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.
Vomiting up blood Coughing up blood
Cough, chest pain epigastric pain
Itchy throat and cough Nausea and vomiting
Bright red blood and sputum, blood and foam
food
alkaline pH acid pH
Separate normal (black swallowing blood)
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.
