Manifestations of respiratory system dysfunctions M. Tatar, J. Hanacek.
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Transcript of Manifestations of respiratory system dysfunctions M. Tatar, J. Hanacek.
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Manifestations of respiratory system dysfunctions
M. Tatar, J. Hanacek
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Cardinal respiratory symptoms and signs
cough
sputum
dyspnea
wheezing
cyanosis
chest discomfort
chest pain
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Disorders of lung mechanics
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Disorders of the lung mechanics
• Airway obstruction– nasal cavity: nasal congestion
– pharynx: collapse during sleep
– larynx: suffocation
– central aw:
• trachea: stridor
• main bronchi: dyspnea, wheezing
• lobar bronchi: asymptomatic or minor dyspnea
– peripheral aw: dyspnea
• Lung parenchyma ( or compliance): dyspnea
• Chest wall (abnormalities): dyspnea
• Respiratory muscles (fatigue): dyspnea
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Disorders of airway defence mechanisms
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Disorders of airways defence mechanisms
• Nasal cavity– sneezing
– nasal dyscharge
• Airways– Cough: acute respiratory infections, foreign body
aspiration, chronic bronchitis, chronic cough
– Expectoration - Sputum• mucoid (mainly macrophages) • purulent (neutrophils) • Pneumococcus - bloody or rust-colored • Pseudomonas, Haemophilus - green sputum
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Hyperplasia and hypertrophy of submucosal glands
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Disorders of gas exchange
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Disorders of gas exchange
Respiratory insufficiency (failure)
– Hypoxemic• Decreased ventilation/perfusion ratio• Venous admixture• Diffusion impairment
– Hypercapnic • Overall alveolar hypoventilation• Limits for hyperventilatory compensation of decreased ventilation/perfusion ratio
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Vznik hypoxémie vplyvom zníženia V/Q pomeru
?
2 0 4 0 6 0 8 0 1 0 0 1 2 0 m m H gP a O 2
C
C
D
CA
C
B
C
2 0
1 0
Vol
% O
2
V yso k ý V ´A = 1 1/2
V ´A /Q ´
Q ´= 1 V ´A = 1/ 2 N ízk y
V ´A /Q ´
Q ´= 1
Fy z io lo g ic k ý V ´A /Q ´
V ´A = 1 V ´A = 1
Q ´= 1 Q ´= 1
’
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Kompenzačné mechanizmy pri hyperkapnii
50
25
mmHg 20 4060
PaCO2
Vol
% C
O 2
B
A
C
Nízky V´A=2/3
V´A/Q´
Q ́= 1
V´A=11/3
Vysoký Q´=1V´A/Q´ Fyziologický V´A/Q´
Q´=1 V´A=1 V´A=1 Q´=1
11/3 + 2/3 = 2
P
Z
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Disturbed regulation of breathing
Cheyne-Stokes respiration
Sleep apnea
Hyperventilation
Gasping
Hypopnea
Shortness of breath
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Cheyne-Stokes breathing
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General body responses
Fever
Weakness, fatigue
Decreased exercise tolerance
Immunity: eosinophilia
Weight loss: advanced disease
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Cough
• Physiologic reflex
• Pathologic reflex
• Acute cough
• Chronic cough– Rhinitis/sinusitis– Asthma– Gastroesophageal reflux disease
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Dyspnea
• Air hunger, chest tighness
• Subject´s feelings – needs for increased ventilatory activity
• Tachypnoea with either shallow or deep breathing
• Increased workload of respiratory muscles – normal gas
exchange cannot be achieved without increased ventilatory
effort
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Pathophysiology of dyspnea
• Hyperventilation – acute hypoxemia
• Relative hyperventilation - decreased ventilatory surfice (atelectasis, pleural effusion, lung congestion, pneumotorax)
• Disordered lung mechanics (most frequent cause)- Upper airways stenosis- Increased arways resistence = obstruction of peripheral
airways (asthma, COPD, heart failure)- Decreased muscle force (polyomyelitis, diaphragm
paralysis, myastenia gravis) - Limited chest movements (kyphoscoliosis)- !!! acute or chronic state; rest or physical activity
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Causes of dyspnea
oxygen content in atmosphere
oxygen consumption during physical activity
Lung function disorders
Heart function disorders
Decreased hemoglobin content (during exercise)
Respiratory center dysfunction (Cheyne-Stokes, acidosis)
Stimulation of airway and lung nerve-endings (pneumonia, lung congestion)
Obesity
Emotive factors (chronic hyperventilatory syndrom)
Brain dysorders
Metabolic dysorders – hyperthyreosis
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Hypoxemia
Tachycardia, tachypnea, dyspnea, mental status changes
Secondary polycythemia ( hematocrit)
Cyanosis
threshold for central cyanosis is a capillary reduced hemoglobin content of 5 g/dL
!!! ancillary nonspecific signs
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Relation between SaO2 and arterial Hb
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Cyanosis
• Central – hemiglobin – methemoglobin, sulphhemoglobin – hemoglobin - content of reduced Hb
• Heart disorders – lung congestion
• Lung disorders
– acute: pneumonia, lung edema
– chronic: COPD, severe lung fibrosis
• Peripheral– local perfusion disorders
• False– pigmentation (silver)
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Peripheral and central cyanosis
Peripheral Central
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Hypercapnia
Morning headaches
Papilledema, dilated conjunctival and superficial facial blood vessels
CO2 narcosis: anxiety may progress to delirium and
somnolency
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Primary respiratory disorders can significantly affect the
function of other systems
Most frequently CVS
Cor pulmonale elevated jugular venous pulse, peripheral edema
Massive pulmonary embolism and tension pneumothorax circulatory shock – hypotension, weakness, pale, sweaty, oliguric, and develops impaired mentation
OSAS daytime sleepiness, right heart failure, systemic arterial hypertension