Symptoms of respiratory function

  In respiratory disease, the main symptoms: chest pain, coughing, shortness of breath, coughing sputum and blood. These symptoms have important implications for diagnosis.

The functional symptoms are the symptoms felt by the patient to suffer from respiratory disease in their patients recalled. In respiratory disease, the main symptoms: chest pain, coughing, shortness of breath, coughing sputum and blood. These symptoms have important implications for diagnosis.

Chest pain

Mechanisms

No branch pulmonary sensory nerve pain. Chest pain is usually caused by damage to the chest wall (muscles, bones, joints), pleura, pericardium, esophagus and tracheobronchial tree. When the lung tissue damage that occurs due to pleural chest pain in response to this damage.

Characteristics

The important point to understand when patients ask:

How onset:

Sudden intense: intense pain without prior notice nature and degree of pain immediately at the maximum.

Persistent pain gradually increased.

Location of pain:

Location pain may suggest organ damage and the nature of the injury.

Pain in the front of the sternum following: Inflammation of the tracheobronchial or mediastinal syndrome.

Pain on the front side: Pneumonia or pleura. Pain in the breast less common in acute pneumonia.

Upper quadrant pain common in pleural disease.

The change of chest pain with breathing movements: The degree of pain when coughing change when changing positions often have little diagnostic value. The pain increases when you cough or breathe deeply.

Characteristics of chest pain according to the agency vulnerable

Chest pain due to lung diseases - the pleura:

Pain is often sudden onset, accompanied by clinical symptoms and x rays.

The pain of acute pneumonia: Sore breasts, increased pain when coughing, often accompanied by other symptoms such as chills, fever, lung examination coagulation syndrome. This pain is encountered in pulmonary embolism.

Tracheobronchitis pain: patients feel a burning pain behind the sternum, increased pain when coughing, may or may not meet sputum in bronchial inflammation caused by influenza gas or smoke inhalation irritation.

Pain due to pleural disease: pain in the side and bottom of the chest, pain intensity changes, increased coughing and deep breathing. Pain spreading to the shoulders and are often associated with dry cough, pain medication less effective and often occur when changing positions. In pleural effusion pain often associated with shortness of breath, chest side fell ill and had to move 3 down syndrome.

Chest pain due to pneumothorax: Sudden, intense "pain stabbing" pain in the side, shoulder, breast orang sometimes like angina. Pain is often accompanied by shortness of breath, coughing when changing positions and the triad of Gaillard. Stabbing pain when faced lung abscesses, abscesses under the diaphragm rupture into the pleura.

In pleurisy in low areas including the periphery of the diaphragm pleura is dominated by six intercostal nerves below, these are the nerves that govern the abdominal wall so as pleurisy in this section may be accompanied by pain in the abdomen. The central part of the diaphragm is controlled by nerve diaphragm (CIII and CIV) as inflammatory diseases in this section
workers may feel pain in the neck or shoulder tip.

Chest pain due to pulmonary tuberculosis is usually dull, nagging.

Chest pain in lung cancer. Pain is not clear, the location may change, but fixed time of day, less analgesic effect, often accompanied by cough, hemoptysis can ... At the peak of lung tumors spread from the chest pain the upper limb.

Pain in the mediastinal disease inflammatory or non-inflammatory:

Pain behind the breastbone can be accompanied by fever.

Chronic pain in mediastinal tumors:

Pain in the mediastinal compression syndrome before: Pain behind the sternum, false angina pain accompanying line jacket, purple and collateral circulation, increasing pressure on the veins of the coughing and straining.

Pain in the mediastinal syndrome pinched between pain type "braces" irregular and often accompanied by shortness of breath hissing, wheezing, cough, voice sometimes backfired cord paralysis due to left, step by compression or mental paralysis Business diaphragm.

Pain in the mediastinal compression syndrome following: pain due to intercostal nerve compression. Pain spreading to the arm or by compression of the nerve roots in the arm plexus CVIII - DI.

Chest pain due to disease: pathology addition of pleural pain in the chest may be caused by:

Bone lesions: Pain due to broken ribs usually persistent, increasing the respiratory movements, changing positions and cough.

Rib cartilage injury (Tietze's syndrome).

Muscle damage, myalgia, myositis.

Intercostal nerve damage: Pain that spreads along the thoracic ribs in half.

Chest pain in people who play sports (tennis).

Pain due to other causes:

Chest pain due to cardiovascular disease:

Pain due to coronary artery disease: Pain behind the breastbone, spreading to the neck and upper limbs.

Pain due to pericardial effusion: pain before the heart, increased exertion, taking a deep breath.

Pathologic esophageal pain: Pain after sternum, appeared to swallow and supine can be combined with difficulty swallowing.

The chest pain caused by disease of the breast: The pain spread to other parts of the chest.

Pain comes from the belly: The pathology of the liver, bile, stomach, pancreas.

Pain from retroperitoneal: nephropathy.

Cough

Define

Ho is reflective of the respiratory organs, causing cough receptors are stimulated. This is a positive reflection to exclude from airway secretions and foreign material.

Mechanisms

Cough reflex arc include: The cause cough receptors in the pharynx, larynx, bronchi large mediastinal pleura and, in addition to other receptors in the liver, uterus, ear canal. Lung parenchyma and small airways at the receptor causes coughing. Medullary cough center, floor 4 intraventricular nerve afferent nerves consisting of strings X backfired, nerve diaphragm, intercostal nerves, abdominal muscles.

Characteristics

Analysis of the characteristics of cough may help diagnosis.

Circumstances and time appear cough:

Spontaneous.

Appears on exertion, change posture, swallowing (cough when swallowing is characteristic symptom of esophageal probe - windpipe).

Ho morning waking up, day or night cough.

Paroxysmal or persistent cough, Chronic: Chronic cough is a cough that lasts more than 3 weeks

Rhythm: Ho ho to attack or aggression.

Timbre: cough may be higher or depression.

Him in his hoarse cough or laryngitis. like barking dogs.

Ho voice double: cough at high-downs. Meet the opposite recurrent nerve paralysis.

Cough or sputum: Coughing up phlegm mucus that is coughed prove the quality of bronchial secretions (children and women often do not spit out phlegm that swallowed the stomach).

Value of Symptoms

Dry cough occurs when changes in posture having pleural effusion.

Productive cough with fever, chest pain, dyspnea, pulmonary inflammation

Cough lasts: laryngeal disease, interstitial lung disease, chronic mastoiditis. pharyngitis beads, felt throat disorders, inflammation of the sinuses mountain.

A persistent cough with sputum in chronic bronchitis, bronchiectasis.

Paroxysmal cough: There may encounter due to the following reasons:

Pertussis: a bout ho, ho often limp night, causing vomiting, productive cough flow into wires.

Respiratory viral infections.

Foreign body airway: Tigers first fall in airway foreign bodies previously overlooked - common in children.

Lung cancer in adults: Cough lasts. in smokers symptoms are often ignored by the mistaken idea that cough from smoking.

Tuberculosis: According to national TB programs Vietnam, coughing more than 3 weeks needed medical care whether or not infected with tuberculosis.

Tracheobronchial spasm: Common in bronchial asthma, cough, shortness of breath attacks, but also when asthma attacks only manifested by cough, about dawn, common in children.

Ho led to disorder awareness: Often sudden onset, with one or more coughs caused a temporary sense of gloom or fainting (Cough Syncope), also known as stroke larynx (Ictus Larynge) met in respiratory failure very severe, dyskinesia tracheobronchial atypical.

Cough in heart disease: nocturnal cough accompanied by shortness of breath, asthma, heart in hypertension due to left heart failure, valve stenosis 2 leaves.

Gob

Define

Sputum is coughing and spitting out the discharge, the product is in airway pathology orang lid glottis.

Characteristics

Features phlegm is coughed up from the tracheal tree is very important in the diagnosis and treatment of respiratory diseases. But it must first determine whether the patient actually productive cough or not. It should be noted the following cases are not sputum:

Spit out saliva: white and thinning.

Spit out the substance from the nose and throat, or the quality of esophageal reflux, stomach.

Need to determine the time and number of colors, flavors and ingredients not stink of sputum.

Characteristics of sputum under bronchopulmonary disease

Acute bronchitis: After the cough is productive cough mucus stage latex. yellow or green.

Chronic bronchitis: In the absence of multiple infections; greyish white mucus or phlegm.

Pneumonia:

Level lobe pneumonia in adult pneumococcal: cough sputum usually on day 3 of the illness, difficult to expectorate sputum stick, with less blood and sputum called "rust", along with typical coagulation syndrome. After illness variables in the 9th day of the disease, sputum becomes diluted, easy to cough up, down and out in the 15th.

Klebsiella pneumonia: Sputum color stone tiles.

Pneumonia caused by pseudomonas curling: green sputum stuck.

Sputum in bronchoalveolar inflammation: A green or yellow purulent sputum, mucus.

Viral pneumonia: Usually cough or sputum with white mucus. When multiple infections with purulent sputum mucus.

Lung abscess: sputum is basic symptoms of lung abscess help diagnose, monitor progress and direction pathogens. To monitor the number and nature of sputum daily.

The first phase cough or coughing up mucous sputum.

Phase ộc pus: Usually happens from day 5 to day 10.

Prodrome: Breathing the smell rotten, sometimes with blood concepts.

OC latex bulk: Patients with Severe chest pain feels like chest x, can be passed. Then ho ộc hundreds ml pus comes out through the mouth to the nose sometimes.

OC latex partial Patients cough up different amounts of pus, several times a day.

Sputum knob coin: When patients stop coughing coughing up thick gob, the coin (Crachat nummulaire).

Sputum odor suggesting abscess caused by anaerobic bacteria.

Chocolate colored sputum, or chicle: Abscess by amoeba.

Bronchiectasis:

More productive cough in the morning, when waking up. The total amount of mucus in the day from a few tens to hundreds of milliliters (probably more than 300 ml / 24 hours). Place in a glass cup with 3 layers:

On the mucous layer of foam.

The middle layer is mucus (due to increased bronchial secretion)

The bottom layer of latex.

Asthma:

Sputum in the last bout dyspnea, sputum white sticky or cooked like tapioca, pearls can have phlegm (as described by Laennec).

Pulmonary edema: pink foam sputum, greater numbers.

Tuberculosis: Sputum "top three" white, smooth, sometimes mixed with mucus and blood.

Follicle available for: Sputum diluted, clear, with particles such as millet, color, available for the first tests.

Coughing up blood

Define

Coughing up blood is the phenomenon of blood from the lower respiratory tract is escaping through the mouth. Coughing up blood is often a medical emergency.

Mechanisms

Common mechanisms are:

Ulcers, broken blood vessels in labor: Rupture of an aneurysm Ramussen, bronchiectasis: breaking the circuit in paragraph stop-Von Hayek, lung cancer.

Due to increased vascular pressure: hemodynamic pulmonary edema, increased permeability of blood vessels in the pulmonary edema lesions.

Damage to the alveolar capillary membrane: Good Pasture Syndrome.

Coagulopathy, bleeding, especially when accompanied by lung disease.

Characteristics

Circumstances occur: After exertion, emotion, women in menstrual period or no special circumstances.

Prodrome: A burning feeling behind the breastbone, itchy throat, or mouth fishy tired fainted away.

Coughing up bright red blood, foam, can only pure blood or sputum.

Tail blood summary: the sign had stopped bleeding, common in tuberculosis, blood spitting out little by little, dark red and black again.

Classification level hemoptysis

Currently, the classification of the severity of hemoptysis inconsistent. In fact, there are usually two likelihood that the patient is coughing, coughing up blood in the new few hours or hemoptysis in 24 h.

So to help manage and prognostic classification as follows:

Mild: Cough each small beach bloody sputum, coughing up blood of <50 ml. pulse and blood pressure normal.

Moderate: Whole blood was coughing up from 50 to 200 ml. rapid pulse, blood pressure was normal, no respiratory distress.

The severity: coughing up blood volume> 200 ml / time or 600 ml / 48 hours, more lung damage, respiratory failure, cardiac arrest.

Ho blood lightning: Appears sudden, large amounts of blood, lungs flooded ngap2 gayngat breathing and death.

Differential Diagnosis: There is a difference hemoptysis with bleeding from the nose, throat, mouth and vomited blood.

Coughing up blood	Vomiting blood
Cough, chest pain	Epigastric pain
Itchy throat and cough	Nausea and vomiting
Bright red blood and mucus bubbles	Blood and food
alkaline pH	acid pH
Separate normal (black blood swallowing)	Black stool

Differential diagnosis between coughing and vomiting blood will be difficult, as patients with hemoptysis accompanied by vomiting bloody vomit, blood swallow down by the stomach. When it needs a thorough examination and lung X-ray, mining engineering history of stomach; if necessary, bronchoscopy or gastroscopy to detect lung injury.

The main causes of hemoptysis

Tuberculosis: The most common cause, all TB can cause coughing up blood from the few to the many. In that tuberculosis has progressed bean pulp necrosis majority. Then came bronchial tuberculosis. very rare in primary employment and labor Statistics. Coughing up blood and sputum residue can usually beans and tail concept blood.

Lung Cancer: A common cause, mainly in primary lung cancer, lung cancer is less common in secondary. Sputum and blood rays, with moderate coughing blood, usually in the morning coughing red purple (plum).

Bronchiectasis: In dry bronchiectasis may be expressed only by coughing up blood, bright red blood, recurrent, easily confused with tuberculosis.

Cardiovascular disease and other diseases: pulmonary infarction, 2 leaves stenosis, congenital heart disease, illness or disease Good Pasture Collagen system. Can meet all levels of hemoptysis. Noting: Blood and pink foam found in pulmonary edema.

Pneumonia: Pneumonia caused by bacteria, lung abscess.

Lobe pneumococcal pneumonia: rust colored sputum.

Klebsiella pneumonia necrosis bloody sputum tile adhesive

The rare cause:

Bronchopulmonary Aspergillus.

U pulmonary blood vessels.

Also see hemoptysis due to injury, and lung injury due to intervention procedures such as bronchoscopy, transthoracic lung biopsy ...

Shortness of breath

Define

Difficulty breathing is difficult feelings and problems in the patient's breathing. Trouble breathing alter the performance characteristics of the patient to breathe normally as breathing frequency, duration of the inhalation and exhalation, the coordination and participation of the respiratory muscles. So to describe adequately dyspnea should be combined with patient examinations.

Characteristics

Facial appearance:

Acute paroxysmal dyspnea.

Chronic persistent dyspnea.

Circumstances occur:

When you leave or after exertion, infection, trauma.

Appear suddenly or slowly.

Difficulty breathing rhythm types:

Frequency:

Shortness of breath quickly:> 20 times / minute.

Shortness of breath slow: <12 times / minute.

By the breath:

Shortness of breath is inhaled.

Shortness of breath is exhaled.

By location:

Difficulty breathing when lying down.

Shortness of breath when moving from lying to standing position.

Shortness of breath related to environmental factors:

Changing weather, occupational exposure.

Dyspnea accompanied by functional symptoms and other entities:

Cyanosis (a sign of respiratory distress or chronic), cough, chest pain, sputum, or respiratory muscle contraction not the women.

The degree of dyspnea:

Classification of the American Heart Association NYHA (New York Heart. Associatide).

Level I: No limit physical activity.

Level II: Breathlessness on exertion much.

Level III: mild dyspnea on exertion and limited physical activity.

Level IV: Dyspnea stay.

Some special types of dyspnea

Shortness of breath due to heart disease: Appears on exertion or chronic, with symptoms of heart failure.

Shortness of breath due to central nervous system damage and peripheral: Difficulty breathing Biot type: irregular breathing at quickly, sometimes slowly, while shallow, deep time, no see kz cycle of meningitis.

Shortness of breath due to metabolic disorders:

KUSSMAUL Dyspnea: Shortness of breath with 4-stroke cycle: Inhale - stop - breathe out - stop by metabolic acidosis in diabetes.

Dyspnea type Cheyne - Stokes: Yes cycle, amplitude increase - decrease - stop having pulmonary renal syndrome, obesity, some cerebrovascular disease, severe heart failure ...

Cause shortness of breath

Upper airway: Difficulty in breathing accompanied by withdrawal recessed hole on memory and language Stridor, the hiss sounds harsh and prolonged, on the inhale, spasm, edema loaded hoacday sound, object, laryngitis management, cancer, or thyroid to tracheal compression ..

Airway below:

Emphysema in chronic obstructive pulmonary disease, shortness of breath on exertion, gifts, chronic.

Asthma: In a typical asthma attack, attack paroxysmal dyspnea, shortness of breath out slowly, hissing, spontaneously or after bronchodilator use, or relapse when weather changes.

Lung parenchyma:

Pulmonary fibrosis: Progress slowly smoldering, at first appeared after the exertion of chronic appear both stay.

Pneumonia: Shortness of shortness.

Waste Management - Waste inflammation: rapid shallow breathing is difficult, often accompanied by symptoms of respiratory distress, cyanosis, tachycardia, especially in children, the elderly.

Pleural Disease:

Pleural effusion: Shortness of shortness, increases the movement and coughing.

Pneumothorax: sudden shortness of breath, rapid shallow, sometimes accompanied by cyanosis.

U mediastinal tracheal compression: Difficulty breathing when lying down, wheezing.