Syndromes in diseases of the respiratory system. This syndrome occurs in

The manual provides research methods and semiology for diseases of individual organs and systems, as well as a description of the main diseases and their treatment. For students of higher medical educational institutions, general practitioners.

• LECTURE 1. Diseases of the respiratory system. Clinical syndromes in diseases of the respiratory system. Part 1
• LECTURE 2. Clinical syndromes in diseases of the respiratory system. Part 2
• LECTURE 5. Pneumonia. Etiology, pathogenesis, classification
• LECTURE 6. Pneumonia. Clinical manifestations and diagnosis
• LECTURE 13. Bronchial asthma. Pathogenesis and classification

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The following excerpt from the book Faculty Therapy. Lecture notes (A. V. Pisklov, 2005) provided by our book partner - the company LitRes.

LECTURE 1. Diseases of the respiratory system. Clinical syndromes in diseases of the respiratory system. Part 1

1. Syndrome of fluid in the pleural cavity

2. Syndrome of pleural murmurs

3. Air syndrome in the pleura

4. Syndrome of inflammatory compaction of lung tissue

Diagnosis of respiratory diseases is based on clinical, instrumental, laboratory criteria. The set of deviations obtained when applying various methods research in any pathological condition, commonly called a syndrome.

1. Fluid syndrome in the pleural cavity. characteristic complaint at the same time - shortness of breath. It reflects the degree respiratory failure due to pressure lung pleural, which leads to a decrease in the respiratory surface in the lungs as a whole. On examination, attention is paid to the protrusion and lag in the act of breathing of the corresponding half of the chest. Voice trembling and bronchotonia are weakened or absent. With percussion, a shortening or dullness of the sound or a dull sound is determined. Auscultatory breathing is weakened or absent.

2. Syndrome of pleural noises. Inflammation of the pleura can leave behind a pronounced intrapleural adhesive substrate in the form of adhesive bands, adhesions, fibrinous pleural overlays. Complaints in such patients may be absent, but with severe adhesions, shortness of breath and pain in chest at physical activity. When examining the chest, retraction and lag in the act of breathing of the affected half are noted: here you can also find retraction of the intercostal spaces on inspiration. Voice trembling and bronchophony are weakened or absent. Percussion sound dull. On auscultation, breathing is weak or absent. A pleural friction rub is often heard.

3. Syndrome of air in the pleural cavity. Air in the pleural cavity may appear when a subpleurally located cavity or abscess breaks into it. The message of the bronchus with the pleural cavity leads to the accumulation of air in the latter, which compresses the lung. In this situation high blood pressure in the pleural cavity can lead to the closure of the opening in the pleura with pieces damaged tissue, stopping the flow of air into the pleural cavity and the formation of a closed pneumothorax. If the communication of the bronchus with the pleural cavity is not eliminated, the pneumothorax is called open.

In both cases, the main complaints are rapidly developing dyspnea and chest pains. On examination, the protrusion of the affected half of the chest, the weakening of its participation in the act of breathing, are determined. Voice trembling and bronchophony with closed pneumothorax - weakened or absent, with open pneumothorax - enhanced. Percussion in both cases is determined by tympanitis. Auscultatory with a closed pneumothorax, breathing is sharply weakened or absent, with an open - bronchial breathing. In the latter case, metallic breathing can be heard as a kind of bronchial breathing.

4. Syndrome of inflammatory compaction of the lung tissue. Compaction of lung tissue can occur not only as a result of an inflammatory process (pneumonia), when the alveoli are filled with exudate and fibrin. Compaction can occur as a result of a lung infarction, when the alveoli are filled with blood, with pulmonary edema, when edematous fluid accumulates in the alveoli - transudate. However, compaction of lung tissue inflammatory nature occurs most frequently. With the defeat of an entire lobe of the lung, a lobar or lobar pneumonia; one or more segments - polysegmental pneumonia; less than one segment - focal pneumonia.

Patients complain of cough, shortness of breath, with involvement in the inflammatory process of the pleura - chest pain. On examination, the affected half of the chest lags behind in the act of breathing, which is typical for lobar pneumonia. Voice trembling and bronchophony in the compaction zone are increased. percussion sound at focal pneumonia blunted (not blunt), since the area of ​​compacted lung tissue is surrounded by normal lung tissue. With lobar pneumonia in initial stage the sound is blunted-tympanic, in the stage of height - dull, which in the stage of resolution is gradually replaced by a clear pulmonary sound.

With focal pneumonia, auscultatory revealed mixed (bronchovesicular) breathing. Dry and moist rales are heard, while moist rales are characterized as sonorous, since the inflammatory compaction of the lung tissue around the bronchi contributes to better conduct on the surface of the chest moist rales arising in them. With a deep location of the focus of inflammation, no abnormalities can be detected during physical examination. At the same time, a focus of inflammation of a large size, located in close proximity to visceral pleura, gives the same deviations during physical examination as croupous pneumonia.

With croupous pneumonia, auscultation on the side of the lesion in the initial stage reveals a weakening of vesicular breathing, crepitus and pleural friction noise, in the height stage bronchial breathing is heard, there may be a pleural friction noise. In the resolution stage, bronchial breathing is gradually replaced by vesicular breathing, crepitus appears, moist sonorous rales due to the penetration of liquefied exudate from their alveoli, pleural friction noise is possible.

Importance of anamnesis in the diagnosis of lung diseases. Symptoms (cough, shortness of breath, chest pain, temperature increase), the mechanism of their occurrence, features at various diseases. causes of hemoptysis and pulmonary hemorrhage, diagnostics, emergency therapy.

The main complaints include shortness of breath, cough, hemoptysis, chest pain. Often there is also fever, weakness, malaise, loss of appetite.

Shortness of breath (dishnoe) in its manifestation can be subjective and objective. Subjective shortness of breath is understood in hysteria, neurasthenia, in emotional people. Objective dyspnea is determined by objective research methods and is characterized by a change in the frequency, depth or rhythm of breathing, as well as the duration of inhalation or exhalation. More often in diseases of the respiratory system, shortness of breath is mixed, i.e. subjective and objective, with an increase in respiratory rate (tachipnoe) - with pneumonia, bronchogenic lung cancer, tuberculosis.

According to the phase of breathing, three types of dyspnea are distinguished: inspiratory - difficulty in inhaling, expiratory - difficulty exhaling, mixed dyspnea - simultaneous difficulty in inhaling and exhaling. It is believed that inspiratory dyspnea is more often a sign of heart failure, and expiratory dyspnea is characteristic of obstructive processes in the bronchi. Shortness of breath can be physiological (with increased physical exertion) and pathological (with diseases of the respiratory system, cardiovascular and hematopoietic systems, with poisoning by certain poisons).

In diseases of the respiratory system, shortness of breath can be caused by the appearance in the airways of an obstacle to the normal passage of air, compression of the lungs by accumulated fluid (exudate, transudate) or air in the pleural cavity, a decrease in the airiness of the lung tissue during inflammation, atelectasis, infarction. Under these conditions, it decreases ventilation of the lungs, the concentration of carbon dioxide in the blood increases and tissue acidosis develops.

With a sharp narrowing of the larynx, trachea and large bronchus, stenotic (stridor) breathing appears, audible at a distance. This makes it difficult to inhale and exhale.

With inflammatory edema and swelling of the bronchioles (bronchiolitis) or with a spasm of their smooth muscles (bronchial asthma), the exit of air from the alveoli becomes very difficult - expiratory dyspnea occurs.

With embolism or thrombosis of the pulmonary artery, a sharp mixed shortness of breath suddenly sets in, while the patient takes a forced sitting (orthopnoe) position. Such severe shortness of breath, often accompanied by asphyxia, is called suffocation. Choking that occurs as a sudden attack is called asthma. There are bronchial asthma, in which an asthma attack occurs as a result of a spasm of the small bronchi and is accompanied by a difficult, prolonged and noisy exhalation, and cardiac asthma as a manifestation of acute left ventricular failure, often turning into pulmonary edema. Clinically, cardiac asthma is manifested by a sharp difficulty in breathing. The severity of dyspnea is assessed using the MRC scale (see Table 5.)

Cough(tussis) - a complex reflex act in the form of a sharp exhalation with a closed glottis, which occurs as a protective reaction when mucus accumulates in the larynx, trachea and bronchi or when a foreign body enters them. At the same time, especially sensitive reflexogenic zones are irritated, in particular, in the places of branching of the bronchi, in the area of ​​the bifurcation of the trachea and in the interarytenoid space of the larynx. The same reflexogenic zones that provoke coughing are localized in the mucous membrane of the nose, throat, pleura, etc.

When questioning patients, it is necessary to find out the nature of the cough, its duration and time of appearance, volume and timbre.

By the nature of the cough can be dry (without sputum) and wet (with sputum). With laryngitis, dry pleurisy, compression of the main bronchi by lymph nodes or cancer metastases, there is only a dry cough. Diseases such as bronchitis, pulmonary tuberculosis, pneumosclerosis, abscess, bronchogenic lung cancer at the beginning of their development can only cause a dry cough, and later - with sputum.

In the presence of sputum, it is necessary to find out its amount during the day, at what time of the day and in what position of the patient it leaves better, the nature of sputum, its color and smell.

Morning cough appears in persons suffering from chronic bronchitis, bronchiectasis, lung abscess and cavernous pulmonary tuberculosis. Such a cough is due to the accumulation of sputum in the cavities of the bronchi or lungs at night, which will irritate the reflexogenic zones and cough. Depending on the severity of the inflammatory process in patients with this pathology, the daily amount of sputum can range from 10-15 ml to 2 liters. With the location of cavity formations in one lung, sputum discharge is facilitated in the position of the patient on the opposite side. Often, such patients, in order to facilitate sputum discharge, take postural postures (on a healthy side with their heads down).

With bronchitis and pneumonia, the cough intensifies in the evening (“evening” cough). "Night" cough is observed with tuberculosis, lymphogranulomatosis or malignant neoplasms.

The duration of the cough is constant and periodic. A persistent cough is observed less frequently: with inflammation of the larynx, bronchi, with bronchogenic lung cancer or metastases to the lymph nodes of the mediastinum, some forms of pulmonary tuberculosis. Periodic cough is observed more frequently: with influenza, SARS, pneumonia, chronic bronchitis, especially in the acute stage.

By volume and timbre, a loud, “barking” cough is distinguished - with whooping cough, compression of the trachea by a retrosternal goiter or tumor, damage to the larynx; quiet cough or coughing in the first stage of lobar pneumonia, with dry pleurisy, in the initial stage of pulmonary tuberculosis. With inflammation of the vocal cords, the cough becomes strong, and when they are ulcerated, it becomes silent.

Hemoptysis- (haemoptoe) - the secretion of blood with sputum during coughing. Hemoptysis can appear as in lung diseases (cancer, tuberculosis, viral pneumonia, abscess and gangrene of the lungs, bronchiectasis, actinomycosis, tracheitis and laryngitis with viral flu), and in cardiovascular diseases (narrowing of the left atrioventricular orifice, thrombosis and pulmonary embolism).

The amount of blood excreted with sputum in most diseases is insignificant, in the form of blood streaks or individual clots. With tuberculous caverns, bronchiectasis, a decaying tumor and lung infarction, pulmonary bleeding can also be observed.

Scarlet (unaltered) blood is found in pulmonary tuberculosis, bronchogenic cancer, bronchiectasis, actinomycosis of the lungs. With croupous pneumonia in stage II of the disease, the blood is rusty in color (“rusty sputum”) due to the breakdown of red blood cells and the formation of hemosiderin pigment.

Chest pain must be distinguished by their origin and localization, by nature, intensity, duration and irradiation, by connection with the act of breathing, coughing and the position of the body.

It must be remembered that pain syndrome in the chest can be caused by a pathological process directly in the chest wall, pleura, heart and aorta, as well as as a result of irradiation of pain in diseases of the abdominal organs. Therefore, when examining patients, a practical doctor has to resolve issues of differential diagnosis, while remembering that specific clinical signs are characteristic of pain of a certain origin.

In particular, pain in the chest wall may depend on damage to the skin (trauma, erysipelas, herpes zoster, etc.), muscles (trauma, inflammation - myositis), intercostal nerves (thoracic sciatica with spondyloarthrosis), ribs and costal pleura (bruises, fractures, tumor metastases, periostitis, dry pleurisy).

Pain in diseases of the respiratory system is mostly due to irritation of the pleura, since it is the pleural sheets that have the largest number of nerve endings, while the lung tissue is poorly innervated. Damage to the pleura is possible with its inflammation (dry pleurisy), subpleural inflammation of the lungs (croupous pneumonia, abscess, tuberculosis), lung infarction, with tumor metastases to the pleura or the development of a primary tumor process in it, with trauma (spontaneous pneumothorax, injury, fracture of the ribs, at subphrenic abscess and acute pancreatitis).

With dry pleurisy, pain occurs more often in the left or right lower lateral part of the chest (“pain in the side”). With inflammation of the diaphragmatic pleura, pain can be felt in the abdomen and simulate acute cholecystitis, pancreatitis, or appendicitis.

By nature, pleural pain is more often of a stabbing nature, and with diaphragmatic pleurisy and spontaneous pneumothorax, it is acute, intense. It is aggravated by deep breathing, coughing and in a position on a healthy side. In this position, the movements of the affected side of the chest increase, as a result of which the friction of the inflamed rough pleural sheets increases; when lying on the affected side, the pain in the side becomes weaker, as its respiratory excursion decreases.

Pain with myositis pectoral muscles more often localized in the region of the large pectoral muscles, they are diffuse in nature, aggravated by movements and palpation.

When the ribs are fractured, the pain is strictly local in nature, sharply aggravated by movement, coughing, palpation (symptom of "electric bell"), as well as in the position on the affected side. Careful palpation of the suspected fracture site may reveal costal crepitus.

With intercostal myositis and neuralgia, pain is detected in the intercostal spaces, especially during palpation along the neurovascular bundle.

The value of examination in the diagnosis of lung diseases (symptoms, mechanism of their occurrence, features in lung diseases).

Emphysematous (barrel-shaped) chest resembles hypersthenic. The intercostal spaces are wide, and the supraclavicular and subclavian fossae are smoothed or bulge due to swelling of the tops of the lungs. The thoracic index is sometimes greater than 1.0 due to an increase in the anteroposterior size. The chest is like a barrel. It occurs in patients with emphysema, in which the elasticity of the lung tissue decreases, its airiness increases, i.e. lung volume increases.

The paralytic chest resembles an altered asthenic chest. The anteroposterior size decreases, the chest is flat. It happens in severely malnourished people and in patients with long-term pulmonary tuberculosis. In these cases, the lung shrinks and decreases in size. Often it can be asymmetrical (one half is smaller than the other).

The rachitic (keeled, chicken) chest is characterized by a pronounced increase in its anteroposterior size due to the protruding sternum in the form of a ship's keel. In childhood, thickenings (“rachitic beads”) are observed at the transition points of the bone part of the rib to the cartilage. Sometimes the costal arches are bent upwards (felt hat symptom).

Funnel chest is characterized by a funnel-shaped depression in the lower part of the sternum. It occurs as a result of a congenital anomaly in the development of the sternum or from prolonged pressure on the sternum ("shoemaker's chest"),

The scaphoid chest differs from the funnel-shaped one in that the recess, similar in shape to the recess of the boat, is located mainly in the upper and middle part of the anterior surface of the sternum. It is described in a rare disease of the spinal cord - syringomyelia.

In particular, with severe kyphoscoliosis, the heart and lungs are in a vicious position in the chest, which disrupts normal gas exchange in the lungs. Such patients often suffer from bronchitis, pneumonia, they develop early respiratory failure. Due to the violation of the topographic relationships of large vessels and the heart in such patients, blood circulation in the systemic circulation is disturbed early, signs of the so-called "kyphoscoliotic heart" develop, such patients die early from progressive heart failure.

In conscripts with a pronounced funnel-shaped chest, it is necessary to determine the function external respiration(ZHEL, MOD, MVL). Depending on the severity of deviations in these parameters, they are recognized as partially fit or unfit for military service.

Of great clinical importance is an asymmetric increase or decrease in one of the halves of the chest.

A decrease in the volume of one of the halves of the chest may be due to: a) obturation (blockage) of the central bronchus by a growing tumor or foreign body, resulting in the development of obstructive atelectasis (collapse, collapse) of the lung; b) wrinkling processes in the lung (diffuse or macrofocal pneumosclerosis or cirrhosis of the lung- growth of coarse fibrous connective tissue after unresolved pneumonia; lung cancer, tuberculosis); c) surgical removal of a lobe (lobectomy) or the entire lung (pulmonectomy), after thoracoplasty; G) adhesive process in the pleural cavity with the formation of rough moorings after poorly absorbed exudative pleurisy; e) deformation of the chest itself after injuries, burns, resections of the ribs.

Enlargement of one half of the chest is most often associated with accumulation in the pleural cavity various liquids- non-inflammatory (transudate), inflammatory (exudate), blood (hemothorax) or air (pneumothorax). In severe lobar pneumonia involving two lobes, as a result of severe inflammatory pulmonary edema, half of the chest on the side of the lesion may also increase.

It provides for an assessment of the breathing itself: 1) type of breathing, 2) frequency, 3) depth, 4) rhythm, 5) the symmetry of the participation of the halves of the chest in the act of breathing, 6) the participation of auxiliary muscles in breathing.

Breath types. Allocate: thoracic, abdominal, mixed types of breathing.

Breast type respiration occurs predominantly in women. Breathing is carried out by contraction of the intercostal muscles. The chest expands and rises during inhalation.

abdominal type respiration is observed predominantly in men. Respiratory movements are carried out by the muscles of the diaphragm and the abdominal wall.

Mixed type respiration has features of thoracic and abdominal types of respiration. In pathological conditions, the type of breathing can change.

Breathing rate. Normal at rest is 16-20 breaths per minute. With physical exertion, emotional arousal, after eating, the respiratory rate increases.

Pathological increased respiration (tachypnea) occurs: 1) with a narrowing of the lumen of small bronchi (bronchospasm), 2) a decrease in the respiratory surface of the lungs with pneumonia, with compression of the lung, with lung infarction; 3) when sharp pains in the chest (dry pleurisy, rib fracture, myositis).

Pathological decrease in respiration (bradypnea) occurs when the respiratory center is depressed (cerebral hemorrhage, cerebral edema, brain tumor, exposure to the respiratory center of toxic substances).

Depth of breathing. Breathing can be deep or shallow. The depth of breathing is inversely related to the frequency of breathing: the more often the breath, the more shallow it is; rare breathing, usually deep. An exception to this rule may be stenotic breathing, which is both rare, drawn out, but at the same time superficial. deep, noisy breathing Kussmaul can be both frequent (the breath of a hunted animal).

Breathing rhythm. Normal breathing is rhythmic. When the respiratory center is depressed, the following types of breathing can occur: Biot breath, Cheyne-Stokes breath, Grocco breath .

Breath of Biot characterized by rhythmic, deep, breathing movements that alternate with periodic respiratory pauses. In this case, the amplitude of respiratory movements is the same. It happens with inflammatory lesions of the brain and membranes (meningitis, encephalitis).

Cheyne-Stokes breathing . With this type of breathing, after a long respiratory pause (up to 1 minute), shallow breathing first appears, which gradually increases in depth and reaches a maximum at 5-7 breaths. Then it decreases again until a pause. This breathing is observed in acute cerebrovascular insufficiency (strokes).

Wavy breathing, or Grocco breathing . It is considered by many as a precursor to Cheyne-Stokes breathing. Unlike the latter, during Grocco's breathing, periods of complete apnea do not occur, it periodically becomes only very superficial.

Dissociated respiration Grocco-Frugoni . It arises as a result of a deep disorder in the synchrony of the work of the respiratory muscles (intercostal muscles and diaphragm) due to a pronounced depression of the respiratory center. Observing patients with such breathing, it can be stated that the upper half of the chest is in the inspiratory phase, while the lower part is in the exhalation phase due to diaphragm contraction.

Palpation of the chest. Determination of voice trembling, causes of amplification and weakening.

The goals of palpation: 1) to clarify the examination data regarding the shape of the chest and the nature of breathing, 2) to establish the location and severity of pain, 3) to determine the resistance and elasticity of the chest, 4) to determine "voice trembling", 5) to identify friction of the pleura and the noise of liquid splashing.

Palpation of the chest in order to identify pain points is performed with fingertips in symmetrical areas, pressing on the chest in a certain sequence. The resistance or elasticity of the chest is determined by palpation - squeezing it with your hands both in front and behind, and from the sides in lower sections(Fig. 21). Palpation of the chest and intercostal spaces healthy person gives a feeling of elasticity, suppleness. In the presence of exudative (exudative) pleurisy or tumor of the pleura, the intercostal spaces become rigid, compacted one-sided. An increase in the resistance of the entire chest is observed in the elderly due to ossification of the costal cartilages, with the development of emphysema and pneumosclerosis, as well as when both pleural cavities are filled with fluid (transudate or exudate).

Voice trembling is a small mechanical trembling of the chest, resulting from the conduction of the sound of the voice through the airways to its surface. For its implementation, two conditions are necessary: ​​normal bronchial patency and the state of the lung tissue. To identify the phenomenon voice jitter the doctor puts his palms flat on the symmetrical sections of the chest and asks the patient to pronounce the words containing low sounds- the letter "P" ("thirty-three" or "three hundred thirty-three"). At the same time, the doctor feels the trembling of the chest with his palms. Normally, it is expressed moderately and of the same strength in symmetrical areas.

The definition of voice trembling is carried out in the established sequence: from behind, first in the supraspinatus regions, then in the interscapular region, below the angles of the shoulder blades (Fig. 22), in the lower lateral regions. In the same way, voice trembling is determined sequentially from top to bottom in symmetrical areas along axillary lines. From the front, the study begins with the supraclavicular areas, then the areas of diseased pectoral muscles, the lower lateral sections of the chest are examined. At pathological conditions in the bronchopulmonary system, voice trembling can either weaken or increase.

Weakening of voice trembling occurs when blockage (obstruction) of the bronchi and the occurrence of obstructive atelectasis, increased airiness of the lung tissue (emphysema), accumulation of air (pneumothorax) or any fluid in the pleural cavity (exudate, transudate, hemothorax, pyopneumothorax). This is due to the fact that air and liquid do not conduct sounds well.

An increase in voice trembling naturally occurs when a syndrome of compaction of the lung tissue occurs, since dense areas conduct sounds well. In this case, a prerequisite is the preservation of bronchial conduction. Compaction of the lung tissue is due to inflammatory processes (focal and croupous pneumonia, lung abscess in the stage of infiltration, pulmonary tuberculosis, pulmonary infarction with the development of a heart attack - pneumonia), diffuse or focal proliferation of connective tissue (pneumosclerosis, lung carnification), tumor growth, mechanical compression of the lung tissue with the development of compression atelectasis (with exudative pleurisy, pneumothorax).

Comparative percussion of the lungs. Methodology. The characteristic of percussion sounds is normal and the reasons for their change (blunt, tympanic).

Topographic percussion of the lungs. Determination of the mobility of the lower pulmonary edge. Methodology and diagnostic value.

PERCUTARY SOUND OVER THE LUNGS IN NORM AND IN PATHOLOGICAL CONDITIONS

In a notebook.

TOPOGRAPHIC PERCUSSION OF THE LUNGS

It is used to determine the boundaries of the lungs, the width of the tops of the lungs (Krenig fields), the mobility of the lower edge of the lungs. First determine the lower boundaries of the lungs. Percussion is carried out from top to bottom along symmetrical topographic lines on the left and right. However, on the left, it is usually not determined by two lines - parasternal (parasternal) and midclavicular. In the first case, this is due to the fact that the border of relative cardiac dullness begins from the third rib on the left and, thus, this level does not reflect the true border of the lung. As for the midclavicular line, the definition lower bound lung along it is difficult due to tympanitis over Traube's space (a gas bubble in the region of the fornix of the stomach). When determining the lower boundaries, the finger-plessimeter is placed in the intercostal space parallel to the ribs, moving it down to a dull sound. The latter is formed during the transition from the lower edge of the lung to the diaphragm and hepatic dullness. The boundary is marked along the edge of the finger facing the clear sound.

The location of the lower borders of the lungs along the vertical topographic lines in healthy individuals

topographic lines Right lung Left lung

L. parasternalis V intercostal space -

L. medioclavicularis VI rib -

L. axillaris anter VII rib VII rib

L. axillaris media VIII rib VIII rib

L. axillaris posterior IX rib IX rib

L. scapularis X rib X rib

L. paravertebralis Spinous process XI thoracic vertebra Spinous process of XI thoracic vertebra

The height and width of the tops most often increase with emphysema, while their decrease is noted with wrinkling processes in the lungs: tuberculosis, cancer, pneumosclerosis.

Most often, changes in the lower border of the lungs occur. Bilateral descent of it happens during an attack bronchial asthma, chronic emphysema. Unilateral downward displacement can be with replacement emphysema of one lung against the background of turning off the other from the act of breathing. This happens with exudative pleurisy, hydrothorax, pneumothorax.

The displacement of the lower border upwards is more often unilateral and occurs when: wrinkling of the lung due to pneumosclerosis or cirrhosis; obstructive atelectasis due to complete blockage of the lower lobe bronchus by a tumor; accumulation in the pleural cavity of fluid or air, which push the lungs up; a sharp increase in the liver or spleen. With severe ascites and flatulence, at the end of pregnancy, there may be a mixture of the lower border of the lungs on both sides.

Normally, the mobility of the lower edge of the lung along the right midclavicular and scapular lines is 4-6 cm (2-3 cm each on inspiration and exhalation), along the middle axillary lines - 8 cm (3-4 cm each on inspiration and expiration).

The mobility of the lower edge decreases with inflammation of the lung, its edema, emphysema, inflammation of the pleura, the presence of fluid and air in the pleural cavity, the presence of adhesions of the pleura sheets (moorings), with pneumosclerosis.

COMPARATIVE LUNG PERCUSSION

Normally, over the symmetrical sections of the lungs on the right and on the left, a clear pulmonary sound, identical in its parameters, is determined. Any asymmetry in sounds most often indicates a pathological process. Comparative percussion reveals these deviations.

Comparative percussion of the lungs is carried out along all topographic lines of the chest, but most often it is carried out along the mid-clavicular, mid-axillary and scapular lines. Let's dwell on some features of this percussion.

On the anterior surface of the chest, comparative percussion begins from the tops of the lungs. To do this, the finger-plessimeter is alternately located in the supraclavicular fossae. Then percussion blows are applied to the collarbones, in the I, II, and III intercostal spaces on the left and right. In this case, the sounds are compared.

On the midclavicular and parasternal lines, comparative percussion is carried out only up to the IV rib, since cardiac dullness is detected on the left from this level. Further comparative percussion below the 4th rib continues only on the right. In this case, the sounds of the overlying intercostal space are alternately compared with the underlying one.

Normally, the sound above the left apex may be louder, since it is located higher than the right one. On level III the intercostal space on the left, on the contrary, the sound can normally be shorter, since the heart is nearby.

A feature of comparative percussion along the mid-axillary lines is that in the depth of the armpits the finger-plessimeter is placed perpendicular to the ribs, after leaving the cavities - parallel to the ribs in the intercostal spaces. It must be remembered that in the lower sections on the right along this line, a dull sound is normally detected due to the proximity of the liver, on the left at the same level there is a tympanic sound, since Traube's space is located nearby. When percussion is carried out along the axillary lines, the patient's arms should be crossed above the head.

When conducting comparative percussion from behind (along the scapular lines), the patient's arms should be crossed on the chest, while the shoulder blades move apart and the interscapular space is released.

Auscultation of the lungs. Methodology:

A) the mechanism of occurrence and characteristics of the main physiological respiratory sounds;

B) the mechanism of occurrence and diagnostic significance of weakened and enhanced vesicular respiration;

C) the mechanism of occurrence and diagnostic value of pathological bronchial breathing, its types;

D) the mechanism of occurrence and diagnostic value of dry and wet rales, crepitus, pleural friction noise.

RULES OF LUNG AUSCULTATION

1. The room should be quiet and warm.

2. Lungs listen in vertical position the patient (standing or sitting), only in a serious condition of the patient can be listened to in the supine position.

3. Auscultation of the lungs, as well as percussion, should be comparative.

4. Listening to the lungs, unlike percussion, is carried out not along topographic lines, but in regions, starting from the supraclavicular regions (the region of the tops of the lungs), then the region of the pectoralis major muscles and the lower lateral sections of the anterior surface of the chest

5. In each area, auscultation is carried out by the "nested method", i.e. the tube is placed at at least 2-3 points, since it is impossible to evaluate the auscultatory picture at one point, then auscultation is performed in the same way on the symmetrical section of the opposite side.

6. First, the main respiratory sounds are analyzed, while the patient's breathing should be even through the nose and of medium depth.

7. Then the patient is asked to breathe deeply and through the mouth, while side breath sounds are better detected. For the same purpose, if necessary, ask the patient to cough, exhale quickly and sharply.

BASIC RESPIRATORY NOISES

The main respiratory sounds include: 1) vesicular breathing, 2) bronchial breathing.

Vesicular breathing is heard normally over the entire surface of the lungs. It arises as a result of fluctuations in the alveolar walls at the moment of inhalation when the alveoli are filled with air and at the beginning of exhalation. When exhaling, these oscillations rapidly decay, as the tension of the alveolar walls decreases. Therefore, vesicular breathing is heard throughout the entire inhalation and in the first third of the exhalation. It is perceived as a soft, blowing noise, reminiscent of the sound "f". Now it is believed that the mechanism of the occurrence of vesicular respiration also involves the noise that occurs when air moves along the smallest dichotomies of the terminal bronchioles.

The strength of vesicular respiration is affected by: 1) the elastic properties of the lung tissue (walls of the alveoli); 2) the number of alveoli involved in respiration per unit volume; 3) the rate of filling the alveoli with air; 4) duration of inspiration and exit; 5) changes in the chest wall, pleural sheets and pleural cavity; 6) bronchial patency.

CHANGES IN VESICULAR BREATHING

Physiological weakening of vesicular respiration is observed with thickening of the chest wall (obesity).

A physiological increase in vesicular respiration is noted in people with an asthenic physique with poorly developed muscles and subcutaneous fat, as well as during physical exertion. In children, due to the high elasticity of the lung tissue and the thin chest wall, a sharper and louder vesicular breathing is heard. It is called puerile (Latin puer- boy). This intensifies both inhalation and exhalation.

In pathology, vesicular respiration can change simultaneously in both lungs, or in one lung, or in a limited area.

Pathological weakening of vesicular respiration is:

1. With a syndrome of increased airiness of the lung tissue - emphysema. This reduces the elasticity of the lung tissue and the number of alveoli per unit volume.

2. With the syndrome of compaction of the lung tissue. This happens when inflammation of the lung when inflammatory swelling of the walls of the alveoli occurs, they become inactive.

3. With diffuse or macrofocal pneumosclerosis, lung tumors.

4. With insufficient air supply to the alveoli through the airways due to the formation of an obstacle in them ( foreign body in the bronchus, tumor in the bronchus).

5. With thickening of the pleural sheets, with the accumulation of fluid (hydrothorax, pleurisy) or air (pneumothorax) in the pleural cavity. In this case, the sound of vesicular breathing is worse carried out on the surface of the chest wall.

6. With damage to the intercostal muscles (myositis, myasthenia gravis), fracture of the ribs, bruises of the chest. In all these conditions, due to pain, the patient limits the depth of breathing, especially inhalation, this can also explain the weakening of vesicular breathing in dry pleurisy.

Another type of vesicular respiration is saccoded respiration. This is intermittent breathing (2-3 intermittent sounds on inspiration, and exhalation is not changed). It occurs in healthy people with an uneven contraction respiratory muscles(with hypothermia, nervous trembling). At focal tuberculosis lungs, it can occur in a limited area of ​​\u200b\u200bthe lung due to the difficulty of passing air through the small bronchi and bronchioles and the non-simultaneous expansion of the lung tissue.

BRONCHIAL BREATHING

It occurs in the larynx and trachea when air passes through the glottis. In this case, turbulent air flows (vortices) arise. This breathing is normally auscultated over the larynx and trachea in the region of the manubrium of the sternum and the interscapular space at the level of the III and IV thoracic vertebrae. During bronchial breathing, the exhalation is louder and longer, its sound resembles the sound "x". Normally, bronchial breathing is not carried out on the chest wall, since healthy lung tissue dampens these vibrations. If this breathing begins to be carried out on the chest wall, then it is called pathological bronchial breathing. This happens with lung compaction syndrome (with croupous pneumonia in stage II, infarction of the lobe of the lung, compression atelectasis, focal pneumosclerosis, lung cancer). This occurs due to the fact that the lung tissue becomes denser, becomes airless, vesicular breathing disappears, and therefore bronchial breathing begins to be carried out on the surface of the chest wall.

Pathological bronchial breathing, depending on the degree of compaction, the size of the focus and its location, can change the strength and timbre of the sound. Allocate quiet and loud bronchial breathing. For large lesions ( whole share) breathing is louder and higher in timbre. If the focus is small and deep, then quiet and low-pitched bronchial breathing can be heard. In the same cases, instead of quiet bronchial breathing, mixed or vesiculobronchial breathing may be heard. At the same time, inhalation has the features of vesicular respiration, and exhalation is bronchial. This happens with focal pneumonia, focal pulmonary tuberculosis.

Amphoric respiration - It occurs when there is a smooth-walled air-containing cavity in the lung (lung abscess after opening, tuberculous cavity), which communicates with the bronchus. It is heard in both phases of breathing and resembles a booming sound that occurs when air is blown into an empty vessel. This breathing occurs due to resonance phenomena in the pathological cavity. Note that for the occurrence of amphoric respiration, the diameter of the cavity must be at least 5 cm.

Metallic breathing is a type of bronchial breathing that occurs with an open pneumothorax. It is very loud, high-pitched and resembles the sound of hitting metal. The same breathing can be with large, smooth-walled, superficially located cavities in the lungs.

Stenotic breathing is observed when the larynx or trachea is narrowed (tumor, foreign body in the larynx, laryngeal edema). It is heard in the place of narrowing, but can be heard without a stethoscope, at a distance from the patient (stridor breathing). This is a groaning breath with a sharply elongated breath. At the same time, it is superficial due to the small intake of air into the lungs.

ADVERSE BREATH SOUNDS

These include: 1) wheezing, 2) crepitus, 3) pleural friction noise.

In a notebook

Wet rales occur when air passes through liquid sputum, which accumulates in the lumen of the bronchi or cavities, accumulations of liquid blood. In this case, bubbles are formed that burst - this is perceived as moist rales. Wet rales are better heard in the inspiratory phase, because airflow through the bronchi will increase. Cough affects wheezing. They may intensify or disappear. Wet rales, depending on the place of their occurrence, are divided into: 1) fine bubbling (occur in the small bronchi); 2) medium bubbling (in the middle bronchi); 3) large-bubbly (occur in large bronchi and cavities).

All wet rales are divided into sonorous and non-sound. Sonorous rales are very loud, they are heard if the bronchi are surrounded by dense tissue (with pneumosclerosis, focal pneumonia). In addition, they can occur in cavities. Unvoiced rales are heard worse, they are deaf and quiet. It must be remembered that most often muffled wheezing is a direct sign of bronchitis, and sonorous - indirect sign pneumonia.

Distinctive signs of pleural friction rub, crepitus,

fine bubbling rales

Signs of pleural friction rub crepitus fine bubbling rales

Conditions high on inhalation and exhalation only at the height of inhalation in both phases, but better on inhalation

Effect of cough no effect no effect changes

"False breath" is heard not heard not heard

When the stethoscope is pressed more tightly, it intensifies does not change does not change

Bronchophony is a technique in which the conduction of the voice to the surface of the chest wall is studied. The patient is asked to quietly pronounce the words containing the letters “p” and “h” (“cup of tea”) and compare the conduction of sound in symmetrical areas of the chest when listening with a stethoscope. At the same time, only separate sounds are heard fragmentarily over unchanged lungs. When lung tissue is compacted, sounds are conducted better and you can clearly hear over the compacted area full phrase"Cup of tea". We remind you that lung tissue compaction syndrome occurs with pneumonia, compression atelectasis, pneumosclerosis, cirrhosis of the lung, and tumors. Increased bronchophony also occurs with air-containing cavities in the lung. Note that bronchophony is more informative in women, children, the elderly, and voice trembling in men, since they have a low tone of voice.

Laboratory and instrumental methods research:

A) sputum examination (examination, microscopy);

B) study of pleural punctate;

C) spirography, pneumotachometry, peak flowmetry;

D) the concept of fluoroscopy, radiography, lung tomography, bronchography, bronchoscopy.

The respiratory system is one of the most important "mechanisms" of our body. It not only fills the body with oxygen, participating in the process of respiration and gas exchange, but also performs whole line functions: thermoregulation, voice formation, sense of smell, air humidification, hormone synthesis, protection from factors external environment etc.

At the same time, the organs of the respiratory system, perhaps more often than others, are faced with various diseases. Every year we endure acute respiratory viral infections, acute respiratory infections and laryngitis, and sometimes we struggle with more serious bronchitis, tonsillitis and sinusitis.

We will talk about the features of diseases of the respiratory system, the causes of their occurrence and types in today's article.

Why do diseases of the respiratory system occur?

Diseases of the respiratory system are divided into four types:

• infectious- they are caused by viruses, bacteria, fungi that enter the body and cause inflammatory diseases respiratory organs. For example, bronchitis, pneumonia, tonsillitis, etc.
• allergic- appear due to pollen, food and household particles, which provoke a violent reaction of the body to some allergens, and contribute to the development of respiratory diseases. For example, bronchial asthma.
• Autoimmune diseases of the respiratory system occur when the body fails, and it begins to produce substances directed against its own cells. An example of such an impact is idiopathic hemosiderosis lungs.
• hereditary- a person is predisposed to the development of certain diseases at the gene level.

Contribute to the development of diseases of the respiratory system and external factors. They do not directly cause the disease, but they can provoke its development. For example, in a poorly ventilated room, the risk of getting ARVI, bronchitis or tonsillitis increases.

Often, this is why office workers get sick viral diseases more often than others. If air conditioning is used in offices in the summer instead of normal ventilation, then the risk of infectious and inflammatory diseases also increases.

Another mandatory office attribute - a printer - provokes the occurrence of allergic diseases of the respiratory system.

The main symptoms of diseases of the respiratory system

You can identify a disease of the respiratory system by the following symptoms:

• cough;
• pain;
• dyspnea;
• suffocation;
• hemoptysis

Cough is a reflex defensive reaction body on the mucus accumulated in the larynx, trachea or bronchi. By its nature, cough is different: dry (with laryngitis or dry pleurisy) or wet (with chronic bronchitis, pneumonia, tuberculosis), as well as constant (with inflammation of the larynx) and periodic (with infectious diseases - SARS, influenza).

Coughing may cause pain. Pain also accompanies those suffering from diseases of the respiratory system when breathing or a certain position of the body. It may vary in intensity, localization and duration.

Shortness of breath is also divided into several types: subjective, objective and mixed. Subjective appears in patients with neurosis and hysteria, objective occurs with emphysema and is characterized by a change in the rhythm of breathing and the duration of inhalation and exhalation.

Mixed shortness of breath occurs with pneumonia, bronchogenic lung cancer, tuberculosis and is characterized by an increase in respiratory rate. Also, shortness of breath can be inspiratory with difficulty in inhaling (diseases of the larynx, trachea), expiratory with difficulty exhaling (with bronchial damage) and mixed (pulmonary embolism).

Choking is the most severe form of shortness of breath. Sudden seizures choking can be a sign of bronchial or cardiac asthma. With another symptom of diseases of the respiratory system - hemoptysis - when coughing, blood is released with sputum.

Allocations can appear with lung cancer, tuberculosis, lung abscess, as well as with diseases of cardio-vascular system(heart defects).

Types of diseases of the respiratory system

In medicine, there are more than twenty types of diseases of the respiratory system: some of them are extremely rare, while others we encounter quite often, especially during cold seasons.

Doctors divide them into two types: diseases of the upper respiratory tract and diseases of the lower respiratory tract. Conventionally, the first of them are considered easier. These are mainly inflammatory diseases: SARS, acute respiratory infections, pharyngitis, laryngitis, rhinitis, sinusitis, tracheitis, tonsillitis, sinusitis, etc.

Diseases of the lower respiratory tract are considered more serious, as they often occur with complications. These are, for example, bronchitis, bronchial asthma, pneumonia, chronic obstructive pulmonary disease (COPD), tuberculosis, sarcoidosis, pulmonary emphysema, etc.

Let us dwell on the diseases of the first and second groups, which are more common than others.

Angina

angina, or acute tonsillitis, - This infection affecting the palatine tonsils. Bacteria are especially active causing sore throat, act in cold and damp weather, so most often we get sick in autumn, winter and early spring.

You can get a sore throat by airborne or alimentary routes (for example, when using one dish). Particularly susceptible to angina are people with chronic tonsillitis– inflammation palatine tonsils and caries.

There are two types of angina: viral and bacterial. Bacterial - a more severe form, it is accompanied severe pain in the throat, enlarged tonsils and lymph nodes, fever up to 39-40 degrees.

The main symptom of this type of angina is purulent plaque on the tonsils. The disease is treated in this form with antibiotics and antipyretics.

Viral angina is easier. The temperature rises to 37-39 degrees, there is no plaque on the tonsils, but cough and runny nose appear.

If you start treating viral sore throat in time, you will be on your feet in 5-7 days.

Symptoms of angina: Bacterial - malaise, pain when swallowing, fever, headache, white coating on the tonsils, enlarged lymph nodes; viral - sore throat, temperature 37-39 degrees, runny nose, cough.

Bronchitis

Bronchitis is an infectious disease accompanied by diffuse (affecting the entire organ) changes in the bronchi. Bacteria, viruses, or the occurrence of atypical flora can cause bronchitis.

Bronchitis is of three types: acute, chronic and obstructive. The first is cured in less than three weeks. A chronic diagnosis is made if the disease manifests itself for more than three months a year for two years.

If bronchitis is accompanied by shortness of breath, then it is called obstructive. With this type of bronchitis, a spasm occurs, due to which mucus accumulates in the bronchi. the main objective treatment - relieve spasm and remove accumulated sputum.

Symptoms: the main one is cough, shortness of breath with obstructive bronchitis.

Bronchial asthma

Bronchial asthma - chronic allergic disease in which the walls of the airways expand and the lumen narrows. Because of this, a lot of mucus appears in the bronchi and it becomes difficult for the patient to breathe.

Bronchial asthma is one of the most common diseases and the number of people suffering from this pathology is increasing every year. At acute forms bronchial asthma may cause life-threatening attacks.

Symptoms of bronchial asthma: cough, wheezing, shortness of breath, suffocation.

Pneumonia

Pneumonia is an acute infectious and inflammatory disease that affects the lungs. Inflammatory process affects the alveoli - the end part respiratory apparatus and they are filled with liquid.

The causative agents of pneumonia are viruses, bacteria, fungi and protozoa. Pneumonia is usually severe, especially in children, the elderly, and those who already had other infectious diseases before the onset of pneumonia.

If symptoms appear, it is best to consult a doctor.

Symptoms of pneumonia: fever, weakness, cough, shortness of breath, chest pain.

Sinusitis

Sinusitis - acute or chronic inflammation paranasal sinuses, there are four types:

• sinusitis - inflammation of the maxillary sinus;
• frontal sinusitis - inflammation of the frontal paranasal sinus;
• ethmoiditis - inflammation of the cells of the ethmoid bone;
• sphenoiditis - inflammation of the sphenoid sinus;

Inflammation in sinusitis can be unilateral or bilateral, with damage to all the paranasal sinuses on one or both sides. The most common type of sinusitis is sinusitis.

Acute sinusitis can occur when acute cold, influenza, measles, scarlet fever and other infectious diseases. Diseases of the roots of the four rear upper teeth can also provoke the appearance of sinusitis.

Sinusitis symptoms: fever, nasal congestion, mucous or purulent discharge, deterioration or loss of smell, swelling, pain when pressing on the affected area.

Tuberculosis

Tuberculosis is an infectious disease that most often affects the lungs, and in some cases genitourinary system, skin, eyes and peripheral (visible) lymph nodes.

Tuberculosis comes in two forms: open and closed. At open form Mycobacterium tuberculosis is present in the patient's sputum. This makes it contagious to others. At closed form there are no mycobacteria in the sputum, so the carrier cannot harm others.

Tuberculosis is caused by mycobacteria transmitted by airborne droplets when coughing and sneezing or talking with the patient.

But you don't necessarily get infected through contact. The likelihood of infection depends on the duration and intensity of contact, as well as the activity of your immune system.

Symptoms of tuberculosis: cough, hemoptysis, fever, sweating, deterioration in performance, weakness, weight loss.

Chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease is a non-allergic inflammation of the bronchi that causes them to narrow. Obstruction, or more simply, deterioration of patency, affects the normal gas exchange of the body.

COPD results from inflammatory response, developing after interaction with aggressive substances (aerosols, particles, gases). The consequences of the disease are irreversible or only partially reversible.

Symptoms of COPD: cough, sputum, shortness of breath.

The diseases listed above are just a few. big list diseases affecting the respiratory system. We will talk about the diseases themselves, and most importantly their prevention and treatment, in the following articles of our blog.

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nose disease syndrome . At rhinitis due to inflammatory hyperemia, the mucous membrane turns red. Being saturated with exudate, it swells, the nasal passages narrow, breathing becomes difficult, it becomes sniffling, the animals sneeze, snort. There are bilateral nasal discharges, initially serous, and later serous-catarrhal or catarrhal-purulent. With follicular rhinitis, a rash appears on the nasal mucosa, the skin of the wings of the nose, lips and cheeks.

Syndrome of diseases of the paranasal cavities . Inflammation of the maxillary sinusitis ) And frontal sinuses (frontitis ) is characterized by a change in the position of the head and neck, an increase in skin sensitivity. When filling the sinuses with effusion, a dull or dull sound is established by percussion. Nasal discharge of a catarrhal-purulent nature, aggravated by tilting the head down. At long course disease bone wall the sinuses become thinner, arched, forming swelling and deformation of the bones of the skull.

Syndrome of diseases of the larynx and trachea . At laryngitis And tracheitis a strong, loud, short, shallow cough develops. If involved in the pathological process vocal cords , the cough becomes hoarse. The larynx area swells, local temperature and sensitivity are increased. With significant pain, the animal stretches its neck, avoids sudden movements. There is inspiratory dyspnea. Auscultation reveals a laryngeal murmur of stenosis. Bilateral nasal discharge may be catarrhal, catarrhal-purulent, fibrinous, or hemorrhagic.

Syndrome of diseases of the bronchi . At bronchitis the mucous membrane of the bronchi swells, hard vesicular breathing appears, as exudate accumulates in the bronchi, wheezing occurs. If the exudate is liquid, the rales are moist, bubbly; with macrobronchitis - large bubbling, microbronchitis - fine bubbling, with diffuse bronchitis - mixed. An increase in the viscosity of the exudate causes the appearance of dry rales. Bronchitis is accompanied by cough. In the first days, the cough is dry and painful, later it is deaf, wet and less painful. In chronic bronchitis, coughing can be in the form of attacks. Mixed shortness of breath, with microbronchitis - expiratory.

bronchiectasis- pathological expansion of the bronchi that have lost their elasticity, occurs as a complication chronic bronchitis. A sign of bronchiectasis is the release of a large amount of exudate when coughing.

lung disease syndrome . Depends on the nature of the tissue changes. With compaction of the lung tissue ( pneumonia , pulmonary edema ) percussion sound is dulled. If an area of ​​the lung becomes airless ( atelectasis , croupous pneumonia ), percussion reveals a dull sound. Accumulation of fluid in the pleural cavity exudative pleurisy , dropsy ) in the lower part of the chest there is an area of ​​dull percussion sound, delimited from above by a horizontal line (horizontal line of dullness). With the formation of air cavities in the lung tissue (interstitial emphysema, bronchiectasis), the sound becomes tympanic. If the inner shell of the cavity is smooth, the percussion sound acquires a metallic tint. Above the cavity communicating with the bronchus, percussion produces the sound of a cracked pot. In case of lung enlargement ( alveolar emphysema ) the sound becomes boxy, and the caudal border of the lungs shifts back. The defeat of the lungs is accompanied by crepitus, crackling wheezing, breathing becomes bronchial and amphoric. Crepitus occurs when sticky effusion accumulates in the alveoli (with pneumonia, pulmonary edema). At interstitial emphysema air bubbles are formed in the lung tissue, the movement of which to the root of the lungs leads to rupture of the lung tissue and the occurrence of crepitant wheezing. If the lungs thicken, but the patency of the bronchi is preserved, bronchial breathing appears. During auscultation of the cavities communicating with the bronchus, amphoric breathing is heard. With a decrease in the elasticity of the lungs, the cough is weak, dull, prolonged, "deep" (pulmonary).

At bronchopneumonia there are pulmonary cough, expiratory or mixed dyspnea, foci of dullness in the lungs, bronchial breathing, crepitus. Depending on the nature of the inflammation of the bronchial lung tissue, nasal discharges can be catarrhal, catarrhal-purulent or purulent.

At gangrene lungs appear dirty-serous, fetid discharge from the nose, cough, shortness of breath, wheezing. In the presence of cavities communicating with the bronchus, they listen to the sound of a cracked pot, amphoric breathing. The nasal discharge contains elastic fibers of the lungs.

Alveolar emphysema is a disease characterized pathological expansion lungs by stretching the alveoli and reducing their elasticity. characteristic symptoms there will be expiratory dyspnea, a displacement of the caudal border of the lungs backward, a boxed percussion sound, the appearance of an “ignition trough” on exhalation.

Hyperemia and pulmonary edema- a disease characterized by overflow of blood in the pulmonary capillaries, followed by sweating of blood plasma into the lumen of the bronchi and cavities of the alveoli. Pulmonary edema is accompanied by shortness of breath, wet rales and cough. Foamy discharges of a reddish color stand out from the nasal openings. Percussion sound during hyperemia is tympanic, as edema develops, it becomes dull.

Syndrome of diseases of the pleura . Pleurisy accompanied by soreness of the chest and fever, shortness of breath occurs. The cough becomes painful (pleural cough) and the animal groans. At fibrinous inflammation pleura establish friction noise, synchronous with respiratory movements. Accumulation in pleural cavities liquid effusion is accompanied by the appearance of a horizontal line of dullness. In the area of ​​dull sound, heart sounds and breath sounds are weakened.

or last for a long time, during which the mechanisms of tachypnea compensation develop (stabilization of blood pH, development of erythrocytosis, increase in hemoglobin in the blood, etc.).

Main Syndromes:

• bronchial obstruction syndrome;
• thromboembolism syndrome pulmonary arteries;
• drumstick syndrome;
• DN syndrome;
• inflammation syndrome;
• pulmonary obstruction syndrome.

lung tissue compaction syndrome (ULT)

The most common syndrome is ULT syndrome. However, there is no such disease as ULT, it is an artificially created group in order to create a diagnostic algorithm for diseases of the lung parenchyma. Each of the diseases discussed is characterized by loss of airiness and ULT. varying degrees expression and prevalence.
This syndrome is characterized by the appearance above the site of compaction:

• amplification of voice trembling;
• shortening of percussion tone;
• hard (in case of focal compaction) or bronchial (with lobar compaction) the nature of breathing.

ULT syndrome can manifest the following diseases lungs: pneumonia, myocardial pneumonia, lung atelectasis, fibrosis and carnification of the lung.

Syndrome of bronchial obstruction

This syndrome occurs quite often and is always accompanied by shortness of breath. If shortness of breath occurs suddenly, it is customary to talk about asthma. In these cases, damage to small bronchioles is detected, that is, there is obstructive bronchiolitis. In addition, the cause of this obstruction may be destructive changes lung parenchyma (emphysema).

Pulmonary embolism syndrome

Pulmonary embolism is characterized by sudden chest pain and hemoptysis. Percussion and auscultation may reveal symptoms of atelectasis or ULT.

Respiratory failure syndrome

The syndrome is characterized by a deterioration in gas exchange between the environment air environment and blood., DN can be acute and chronic, when these deteriorations occur quickly or gradually and lead to disruption of gas exchange and tissue metabolism.

The main function of the lungs is to constantly oxygenate the blood (and hence tissues) and remove CO 2 . In this case, either oxygenation (intracellular gas exchange, in which blood saturation with oxygen and removal of carbon dioxide is disturbed), or ventilation can be disturbed.

Classification of respiratory failure. It is advisable to distinguish three forms of DN - parenchymal, ventilatory and mixed.

Parenchymal (hypoxemic) respiratory failure is characterized by arterial hypoxemia. leading pathophysiological cause This type of DN is uneven intrapulmonary oxygenation of blood with increased intrapulmonary shunting of blood.

Ventilation (hypercapnic) respiratory failure develops with a primary decrease in alveolar hypoventilation. Causes given state are: pronounced, violations of the regulation of breathing. This form DN is rare.

mixed form of DN is the most frequent form DN. Observed in violation of patency bronchial tree in combination with inadequate work of the respiratory muscles due to its compensatory overload.