兰州大学检体诊断学课件 咳嗽与咳痰咯血呼吸困难（英文）.pptVIP

咳嗽、咳痰、咯血和呼吸困难 Cough, Expectoration and hemoptysis 兰州大学第二医院 万毅新 Hemoptysis Hemo: blood Pty/o: saliva Ptysis: spitting Hemoptysis: coughing up blood as a result of bleeding from the respiratory tract Chest Radiograph Demonstrating an arteriovenous Malformation Wegeners granulomatosis Differential Diagnosis of Hemoptysis Source other than the lower respiratory tract Upper airway Gastrointestinal bleeding Tracheobronchial source Neoplasm Bronchitis Bronchiectasis Broncholithiasis Airway trauma Foreign body Primary vascular disease Arteriovenous malformation Pul. Embolism Elevated pul. venous pres. Pul. parenchymal source Lung abscess Pneumonia Tuberculosis Mycetoma Goodpasture’s syndrome Idiopathic pul. hemosiderosis Wagener’s granulomatosis Lupus pneumonia Lung contusion Miscellaneous/rare causes Pul. Endometriosis Systemic coagulopathy Use of anticoagulants 呼吸困难Dyspnea Definition of Dyspnea Dyspnea is defined as: An abnormally uncomfortable awareness of breathing, or difficult, labored, uncomfortable breathing. A normal resting person is unaware of the act of breathing, he or she may become conscious of breathing during mild or moderate exertion, but no discomfort During and following exhausting exertion, an individual may become unpleasantly aware of breathing yet feel reasonably assured that the sensation will be transitory and is appropriate to the level of exercise breathing 呼吸正常 端正呼吸 侧卧呼吸 平卧呼吸: Efferent and Afferent Signals Contributing to Sensation of Dyspnea Possible Mechanisms of Dyspnea in Selected Condition Positional dyspnea Some Syndromes Cardiac asthma A state of acute respiratory insufficiency with bronchospasm, wheezing, and hyperventilation. It may be indistinguishable from other types of asthma, but the cause is left ventricular failure Periodic or Cheyne-stokes respiration Characterized by regularly alternating periods of apnea and hyperpnea. Often, it is caused both by neurologic or pharmacologic medullary respiratory center impairment