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The main symptoms of respiratory diseases include shortness of breath, cough, sputum secretion, bleeding and pain.
Shortness of breath. Dyspnoea, a disorder of respiratory rate, rhythm, and depth, is usually accompanied by shortness of breath. Shortness of breath from the lungs occurs when the chest is injured, the lungs are severely poisoned, the lungs become inflamed, tuberculosis, bronchial asthma, pulmonary emphysema, resistance to air passage in the airways appear. as a result of decreased elasticity of the lung tissue or shortening of the respiratory surface, the presence of fluid in the pleural cavity, adhesion of the pleural membranes, paresis of the respiratory muscles, ossification of the thoracic spine and limited mobility may appear.
In such cases, not enough air, and therefore oxygen, enters the lungs, which leads to the accumulation of incompletely oxidized intermediates in the blood (lactic acid, etc.) and carbon dioxide. This condition constantly stimulates the respiratory center and is characterized by shortness of breath.
- Shortness of breath with impaired respiratory phases (breathing and exhalation):
- inspiratory shortness of breath - difficulty breathing - occurs when there is a mechanical obstruction in the upper respiratory tract. This slows down breathing. If the airways are strongly constricted, the breath is taken with a noise, a sound-stridor appears, as if pushing the air. Such breathing is called stridor breath;
- expiratory shortness of breath - difficulty in exhalation, which leads to difficulty in the passage of air into the airways due to spasm of the bronchioles (bronchial asthma, bronchiolitis), as well as a decrease in the elasticity of lung tissue (pulmonary emphysema), lung health this is due to the fact that the alveoli cannot shrink as in humans, and as a result the alveoli cannot completely expel the air that enters during respiration;
- mixed shortness of breath - shortness of breath makes it difficult to both breathe and exhale. This type of shortness of breath is caused by the shrinkage of the respiratory surface of the lungs under the influence of toxins (uremia) to the respiratory center, for example, in pneumonia or pneumothorax. observed as a result of compression. Mixed shortness of breath can also occur when the diaphragm is high in pulmonary edema.
Strongly expressed shortness of breath leading to asphyxia is called suffocation. It occurs in spasm of the vocal cords, when the large branches of the pulmonary artery become blocked, and when the lungs become severely swollen. Choking that occurs with sensitivity is called asthma - it is difficult to breathe, bronchial asthma that passes with a sudden spasm of bronchioles can be an example of this.
- Shortness of breath with varying frequency of breathing movements:
- taxipnoe - accelerated breathing. Accelerated and shallow breathing is characteristic of heart-related, heart-lung-related shortness of breath, fever, hysteria-related shortness of breath;
- bradipnoe - slowed breathing. Slow and deep breathing “Kussmaul’s big breath” is a type of hematogenous shortness of breath. It occurs in diabetics, liver and other comas due to the accumulation of toxic acidic products in the blood as a result of metabolic disorders. When blood is pumped to the brain, breathing can become sluggish and deep (centrogenic shortness of breath).
- Shortness of breath with disrupted rhythm of breathing:
- wavy breathing. The depth of the breathing movements is a breath that changes from time to time;
- Biot breath. Breathing is characterized by the presence of pauses in the normal, normal type, differing in the pause that occurs after a few breaths. These breathing pauses vary in duration, sometimes reaching 30 seconds or more. Biot respiration occurs in brain tumors, meningitis, cerebral hemorrhage, sometimes uremia, and diabetic coma;
- Cheyn-Stokscha breath. It is characterized by a gradual increase in the depth of the breath, as the breath deepens and reaches a maximum, it gradually decreases and pauses. It is observed in brain diseases, severe circulatory disorders, comas and drug poisoning;
- They also distinguish Kussmaul-type shortness of breath. This does not disrupt the rhythm of breathing movements, but the depth of breathing changes significantly. Breathing becomes deep and noisy (exhalation with breathing lasts longer, then a long pause is observed, then all is repeated).
Cough. It is a protective-reflex act aimed at the removal of mucus and sputum from the bronchi and upper respiratory tract in various diseases of foreign bodies, upper respiratory tract, bronchi and lungs. The mechanism of the cough stimulus is deep breathing, followed by strong exhalation, in which exhalation begins when the vocal cords are closed.
Depending on the nature of the cough, they become dry, that is, sputum-free and wet sputum-producing cough.
Typically, dry cough occurs in bronchitis, when the pleura is affected, miliary tuberculosis, and wet cough in bronchitis and pneumonia.
Depending on the duration of the cough, there is an aggressive, intermittent, and persistent cough; Depending on the timbre, there are short and slow coughing, wheezing and hysterical wheezing, choking and wheezing when the vocal cords are inflamed and sore.
A cough that occurs when the body is in a certain position and causes a lot of sputum to fall is an indication that there is a cavity in the lungs, depending on the condition of the body, it is possible to roughly determine where the cavity is located. Coughing while eating, especially the appearance of food particles in the sputum, indicates that there is a hole between the esophagus and the trachea. A whooping cough is characterized by wheezing, shortness of breath, in which the patient's face is bruised, and the patient often vomits after coughing.
If a large amount of sputum is released after coughing, it is characteristic of broncho-ectasia, the emptying of the cavity, the opening of a lung abscess or pleural empyema in the bronchi.
Sputum is secreted in various diseases of the respiratory tract. If a person coughs up sputum, he should see a doctor immediately, because sputum production is one of the main symptoms of some diseases. The amount of sputum varies; In the initial form of bronchitis and pneumonia, the patient spits sputum once or twice, and in purulent diseases of the lungs secretes up to 1-2 liters of sputum.
Usually, there is no odor of sputum, if there is a purulent process in the lungs, the sputum is foul or smelly when applied, the sputum is thick-liquid, color (white, rusty, red ) depending on its composition, mucous, mucous-purulent, serous-purulent and bloody mixed sputum are distinguished. In the period of pneumonia, bronchial asthma, the onset of bronchitis, colorless, clear, sticky mucous sputum is secreted.
When there is swelling in the lungs, the sputum is liquid, serous clear and foamy, if there are purulent processes in the lungs, it is purulent, bluish, in various diseases of the heart and lungs, sputum mixed with blood. Sputum can contain blood cell elements, tumor cells, the simplest animals, echinococci, ascarid larvae, and plant parasites (fungi) bacteria.
Blood spitting. This is one of the main and serious symptoms of respiratory diseases. It is the result of rupture of blood vessels when the bronchi are stretched and dilated (bronchiectasis) during a strong cough, purulent processes (abscesses) in the lungs, tuberculosis, a violation of the integrity of lung tissue due to a dangerous tumor. A small amount of blood spitting is also dangerous because it can turn into bleeding from the lungs, which can be life-threatening, requiring immediate action. Blood often flows from the lungs during a strong cough. The color of the blood is reddish, frothy, alkaline reaction, and at the same time, in contrast to bleeding from the lungs, vomiting, nausea is observed when bleeding from the stomach. The blood is mixed with food, dark in color, sometimes clotted. In order to exclude bleeding from the gums and throat, the oral cavity and throat should be carefully examined. The bloody fluid flowing from the gums, tonsils, and nose and throat becomes pink, brown, and mucous.
Pain. In diseases of the respiratory organs, pain occurs mainly when the pleura is injured. When only lung tissue is injured, there is usually no or minimal pain. In dry pleurisy, pleural pain is observed when the inflamed pleural membranes rub against each other. The pain is felt in the chest at this time, especially in its lateral parts. If only the diaphragmatic pleura is injured, the pain is often in the abdomen. A characteristic symptom of pleural pain is their intensification during respiration, especially during deep breathing. This pain may be exacerbated during coughing.
In lung disease, pain occurs in cases of metastasis to the pleura, such as pneumonia, pulmonary infarction. Severe pain occurs when a dangerous tumor (cancer) in the lung grows into the pleura or when it appears in the pleura itself. In spontaneous pneumothorax, after a strong cough, there is a strong pain in the side during its formation, and it passes with a strong shortness of breath. Once the pleurisy has healed, sometimes the pleural membranes stick together and they cause pain that is not very strong for a long time, but intensifies from time to time.
Review. The scan allows you to get a lot of important information to make a diagnosis. For example, in bronchial asthma, the patient may sit up and put his hands on his hips. Bruising of the lips, face, hands (cyanosis) indicates a violation of gas exchange.
The face of a patient with a fever in Zotiljam is red, while in a long-lasting disease the patient's color is pale. Herpes rash, i.e. herpes, is often located on the wings of the lips or nose and occurs in influenza, pneumonia, fever. Stretching of the nasal wings indicates difficulty breathing.
Facial irritation is due to coughing. The shortness of the neck is characteristic of patients with emphysema. The dilation and beating of the jugular veins indicate that the venous pressure is elevated and that cardiac activity is significantly impaired. In lung disease, the chest may be dilated (barrel-shaped chest in patients with pulmonary emphysema) or flattened (‘paralyptic’ chest in tuberculosis). Chest tightness on one side is seen in chronic pneumonia and pleural effusions, while bulging chest is found in exudative pleurisy and pneumothorax. In addition, the neck and upper body may be swollen. If the spine is sharply tilted to one side (scoliosis) or back (kyphosis), respiratory and cardiovascular function may be impaired.
Palpation of the chest revealed palpation of the bones and muscles, enlargement of the lymph nodes in the neck and armpits, enlargement of the intercostal spaces, swelling of the tissues, and changes in vocal vibrations. allows you to determine if it has changed. Palpation also reveals a decrease in chest tightness. Sometimes the skin fold on the sick side is thicker than on the healthy side, which is due to the swelling of the soft tissues due to inflammation.
Vibration of the voice (fremitus vocalis) - when the patient puts his hand on his chest and pronounces the words "one", "four", "forty", "cake", "tractor" aloud is a known instinct. In a healthy person, the vibration is felt the same in both lungs. When the lungs become congested (tuberculosis, pneumonia), the sound vibration increases. When fluid accumulates in the pleural cavity, it shrinks when the bronchus is blocked.
Percussion. Percussion of two organs with the same anatomical structure is called comparative percussion, i.e., comparing the sound of the lungs with the lungs using percussion.
Percussion of two organs with different anatomical structures is called topographic percussion. For example, the lungs and the heart, because they are organs with different structures, topographic percussion determines the location, border, and enlargement or contraction of the organ.
The lower border of the right lung is located slightly below the upper edge of the hepatic obtuse angle, which means that it corresponds to the anterior VI rib. In this case, the lower border corresponds to the place where the lungs pass the clear sound into the impassable sound. The lower border of the left lung is defined starting from the left anterior axillary line because the heart impermeability is located inside it. The upper limit of the lung is determined by percussion from the anterior lumbar spine and the posterior lumbar spine. Normally, the location of the lungs is 3-5 cm above the anterior lumbar spine, and posteriorly to the VII cervical spine.
In some diseases, the degree of mobility of the lower edge of the lungs is of great (diagnostic) importance. They distinguish between active and passive mobility. Active mobility is determined as follows: in normal calm breathing, the lower border of the lung is identified and marked with a pencil, then the patient is asked to take a deep breath and not exhale it. At this time, the lower border of the lung is redefined and its location yen is determined. After that, the patient should take a deep breath, the lower limit of the lung is again determined by the passive mobility of the lower edge when the position of the patient's body changes. For example, when the patient is lying upright, the lower edge of the lungs falls 2 cm in front: when the patient is lying down, the lower edge of the lungs falls 3-4 cm down on the free side.
Normally, the mobility of the lower edge of the lung is 8 cm along the mid-axillary line (4 cm at maximum exhalation and 4 cm at maximum exhalation). Normally, the respiratory rate for the lungs is on average 1,5-2 cm.
Hearing and seeing the lungs. The lungs should be heard only in symmetrical areas of the chest and the data obtained should be compared. The patient can be heard in any position, depending on the circumstances and taking into account the patient's condition, the patient should breathe deeply calmly and evenly. Initially, a breathing noise is heard.
Respiratory noises, by their nature, consist of vesicular and bronchial noises. In bronchial breathing, a breathing noise reminiscent of the “X” sound is heard. It is best heard in the larynx, trachea, large bronchi in the anterior thoracic cavity and posterior intercostal space, especially in front of the III-IV thoracic vertebrae. During exhalation, the sound crack is much narrower than during exhalation, so the sound is stronger, rougher, and longer during the exhalation phase.
Vesicular breathing is a soft, other-like noise on the rest of the chest surface, reminiscent of the “F” sound that occurs when air is inhaled. Strong and long during exhalation and weak and short during exhalation.
Vesicular breathing is best heard on the anterior surface of the chest, especially in the lumbar region. In the audibility of sound, the kurakosti area takes second place. Vesicular breathing can be strong and weak. In weak vesicular breathing, there is a general decrease in sound, shortness of breath, and exhalation are often inaudible. Increased vesicular respiration is observed in cases where the alveoli are very dilated during respiration, for example, during physical activity.
Coarse breathing is a breath that is rougher and more often intensified than normal vesicular breathing. It is observed in bronchitis, focal pneumonia, due to the accumulation of inflammatory exudate in the bronchi, when they do not narrow the hole evenly.
Prolongation of deep exhalation can occur with changes in the bronchi, as in rough breathing, so deep exhalation and rough breathing often occur together. Pathological bronchial breathing is heard when a large hardened area is formed in the lungs or when there is an air-retaining cavity that connects with the resonant-forming bronchi.
Whistling and crepitation. The lungs wheeze when sputum separates or accumulates in the airways. This condition can occur when the bronchial mucosa and lung parenchyma become inflamed or when the mucous membrane swells, leading to narrowing of the bronchial cleft. Depending on the nature of the secretion, the wheezing will be wet and dry.
Dry wheezing - occurs in the presence of sticky secretory threads that are easily formed in the bronchi and hang freely from one wall of the bronchi to another. During breathing, air passing through the bronchi vibrates them and causes various sounds. Dry wheezing can be accompanied by loud noises, whistling, whistling, depending on the size of the bronchi.
Wet wheezing - occurs in the presence of fluid in the bronchi, the sound of bursting air bubbles is heard. As the air passes through the liquid during respiration, large or small bubbles form on its surface and they immediately burst.
Wet wheezing: Divided into small-bubble, medium-bubble, large-bubble, resonant and non-resonant. Occurs in small and medium bronchi with small and medium vesicles. Large vesicles form in the large bronchi and trachea.
Crepitation (squeaking sound) - heard only at the apex of breathing. Crepitation occurs when the alveoli, which are closed or stuck and contain less fluid, are straightened and opened due to the ingress of air during respiration. A bunch of hair can be rubbed between the fingers in front of the ear to create an artificial crepe.
Crepitation occurs, especially at the onset of pneumonia, when the exudate now begins to accumulate in the alveoli (crepitatio indux), and then at the end of pneumonia when the exudate begins to swell (crepitatio redux).
The visceral membrane of the pleura slides along the inner surface of the parietal membrane without any noise during respiration under normal conditions of frictional noise of the pleura. If, as a result of various pathological processes, the pleural membranes become unevenly rough or dry, when they rub against each other, a noise called pleural friction is formed.
Pleural friction noise is most often detected in the lower part of the chest, along the midline, as this is where the excursion of the lung edge is most pronounced.
Pleural friction noise is heard both when breathing in and out. It is heard on the surface, under the ear. The sound of the noise will be dry, ringing. It is reminiscent of the rubbing of a silk fabric, sometimes the rustling of snow, or the rustling of new leather.When a healthy person's chest is examined using X-rays, ribs and bright lung areas appear on the screen. In the center of the lung areas is the middle shadow, which consists of the heart, large vessels, trachea, esophagus, lymph nodes, as well as the spinal cord. Along the edges of this middle shadow is a slightly unexpressed shadow called the pulmonary root shadow, consisting of large vessels and lymph nodes that go to the right and left lungs.