SYMPTOMS of CHYEST DISORDERS

（胸部疾病的症状）

Zhengcuixia

Cough (咳嗽 )

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.

Cough reflex （咳嗽反射）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.

Cough reflex（咳嗽反射） Efferent signals larynx: glottis close or open Relating muscles ( diaphragm,chest wall, a

bdomen ) 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.

Influencing factors（影响因素） Supressed afferant or efferent nerve function :

coma, senior age Failed glottis function Diminished muscle force: cachexy(恶液质） Obstructed airway seen in severe COPD Trachea intubation Chest or abdominal pain limit cough movemen

t

Main Causes（原因） 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

Classification (分类）Non production ( dry cough ，干咳 )

Expecteration (with sputum，咳痰 )

Clinical appearance in common diseases （常见疾病中的临床表现）

• Acute infection or exasperation of chronic infectious illnesss

•Neoplasms： insidiously initiation

•Pleural disease

•Cardiovascular diseases

•General disease affecting the respiratory system

Accompanied symptoms(伴随症状）

FeverChest pain Dyspnea & wheezing Sputum production

Complication（并发症）

Cough syncope syndromaFatigueFractures due to severe persistent cough Pneumomediastinum, pneumothorax, an

d subcutaneous emphysema due to high intrathoracic pressure during cough.

Chronic cough(>3weeks):

postualnasal drip syndroma(鼻后滴漏综合征）

cough type asthma smoker

Post URW infection GERD

Sputum expecteration（咳痰）

Denote airway secretions being coughed out .

Characters: mucoid, tenasious, purulent, blood stained, with special odor, rusty, serous

Volume: Accompanied manifestationSpecial conditions

Laboratory examination

RutineMicrobiologic test ( including culture &

drug sensitivity)Cellular

Hemoptysis (咯血 )

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.

Common causes （常见原因）

Infectious respiratory disease: bronchitis, bronchiectasis, TBNeoplasm:Cardiovascular disease: MS, PE, PAH, deformity of blood vesselsOther less seen disease leading to hemoptysis： CTDs & hemologic disorders.

Classification (分级 )

Small amount

Moderate

Massive (>600ml/24hrs)

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

Differentiating from upper airway bleeding by intenssive investigation and examination

Post nasal bleeding

Mouth and farynxil membrane bleeding

Investigation

whether coughed out or vomitted out

Volume: how muchTime durationAny accompanied appearances

Chest pain （胸痛）Character （性质）

Degree （强度）

Location （部位）

Reflection （牵涉痛）

Common causes

Cardiovascular & pulmonary vascular (iscamic)

Pleural Chest wall Emanating pains of neighboring abnor

malities

Cardiovascular （心血管） Location blured press like discomfort Eradiation Cardiavascular & pulmonary vascular

Angina, MI, aortic stenosis (ischemic),

Myocarditis, pericarditis, (inflamation)

Pleorial （胸膜疾病） Pleoritis

Chest wall (胸壁疾病） :

Injury

Inflamation

Costal Neuritis

Other diseases causing chest pain

Acute abdominal syndroms