Respiratory system

Outline of the lecture

Anatomy Physiology History and Examination Investigation

Anatomy

Anatomy
Upper respiratory tract Lower respiratory tract

Upper airway
Lower airway

Physiology

Physiology
Respiratory movements
Air diffusion Defense mechanism

History And Examination

History
Symptoms:

Cough
Sputum

Dyspnoea
Wheezing

Chest pain
Haemoptysis

Cough
Duration? Dry or productive? Worse at any time? Aggravated by any thing?

Cough
Causes: Cigarette smoking Chronic bronchitis Asthma Bronchial carcinoma Tuberculosis

Sputum
Colour? Quality? Amount? Odor?

Sputum
Causes: Cigarette smoking Bronchiectasis
(yellow or green colour)

Bacterial Infections Asthma

Dyspnoea
Occurs at any time? With rest or with exertion? Change with posture?

Dyspnoea
Causes: Asthma COPD Pulmonary fibrosis Congestive heart failure Pulmonary vascular disease

Wheezing
Causes: Asthma COPD Air flow limitation due to any disease

Chest pain
Type of pain? Time & mode of onset? Severity? Progression of pain? Duration of pain? Radiate in to anywhere? Associated features?

Chest pain
Causes: Angina Costochondritis Tracheitis Carcinoma

Haemoptysis
Causes: Bronchial carcinoma Tuberculosis Bronchiectasis Pulmonary infarction Pulmonary oedema(pink colour) Good pastures syndrome

General examination (Physical signs)

Appearance Central cyanosis Clubbing Breath smell Neck veins Lymph nodes Accessory muscles Position

Severe clubbing

Severe clubbing

System examination
Inspection Palpation

Percussion
Auscultation

What are positive physical signs? Interpretation of signs

Diagnosis

What is the lung pathology?

Consolidation Collapse Fibrosis Pleural effusion Pneumothorax Cavitation Solid mass Abscess

Post primary tuberculosis

Bronchopleural fistula

Spontaneous pneumothorax

Right upper lobe consolidation

Consolidation of left upper lobe with involvement of the lingula

Bronchiectasis

Examination in detail

Inspection (chest)

Shape, scars, deformities, muscle wasting

Respiratory rate
Movements

Barrel shaped chest with increase in antero-posterior diameter

Pigeon chest

Severe kyphoscoliosis

Gynaecomastia

Superior vena caval obstruction

Flattening of upper anterior chest

Palpation
Trachea and apex beat
Movement

Vocal fremitus

Percussion
Hyper resonance Resonance Normal Dull

Stony dull

Auscultation
Intensity Breath sound Quality

vesicular breathing, bronchial breathing, vesicular prolong expiration

Added sounds Rhonci Crepitations

Vocal Resonance
Whispering pectoriloquy

Special examination
Bronchophony Egophony Shifting dullness Succussion splash Coin sign

Pneumothorax click
Crack pot sign

Tidal percussion

Interpretation

Chest movements:
Reduced unilateral Consolidation

Collapse
Fibrosis

Pleural effusion
Pneumothorax Reduced bilateral Bronchial asthma emphysema

Tracheal displacement
To the affected side
To the normal side

collapse , fibrosis
pleural effusion, pneumonia

Midline

consolidation, solid mass

Apex beat (same as trachea)

Both displace in major pathology

Vocal fremitus

Increase in consolidation, cavities

decrease in other conditions

Percussion note
Hyper resonant Normal Impaired

Pneumothorax , Emphysema

Consolidation , Fibrosis Fibrosis , Consolidation Effusion , Solid Masses

Dull Stony dull

Auscultation
Vocal resonance

Breath sound
Added sounds

Breath sounds
Intensity

Quality

Reduced Normal

Vesicular breathing Bronchial breathing Asthmatic breathing

Breath sounds
Inspiration Expiration Vesicular breathing

Bronchial breathing

Asthmatic breathing

Breath sounds
Vesicular breathing

High Pitch (tubular)

Consolidation Bronchial breathing

low pitch (Cavernous)

fibrosis, Cavity (ampharic breath sounds)

Breath sound
Reduced or absent collapse fibrosis effusion

Vesicular with prolonged expiration

Bronchial Asthma COPD

Bronchial breathing

Added sounds Rhonchi (wheezes) Crackles (crepitations) Fine Course Inspiratory expiratory Pleural rub
pleurisy Heart failure Bronchiectasis

Bronchial asthma

Diseases affecting the respiratory system

Bronchial asthma COPD (emphysema, chronic bronchitis) Bronchiectasis Pneumonia (bacterial, tuberculosis) Malignant tumors Occupational lung diseases Diseases of pleura

Systemic diseases affecting lung

Respiratory failure

Investigation

Investigation

Haematological & biochemical tests Sputum Cytology Imaging Respiratory function tests Pleural aspiration Pleural biopsy Bronchoscopy Skin prick tests

THANK YOU