SYMPTOMS of CHYEST DISORDERS (???????)

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SYMPTOMS of CHYEST DISORDERS(???????)

• Zhengcuixia

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Cough (??)

• A protective reflex that uncommon in healthy
  personal
• cleanse secretion foreign material from the
  airway
• Initiated by miscellaneous stimuli or by
  voluntary exertion.
• The most common respiratory symptom.

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Cough reflex (????)

• Afferent inform.from ENT, trachea, bifurcation
  of the bronchi. skin of the face neck pleura
• Irritant type mechanical, chemical, inflammation
• Afferent fibers (vague nerve)
• cough center.

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Cough reflex(????)

• Efferent signals
• larynx glottis close or open
• Relating muscles ( diaphragm,chest wall,
  abdomen )
• A coordinated series of action to perform the
  cough movement. Deep inspiration expiration
  effort with glottis closed- glottis open abruptly
  high volocity of airflow brings out screations
  from airways.

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Influencing factors(????)

• Supressed afferant or efferent nerve function
  coma, senior age
• Failed glottis function
• Diminished muscle force cachexy(???)
• Obstructed airway seen in severe COPD
• Trachea intubation
• Chest or abdominal pain limit cough movement

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Main Causes(??)

• Airway infection inflammation
• Lung parenchyma disorders
• Airway stimulation by chemicals foreign
  material
• Pleural chest wall disorders
• Cardiovascular abnormalities
• Afferent nerve fiber
• Other causes Psychiatric cough

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Classification (??)

• Non production ( dry cough ,??)
• Expecteration (with sputum,??)

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Clinical appearance in common diseases
(??????????)

• Acute infection or exasperation of chronic
  infectious illnesss
• Neoplasmsinsidiously initiation
• Pleural disease
• Cardiovascular diseases
• General disease affecting the respiratory system

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Accompanied symptoms(????)

• Fever
• Chest pain
• Dyspnea wheezing
• Sputum production

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Complication(???)

• Cough syncope syndroma
• Fatigue
• Fractures due to severe persistent cough
• Pneumomediastinum, pneumothorax, and subcutaneous
  emphysema due to high intrathoracic pressure
  during cough.

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Chronic cough(gt3weeks)

• postualnasal drip syndroma(???????)
• cough type asthma
• smoker
• Post URW infection
• GERD

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Sputum expecteration(??)

• Denote airway secretions being coughed out .

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• Characters mucoid, tenasious, purulent, blood
  stained, with special odor, rusty, serous
• Volume
• Accompanied manifestation
• Special conditions

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Laboratory examination

• Rutine
• Microbiologic test ( including culture drug
  sensitivity)
• Cellular

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Hemoptysis (??)

• Blood originate below the level of the larynx
  that being coughed out. Usually bright red
• Degrees from blood-tinged sputum to massive
  gross blood,even leading to airway occlusion
  (apnea ) shock. The latter is much less seen.

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Common causes (????)

• Infectious respiratory disease bronchitis,
  bronchiectasis, TB
• Neoplasm
• Cardiovascular disease MS, PE, PAH, deformity of
  blood vessels
• Other less seen disease leading to
  hemoptysisCTDs hemologic disorders.

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Classification (??)

• Small amount
• Moderate
• Massive (gt600ml/24hrs)

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Differentiating from hematemesis
hemoptysis hematemesis
Coughed up with frothy Vomited without frothy
Preceded by cough Preceded nausea, vomiting
Bright red Dark red or brown
alkaline acid
History of coughing Hist. of gastric, liver disease
Blood-tinged sputum No blood-tinged sputum
Mixed with sputum materials Mixed with food particles
Anemia variable Blood loss common

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Differentiating from upper airway bleeding by
intenssive investigation and examination

• Post nasal bleeding
• Mouth and farynxil membrane bleeding

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Investigation
investigation

• whether coughed out or vomitted out
• Volume how much
• Time duration
• Any accompanied appearances

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Chest pain (??)

• Character (??)
• Degree (??)
• Location (??)
• Reflection (???)

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Common causes

• Cardiovascular pulmonary vascular (iscamic)
• Pleural
• Chest wall
• Emanating pains of neighboring abnormalities

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Cardiovascular (???)

• Location blured press like discomfort
• Eradiation
• Cardiavascular pulmonary vascular
• Angina, MI, aortic stenosis (ischemic),
• Myocarditis, pericarditis, (inflamation)

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Pleorial (????)

• Pleoritis

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Chest wall (????)

• Injury
• Inflamation
• Costal Neuritis

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Other diseases causing chest pain

• Acute abdominal syndroms