Professional Documents
Culture Documents
With
Prof. Dr Mohammed Abo El-Asrar
Edited By
El-Azhar Medical students 2012
Chest INDEX
Total pages = 55
Total time = about 6.5 hours
Lecture number
Pages
1- lecture 56 4 - 18
introduction to chest ( page 4 )
2- lecture 57 19 29
Bronchial asthma ( page 19 )
3- lecture 58 29 37
cont. BA (types of asthma) ( page 29 )
Pneumonia ( intro ) ( page 31 )
Pneumococci ( page 33 )
staph pneumonia ( page 34 )
streptococci + gram -ve ( page 35 )
viral ( page 36 )
4- lecture 59 38 - 56
mycoplasma ( page 38 )
Acute bronchiolitis ( page 38 )
Bronchiectasis ( page 43 )
Croup ( page 50 )
Dry pleurisy ( page 53 )
Pleural effusion ( page 54 )
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symptoms chest
Introduction to chest
,, chest
Symptoms in any chest disease
,,,
..
1- cough
,,, dry cough productive cough
2- expectoration
3- Dyspnea
,,, dyspnea ,, Hypoxia
dyspnea grade grades of respiratory distress
:
4- Noisy respiration
,, ( naked ear ,, ) ,, ,,
,, noisy respiration
,,, respiratory tract :
-1 Upper respiratory tract
Nose naso pharynx Larynx
-2 lower respiratory tract
- Medium sized airway
small bronchus small bronchus terminal bronchiole alveoli
terminal bronchiole trachea major bronchus
trachea Major bronchus connectors Upper lower
connectors ,, ring cartilage ring cartilage
,, ,,
chest
inspiration
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- during respiration
upper lower diameter
,,, inspiration Lower respiratory tract
,,, Upper respiratory tract
Inspiration Uppper respiratory tract
,, ,,,
lower respiratory tract
) (
expiration
expiration
,, .. lower respiratory tract upper respiratory tract
elastic ,, alveoli .. alveoli alveoli
diameter diameter ..
diameter
- so, if upper respiratory problem noisy respiration during inspiration .
- & if lower respiratory partial obstruction noisy respiration during expiration .
expiration Inspiration ,, ,, -
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Noisy respiration
surfactant
..
full expiration ) collapse ( pneumonia alveoli .. VC spasm of adductors of the vocal cords
,, tuberculosis
,, malignancy Page |
brain -
nd
th
B chest movement :
) Movement of the chest comment ,,, Inspection (
limitation of movement chest wall ) pathology limitation of movement (
,,, limitation Bilateral pathology
Unilateral
to confirm the movement inspection :
.. fold of skin palpation confirm : Movement of the chest
where is the lesion nothing else bilateral pathology Limitation of movement bilateral ,, Normal ,,, ,, diseased
C - Bulge or retraction :
retraction bulge ,,,
movement , ||
: movement
a - Unilateral bulge or retraction
) (
- if bulge at one side ( means massive pleural effusion,tension pneumothorax or unilateral
emphysema )
if bulged side is bulged ( diseased ) or normal & the other side is retracted ??
- if retraction at one side ( means fibrosis or collapse )
if retracted side is retracted ( diseased ) or normal & the other side is bulged ??
retraction bulge
movement
affected affected
unilateral retraction
collapse fibrosis
,, ,,, ,,,
bulge
bulge
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10
unilateral emphysema
11
,,, trachea
,, .. trachea pushed to the left side
right side
trachea palpation
1- trache is retracted ( pulled ) to Lt side
pushed .. Inspection :- limitation of mov. In lt side & retraction in lt side
trachea .. Lt ..
trachea ..
2- trache is pushed ( from Rt. side ) to Lt side
retracted .. Inspection :- limitation of mov. In Rt side & bulge in Rt. side
trachea .. Lt ..
trachea ..
,,, NB
12
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13
hyper resonance
bilateral
bilateral
emphysema bronchial asthma during the attack bronchiolitis ,,, .. Unilateral hyper resonant chest
obstruction airway
a or b Harsh vesicular breathing prolonged expiratory time NB harsh vesicular breathing normal breathing
- air way
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normal breathing ,,, ,, harsh vesicular breathing lung pathology NB. No gap
C Bronchial breathing :
Inflammatory secretion alveoli .. Pneumonia ) collapse mass ( alveoli .. alveolus
.. alveoli ,,
During inspiration
nearby bronchus trachea alveoli Gap
,,, alveoli Nearby bronchus .. inspiration gap ,, ,, .. alveoli
Expiration
alveoli ,, expiration
bronchial breathing gap expiration Inspiration ,,,, bronchial breathing
tubular sound tube .. alveoli NB hollow breathing tube
TVF bronchial breathing NB
bronchus TVF
3- advential sound :
creptitation .. rhonchi
A Rhonchi : 2 types
a- sibilant rhonchi = wheeze :
broncho stenosis broncho spasm siblent rhonchi ,, ,,
1- Bilateral sibilant rhonchi : 3 causes
siblent rhonchi viral pneumonia .. bronchiolitis .. bronchial asthma
2- unilateral sibilant rhonchi :
unilateral obstruction Page |
15
foreign body -1
unilateral obstruction foreign body inhalation ,,
) bronchus ( Unilateral broncho stenosis -2
tuberculus adenoma ,, adenoma wall of the bronchus -3
bronchus Mass Lymph nodes bronchus -4
,,,
b- sonorous rhonchi :
coarse crepititation sonorous rhonchi coarse sonorous rhonchi bronchus secretion .. crepitus
sonorous rhonchi
snoring
coarse crepititation
B Crepitations :
a- Coarse :
b- Fine crepitations :
In elastic wall of the alveoli
.. alveoli ,, fine crepititation
pneumonia - 1
congestive heart failure - 2
bronchiectasis - 3
Complications
chest complications
: ,,, complications of respiratory diseases
1- Respiratory failure
central cyanosis respiratory failure
respiratory ( respiratory failure central cyanosis ,,,
respiratory respiratory disease ,, ) blood gases failure
failure
2- Heart failure :
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16
a- toxic myocarditis
toxic myocarditis bacteria toxins ,, bacterial infection
b- viral infection
Heart failure viral myocarditis
c- may be due to cor pulmonale right sided failure
pulmonary Pulmonary artery fibrosis Lung pathology cor pulmonale .. Pulmonary artery pressure .. artery vessel
right ventricle back pressure Pulmonary artery pressure d- also, severe hypoxia may cause cardiomyopathy .
,,
Investigations
1- chest X ray :
diagnostic chest X - ray .. chest X - ray chest
2- CBC :
CBC infection total leucocytic count chest Infection differential count
tuberculus viral .. Lympho cytosis *
bacterial Neutrophils *
asthma allergic .. parastic infection .. visceral larva migrans esinophils *
chronic asthma poly cythemia chest " " NB
hypoxia
3- Blood gases for dignosis of respiratory failure.
: respiratory failure a- PH < 7.1
c- PO2
< 50 mmHg
7.2 7.1 PH
50 60 mm Hg CO2
PO2
4- specific investigations according to the pathology
specific investigations
Treatment
skeleton
respiratory distress treatment
A If distressed
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1- Hospitalization
respiratory distress
: hospitalizaiton
,, ,, complete bed rest 1
Intra venous fluids ,, ,, 2
maintenance fluids
900 maintenance fluids
600 2/3 600
900 ,,
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19
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B lymphocytes stimulation
3 2 1
4- etiology of extrinsic asthma ( Why the atopic person is an atopic person ?? )
allergenic asthma extrinsic asthma ..
.. autosomal dominant gene Autosomal male = female
autosomal gene
female male
pre adolescence Incidence ,,, ,,, gene factor .. adolescent period .. female Male
females male exposure
out of control
Dominant +ve family history
pathological gene dominant gene -
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21
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allergen
allergen ,, antibody mast cellsesinophils
antibody .. direct antigen antibody reaction two ends antibody cell membrane
back end antibody binding allergen
Y ,, .. allergens allergens two arms allergens
,, allergen
two limbs .. antibody ( )
antibody allergens ( two limbs ) Y shaped end
(
antibody Y
mast cells esinophils
Y allergen
two ends
allergen
cell membrane
Calcium channels
Calcium channel Calcium channel )
two arms calcium channels Calcium channels calcium Influx mast cells esinophils
.. esinophils Mast cells esinophils Mast cells vesicles ,,, light microscope vesicle
,,, ,,, vesicle Light microscope
granules ,, vesicles
vesicles Inflammatory mediators
allergic inflammatory mediators vesicles
" "
histamine
Prostaglandin E2
22
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thromboxane E2
prostacyclin
bradykinine
cell vesicle electron microscope ,,, vesicle actin and myosine Muscle fibers myo epithelial fibers membrane
cytoplasm calcium
sliding of actin over troponine C and troponine S myosin actin myosin
Contraction cell membrane vesicle
cell membrane cell membrane vesicle cell membrane
,, adhesion .. membranes allergic Mediators .. vesicle
vesicle ....
membrane vesicle membrane vesicle allergic mediators vesicle .. vesicle
vesicle Microscope degranulation
reduction of the number of the vesicle inside the cell degranulation
6- Effects of the inflammatory mediators :
Mediators
A at 1st 6 Hours :
just broncho spasm first 6 hours ,, smooth muscle of the bronchus contraction broncho spasm
dramatic response broncho dilator
B after 6 Hours :
: ,,,
bronchus Lumen broncho spasm ,,, broncho spasm
23
..
.. bronchospasm , secretions & odema
mediators .. muscle mucous membrane wall of the bronchus Dry cough .. lumen bronchospasm 6
lower ) Harsh ( prolonged expiration Expiration
palpable .. .. Wheeze secretions mucosal odema 6 : .. productive cough .. Dyspnea sonorus rhonchi & coarse crepitations due to secretions
hyperinflated alveoli bronchus hyperresonant percussion (
2.
Expectoration
3.
4.
Wheeze
5.
6.
Hemoptysis
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24
Tachypnea
Suprasternal and supra clavicular retraction intercostal and subcostal retraction &
central cyanosis
Pneumonia .. grunting
.1
.2
.3
3- Percussion
bilateral hyper resonant chest
4- Auscultation
1- Air entry bilateral diminished air entry
2- breath sounds harsh vesicular breathing
3- advential sound - siblent rhonchi 6
then may sonorous rhonchi & coarse crepitaions
Complications:
1) May HF 3
1- Hypoxia (if severe asthma)
2- Cor pulmonale
Emphysema
2-
25
Surgical emphysema.
Investigations:
1) Chest X-ray Hyperinflated lung
-Not diagnostic in BA (only to exclude other causes of wheezy chest)
D.D. ........ MR << 2) CBC :
- if precipitating factor is infection >>>> Leucocytosis
- In all allergic asthma >>>>> Eosinophilia
3) Blood gases : for Resp. Failure (cyanosis )
4) Specific investigations :
1- Sputum analysis
- in Allergic asthma >>>> Eosinophils
-but If PPFs is infection >>>> Lymphocytes or others
2- IgE & IgG4 >>> in Extrensic asthma
3- In Extrensic asthma >> so, skin brick test
3
a- good +ve But not good ve >>>
antihistaminic
()
4- Pulmonary functions:
(asthma grade of asthma )
Treatment:
distressed <<<< asthma
A - Hospitalization : ( : 3 )
1-
2-
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26
(oral intake (
3-
Oxygen therapy.
4-
Psychological factors :
5-
<<
C - Symptomatic ttt :
a - for asthma
air way
bronchospasm , secretions & odema (mucosal)
<< .. <<< HR .. ..
1- Epinephrin
: ... epinephrine sc 0.01 mg/kg/dose
Mechanism of action
A - on B2 :
- stimulate Adenyl Cyclase convert ATP to cAMP cAMP
smooth ms. of bronchi ( relive bronchospasm ) Bronchodilatation
B - On alpha receptors :
- VC of blood vs >>> odema & secretions
) (
) ( << pulse & bl. Pressure
2- selective B2 agonist as salbutamol
spasm (selective B2 agonist as Salbutamol( B2 )saline( nebulizer inhalation
secretion mucolytic effect VC mucosal decongestion
. nebulizer
<<< <<< 3
3- Parasympatholytic
ipratropium nebulizer parasympatholytic bronchodil,secretion & odema nebulizer ampule
atrovent B2
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aminophyline + 4- Aminophyllin
enz theophilline phosphodiesterase enz cAMP give initial dose then maintainance <<<< cAMP
5- cortisone
cortisone
- as anti-inflammatory >>> prevent release of mediators , immune reaction , block receptors of
inflamatory mediators
epinephrine +
norepinephrine
epinephrine
>> so, Cortisole is life safing in this time
Dose : Give 1 mg/kg/dose 6 >> 1st 24 Hrs
6- ICU
complications ICU
b - for other symptoms
- for fever, expectoration,infection give symptomatic
D In between attacks
:
In between attacks 3
1- Avoid :
triggering factors ( - .)
also avoid psychological factors >>>psychological support
2- Pharmacotherapy >>> (attacks )
a- give single bronchodilator (B2)
b- theophylline
c- inhaler corticosteroids Or leukotrien receptor antagonist :
.. inhaler corticosteroids Or leukotrien receptor antagonist
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Types of Asthma
1- Extrensic autosomal dominant gene ...
2- Intrinsic
A in adult ( )
due chronic irritaion with smoking
B in childern :
post viral repeated viral infection" >>> irritate parasymp. Ns >>> vagus >>> Asthma
So, it as a neurogenic not an allergic asthma
- ( triggering factor viral infection ) + -ve family history + -ve skin test + normal IgE & IgG4
Grades
Grades according to :
1- Frequency of the attacks :
:
) ( attack -1
nebulizer -2
.. -3
2- Frequency of nocturnal symptoms
3- according to Pulmonary function test ( FEV 1 Sec. )
Mild, Moderate, Sever
: .. prognosis a mild & moderate asthma 50 % releaved ) complete improve ( at 10 years max. at 20 yrs
recurrence
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Cyclooxygenase Aspirin
-
Aspirin Fever -
Leukotriens as allergic mediator + long acting >> So, cause sever attack
of asthma & may Status Asthmaticus >> anti leukotriens >>
asthma
2- Exercise induced asthma
attacks .. dryness of secretions exercise
mast cell degranulation hyperosmoler state
BA
3- Nocturnal asthma
..
1-
parasymp. Bronchospasm
2-
3-
Risk factors of asthma
1 - Over crowding & Poverty " "
Chronic irritation asthma
Intrinsic asthma << Viral infection << Repeated infection << Over crowding
2 - Early exposure to allergen 6
( allergens 6 .. . )
( +ve family history " )
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3 - Maternal Smoking
chronic irritation
x-ray
Lobar
Broncho
Interstatial
Viral OR bacterial
Viral
only)
Etiologically
Bacterial only ( )
virus
B - Etiological classification :
1- bacterial
as pneumococci, staph, H. infl., psuedomonas, klebs, TB
2- Viral :
Rsv
3- Fungal : as aspergellus , candida only in immunocompromized
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2)
3)
Expectoration
4)
Dyspnea
5)
Grunting
6)
If RF >> Cyanosis
B - Examination
1- Inspection
I.
Respiratory diseress syndrome (Tachypnea_Working ala nasi_intercostal & subcostal retraction &
grunting or cyanosis)
II.
32
2- Palpation
I.
II.
III.
TVF >>
- lobar >> on affected lobe
- broncho >> patchy
- interstitial >> parasternal
II.
III.
C - Complications
1- RF
2- HF if bact. > HF due to Toxic myocarditis & if viral > HF due to viral myocarditis
3- Plural effusion >>
4- May paralytic illeus (Toxic or Hypoxic)
D - Investigations
1)
-complicated or not
2)
3)
4)
E - TTT
1)
Hospitalization : -Rest
O2 therapy
2)
3) symptomatic ttt :
i.
ii.
33
I.
II.
HF
III.
4 % 90
>>>In infancy period cause bronchopneumonia
) (
C/P
1- Complaint >> fever Here is high grade
pneumonia symptoms
2- Signs
A - Inspection
- if < 2 Yrs >> limitation of movement (Bilat) ( bronchopneumonia )
- if >2 Yrs >> unilat ( lobar pneumonia )
pneumococci
B - Palpation : TVF
- if < 2 Yrs patchy & bilat
- if >2Yrsunilat affected lobe
C - Percussion :
as TVF
D - Auscultation : as TVF
Complications
A)
B)
34
Prevention :
pneumococcal vaccine
2) Staph. Pneumonia
Staph infection
...
2-
(lobar (
C/P
1)
2)
Examination
I.
II.
III.
Percussion : as TVF
IV.
Auscultation : as TVF
Investigations
X-ray
Complications :
Lung abscess
) Abscess )
Pyemic abscess
TTT
Peniciollinase resistant antibiotics >> Cloxacilline
3)
Streptococci
Brocho or lobar
Complication :
-post streptococcal GN or Rh. Fever
Investigations : ASO
,,, penicillin ,,, gram positive
third generation cephalosporin ,,,
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4- Gram ve :
penicillin gram negative
A H. influenza pneumonia
,,, Pneumo coccal pneumonia
Complications
Meningitis meningism
complications
Investigations
The same
meningitis meningism Lumbar puncture ,,,
Treatment
gram negative third generation cephalosporin
prevention
H. Influenza vaccine prevention
,,, Pneumonia
pneumo coccal pneumonia
Influenza vaccine
B - klebsiella pneumoina
Immune compromised child .. gram negative bacteria Klebsiella - cause broncho or lobar .
,,,
Mis diagnosed as malignancy
WHY ??
1- if cause lobar in immunocompromised not take triangular shape
tringular Lobar pnuemonia Immune compromised Lobar shape
) tringular shadow ( rounded shadow rounded lobe
tumor mass X ray
,,,,
2- extensive inflam. Reaction friable lung may Hge Hgic effusion
friable surface of the lung extensive inflammatory reaction .. hemorrhagic effusion ,,, effusion .. effusion ,,
Malignancy
klebsiella pneumoina..
lung malignancy
Klebsiella
36
3-Trachea central
4-palpable sounds
Palpable rhonchi
5-TVF increased
6- percussion dullness
hyper asthma .. asthma viral pneumonia
resonance
7-auscultation ,,,
*air entry diminished
*bronchial breathing
*fine Medium sized consenanting crepitation
*siblent ronchi
1-Respiratory failure
2-Heart failure )viral myocarditis)
3- post viral immune disease
post viral auto immune disease ,, .. complications ,,, viral infection auto immune disease
treatment
1-hospitlization
2- ttt of cause
respiratory syncytial virus para influenza virus Ribavirin ,,,
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3-symptomatic treatment
broncho dilator
4- ttt of complications
59 58
Mycoplasma pneumonia
closed contacts, shcool children .. Organism Mycoplasma Over crowding
Penumonia Mycoplasma pneumonia
1- cold antibodies
37 activated anti body ,,, cold antibody Hypothermia ,,,
auto immune hemolytic anemia ,, cold antibody ,,,
Pneumonia auto immune hemolytic anemia Pneumonia
mycoplasma viral pneumonia ,,, auto immune hemolytic auto immune disorder viral pneumonia
anemia
2-specific drug therapy
anti viral 3rd generation cephalosporin generation erythromycin specific drug therapy ,,, ,,
acute bronchiolitis
Acut e bronchiolitis
Is the mose distressing disease
severe respiratory distress
acute bronchiolitis
Introduction
..
Anatomy & Histology
embryology
small bronchus Musclosa ,,, In between Mucosa serosa
.. budding embryology small bronchus Page |
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39
40
Tachypne
cyanosis
41
addventious sounds
1-respiratory failure
2-heart failure due to
viral myocarditis
severe hypoxia
.. cor pulmonale ,,,
,, ,, ,,, severe acute
Cor pulmonale
virus ,,,
5-sputum cultures
secondary bacterial infection
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Treatment
1- Hospitalization :
,, bronchiolitis
oxygen therapy 2/3
IV fluids -
2- ttt of virus :
Most common anti viral Ribavirin ,, 3- Symptomatic treatment
anti pyretics
feverish -
broncho dilators broncho spasm cortico steroid edema : ,,, controversal ,, .. viral infection : cortico steroids
cortico steroids .. ,,,
cortico steroids Some of the authors recommend
terminal bronchioles edema severe distress
4- ttt of complications :
heart failure ,, Heart failure ,,, ventilators mechanical ,, respiratory failure Bronch iectasis
...
Definition
Persistent cystic dilatation of the bronchi (small or medium sized bronchus )
. stagnant secretions dilatation medium sized bronchus infected secretion super added infection stagnant secretion Infected sputum
micro abscesses Medium sized bronchus small bronchus Lower lobes basal bilateral unilateral
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A - congenital
: congenital
1- isolated :
Medium sized bronchus small bronchus ,,, ,, isolated 2ry infection stagnant secretion .. dilated
Lobe .. bilateral Unilateral 2- as a part of immotile cilia syndrome
: syndrome a- Bronchiectasis :
Kartagnar syndrome immotile cilia syndrome stagnant secretion ,,, Immotile cilia ,,, Cilia super added infection +
Bronchiectatic changes
b- chronic sinusitis :
chronic sinusitis ,,,, Bronchiectasis frontal sinus frontal chronic sinusitis drainage
good cilia
chronic
44
45
bulge ,,,
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46
chronic toxemia :
..,, ,,,
2- cough
3-expectoration
,,, expectoration
colored huge amount on leaning forward Related to certain posture
early morning winter time 4-hemoptysis
air way Ulceration
5-wheeze
Upper lobe broncho spasm
6-chest pain
chronic cough Muscle strain ) dry pleurisy( pleurisy
chronic disease central cyanosis
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B - examination
a ) general examination
1-fever 2-very toxic 3-may pallor
4-may clubbing
chronic infection fibrosis Pulmonary artery fibrosis capillaries of the pulmonary artery Hyper inflated alveoli ) Pulmonary hypertension) Pulmonary artery pressure generalized edema right sided heart failure
6-Lower limb edema
chronic cough
b ) local examination
1-Inspection
*Mild respiratory distress
tachypnea
48
*TVF
,, .. diminished
3-percussion
dullness Impaired .. hyper resonance ,,,
4-auscultation
*air entry
bilaterally diminished
*breath sounds
Harsh vesicular ,,, Pneumonia bronchial ,,, *adventious sounds
siblent rhonchi ,,, secretion coarse crepititation sonorous rhonchi ,, fine crepititation
Pneumonia surrounding pleural rub
Complications
1-renal amyloidosis
2-Lung
*Lung abscess , empyema , Pleural effusion , cor pulmonale & Pyopneumothorax
Investigations
1-Chest X - ray
bilateral basal honey comb appearance hyper inflated upper lobe 2-CBC
) infection ( ,,, total leucocytic count bacterial infection Neutrophils
3-blood gases NO NEED
complications respiratory failure blood gases
4-sputum analysis and culture
Organism
5-broncho scopic examination
broncho scope ,, broncho graphy
:
infection Obstruction
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secretion aspiration
broncho scope
bronchial tree ,,, cilia electron microscope Immotile cilia
Treatment
1-Postural drainage
2-mucolytic and expectorant
3-broncho dilators
4-antibiotics
5-resistant cases
surgical treatment .. Hemoptysis ,,
lobe stridor Croup ,,,
Croup
Croup .. stridor
,,,
larynx .. croupy cough Irritative cough Larynx
croupy cough
hoarseness of voice ,, vocal cord stridor larynx respiratory distress
Definition
clinical condition, characterized by croupy cough, hoarseness of voice, stridor with or without respiratory
distress .
Of obstruction of the airway degree of with or without respiratory distress
etiology
larynx
A - mechanical obstruction :
.. very common
1- foreign body
coins
2- congenital anomaly in Larynx as :
a-laryngeal web
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50
,, ,,,
:
b-larngeo malacia
,, :
larynx collapse ,,
c-Mechanical compression as
goiter
B - Inflammatory conditions :
a- viral infection
virus Measles Influenza para influenza .. Respiratory Syncytial Virus
viral larngitis
laryngeo trachitis
acute laryngeo tracheo bronchitis
51
Clinical pictures
A Symptoms :
1-croupy cough
2-hoarsness of voice
3-stridor
4-respiratory distress
NB. Here on examination surasternal & supraclvicular retraction ( as the problem in upper not lower
)
B - Sign
Lower is free ,, upper normal auscultation ,,, Percussion ,, palpation ,, Inspection
.. medical emergency ,,
Investigations
1-plain X - ray
lateral Posterior antero coin radio opaque foreign body X - ray
- radio opaque foreign body
- epi glotis ,, edematous
- Narrowing below epiglotis
acute laryngeo tracheo bronchitis
Management ,, x-ray
Management
1-hospitlization
a- bed rest
b- oxygen
cold modified ,, Oxygen laryngeal edema ,,
laryngeal edema .. vaso constriction of the capillaries c- IV fluids
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2- TTT of the cause
ribavirin viral infection .. foreign body
3- If no improvement give supportive ttt
a- give Epinephrin
Inhaler epinephrine Racemic epinephrine larygeal edema vaso constriction epinephrine .. inhalation nebulizer
capillaries
laryngeal edema
b- if not present give cortisone IV
c- If no improvement do tracheostomy
Acut e spasmodic croup
,, ,,
allergic in nature .. irritative cough
Diseases of the pleura
Dry pleurisy
.. dry pleurisy
Definition
dry fibrinous inflammation of the pleura
Etiology
1-primary
pleura Primary pathology
a- viral infection
Pleura viremia virus ,, viral infection
dry pleurisy
b- renal failure
dry pleurisy pleura deposit urea
c- rheumatic fever
dry pleurisy dry peritonitis dry pleurisy dry pericardititis
d- T.B.
dry pleurisy .. pleura Primary
2-secondary
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a- lung as
Pneumonia
b- Mediastinum as
mediastinitis
c- chest wall
Osteomyelitis fracture rib
d- Infra diaphragmatic as
Liver abscess
Clinical pictures
A - Symptoms
primary cause mainly - chest pain stiching in character
holding of breathing respiration cough
B - signs
1- inespection
- limitation of movement
- tachypnea
2- palpation
pleural rub
3- Percussion
tender percussion .. Pleurisy
4- auscultation
pleural rub
Investigations
-Chest X ray to know the underlying cause
other pathology
Lobar pneumonia
bronchiectasis
Treatment
,,
pain analgesics
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Pleura l effusion
) ( X - ray pleural effusion
,,, pleural effusion
pleural sac fluid collected
: fluid
1- transudate :
bilateral effusion transudate generalized edema ,, )transudate) ,, 2- Exudate :
,, pleura ,, Mediastinum ,, Lung surrounding pathology ,, exudate infra diaphragmatic,,, diaphragmatic
3- Pus :
Lung abscess ,, staph pneumonia ,,, Pus 4- Hemorrhagic effusion :
cancer .. chest wall trauma ,, T.B. klebsiella
5- chylus : ( Lymph )
thoracic duct trauma lymphatic system obstruction
6- idiopathic exuadate :
exudates primary pleurisy .. Primary pleurisy
Symptoms
1-Symptoms of the cause
2-Respiratory distress
Signs
1-Inspection
signs of respiratory distress
2-Palpation
*trachea ,,, pushed to the opposite side
*TVF diminished
3-percussion
diagnostic stony dullness
4-auscultation
*air entry diminished in the affected side
underlying pathology adventious sounds breath sounds *
Investigations
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A - Chest X - ray
B - CBC
empyema marked neutrophilia tuberculus marked lymphocytosis C - blood gases
respiratory failure
D - Pleural tap
:
1- Physical examination
,, transudate
exudate
hemorrhagic hemorrhagic
chylus
LDH
Chloride chemistry
2- for chemistry
3- for cytology
www.facebook.com/dr.tafreegh
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