Exposure to infectious agents H/O systemic disorders-eg:Rheumatic diseases Risk factors for AIDS Treatment history:Immunosuppression,radiotherapy,intake of drugs like beta blockers,ACE inhibitors and Amiodarone. Family history: Cystic fibrosis,asthma,1 antitrypsin defficiency

Systemic examination Inspection Palpation Percussion Auscultation: Breath sounds-Intensity,Character,adventitious sounds Pleural friction rub

Physical examination Enlarged cervical and supraclavicular lymph nodes Disturbance of mentation/coma Nicotine stains on the fingers Infected teeth and gums Clubbing Oedema,cyanosis,enlarged JVP Evidence of mediastinal compression

BreathingBreath sounds

BronchialInsp.ExpHas gapAbnormalTubularAmphoricCavernousVesicularInsp.Exp No gap Normally heard

Adventitious sounds Crackles(rales) Eg:ILD,microatelectasis,pneumonia,pulmonary edema Wheezes Eg:Bronchospasm,airway edema or collapse,intraluminal obstruction Ronchii

Diagnosis Is it a problem of Pulmonary Parenchyma Eg:Pneumonia,Interstitial lung disease,TB

Is it a problem of Pulmonary vasculature Pulmonary embolism,Pulmonary infarction etc

Is it a disease of the airway Eg:COPD,Br.asthama Is it a disease of the pleura Eg: Pleural disease, Pneumothorax etc