Manifestations of respiratory system dysfunctions

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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

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Kompenzacné mechanizmy pri hyperkapnii
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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
• Subjects 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
Central
Peripheral
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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