Investigations - Respiratory System: Vd. Santhosh B
Investigations - Respiratory System: Vd. Santhosh B
Investigations – Respiratory System
Vd. Santhosh B
Objective
• To highlight some of the important
basic investigations pertaining to
diseases of respiratory system
Introduction
• One third of the deaths in world
caused by respiratory diseases
• Emergency management needed
• Diagnosis – Prognosis
Principal Symptoms
1. Cough
2. Sputum production
3. Haemoptysis
4. Chest pain
5. Breathlessness
6. Wheeze
Cough
Sound
• Feeble non-explosive : respiratory muscle weakness
: lung cancer
• Prolonged wheezy : severe airflow obstruction
(Asthma or COPD)
• Harsh barking : laryngeal infection
• Moist : bronchiectasis
• Dry : tracheitis and pneumonia
Circumstance
• Nocturnal – Asthma
• During and after swallowing liquids –
neuromuscular disease of oropharynx
Sputum production
Amount
• Large volume of purulent sputum –
bronchiectasis
• Sudden large purulent – rupture of lung
abscess
• Large watery sputum with pink tinge –
pulmonary oedema
Colour
• Clear/mucoid – COPD without active infection
• Yellowish – acute LRTI (live neutrophils)
• Green – chronic infection (dead neutrophils)
• Rusty red – pneumo-coccal pneumonia
Haemoptysis
Amount and Appearance
• Streaking of clear sputum with blood or the
presence of blood clots in the sputum for
more than a week is suggestive of lung cancer
• Haemoptysis with purulent sputum suggests
an infective cause such as bronchiectasis
Chest Pain
Pleural Pain
• It is sharp, stabbing and always intensified by
inspiration or coughing
Chest Wall Pain
• Indicate respiratory or musculoskeletal
disease
• Patients with COPD or asthma usually develop
this pain
Mediastinal Pain
• Typically central, retrosternal and unrelated to
respiration or cough
Breathlessness
Variability
• Left ventricular failure and respiratory muscle
weakness commonly present with breathlessness
when lying flat
• COPD – waking in the morning (3am – 5am) due to
breathlessness
• Breathlessness that improves at the weekend or on
a holiday is suggestive of occupational asthma
Wheeze
Nature
• Wheeze on exercise is a common symptom of
asthma and COPD
• Wheezing that cause night wakening –
Asthma
• Wheeze after wakening in the morning –
COPD
Thorax Examination
General examination
• Inspection (abnormalities in shape of chest)
• Palpation (chest expansion)
• Percussion (resonant note)
• Auscultation (normal breath sounds)
Percussion Note
• Resonant - Normal
• Hyperresonant - Pneumothorax
• Dull - Pulmonary consolidation
Pulmonary collapse
Pulmonary fibrosis
• Stony dull - Pleural effusion
Haemothorax
Common Investigations
Chest X-ray
• Lung fields (equal translucency)
• Lung apices (look for masses, cavitation)
• Heart (normal shape)
• Diaphragm (hyperinflation)
Sputum Examination
• Patients with unexplained haemoptysis or
suspected lung cancer, sputum is sent for
CYTOLOGICAL EXAMINATION
• In LRTI symptoms – microbiological culture
• Pneumonia – Gram stain is used
• Gram positive – pneumococcus or staphylaococcus
• Gram negative – Haemophilus influenza
Oximetry
• Spectrophotometric device
• Measures arterial oxygen saturation (SaO2)
• Helps in oxygen therapy
• SaO2 <92% indicate need of oxygen therapy
Arterial blood gas analysis
• PaO2 , PaCO2 and pH
• Respiratory Acidosis ( PaCO2 pH)
• Respiratory Alkalosis ( PaCO2 pH)
Spirometry
• Forced expiratory volume in one second
• Forced vital capacity
• Ratio > 75% (Adult)
• If it is < 75%, it indicates air way obstruction
Summary
• Disease condition can be predicted by the
symptoms only
• It can be solidified by the investigations
Conclusion
• Oxygen is the foremost thing required for life
• Alarm of the respiratory disease is given by
the symptoms
• Investigations confirm them and help in
treatment and restoring the life
Further clarification
• Macleod’s Clinical Examination: 11th
edition: pp 124-147
Thank you…