respiratory system Flashcards
Respiratory tract steps of examination
- nose and paranasal sinuses
- coughing
- larynx and pharynx
- trachea 5. thorax
Thorax methods of examination
- inspection
- palpation
- auscultation
- percussion
Additional thorax examinations
-X-ray
-ultrasonography
-endoscopy
-bronchial fluid sample (BAL)
-via endoscope or transtracheal wash -bronchial fluid analysis
(quality, cytological, bacter., mycological, virol. and parasitol. examination)
-thoracocentesis, biopsy
-CT, MR, scintigraphy -thoracotomy
-lung function testing
-blood count, acid-base analysis
Chest inspection
-skin
-size,
shape -bilateral symmetry -local deformities
Respiratory movements
a) frequency
b) rhythm
c) type
d) depth
FREQUENCY resp.mvmt
30/min
tachypnea Normal
under movement, excitement, work, high temperature, obesity, pregnancy
tachypnea Abnormal
fever,
hypoxia,
hypercapnia,
pain in respiratory organs
bradypnea
Always Abnormal CNS diseases, barbiturate toxicosis, shock, agony
respiratory RHYTHM
Normally
Periodic rhythmical inspiration and
expiration, inspiration is a little bit longer
Held inspiration
- narrowed upper airway’s
- higher abdominal pressure (pregnancy, ascites, meteorism)
Held expiration
- decreased lung elasticity
- microbronchitis
Shorter inspiration or expiration
-inhibition about pain
Asymmetric breathing
- one main bronchus obstruction
- pain in one chest
Intermittent inspiration
- normally during excitement, long exhausting work
- abnormally:at painy chest
resp. mvmt TYPE
Normal:
Dogs Cats horses : costoabdominal
Ru: abdominal
resp. mvmt TYPE
Abnormal : Costal respiration
- the function of the diaphragm is lost (abdominal pain caused by inflammation)
- increased abdominal pressure, (pregnancy, meteorism, ascites)
- narrowed upper airways, compression of the lung
resp. mvmt TYPE
Abnormal :Abdominal respiration
painy chest diseases and paralysis of intercostal muscles
resp.mvmt DEPTH
Normal:
medium deep
resp.mvmt DEPTH
Abnormal :Shallow (superficial) respiration
- cases of severe dyspnea
- painy diaphragm and chest diseases -respiratory centre damage
resp.mvmt DEPTH
Abnormal : -Deep respiration
- after fast movement
- at hypoxia
- may the characteristic sign of dyspnea
Dyspnea
The dyspnea caused by difficulties of respiration (compression, obstruction of the air passages, decreased lung compliance). During resting or better at works the muscles working in respiration seem to do their work forcedly
Types of dyspnea
- Inspiratory dyspnea
- Expiratory dyspnea
- Mixed dyspnea
INSPIRATORY DYSPNEA Caused by
-narrowed upper airways (stridor) (laryngeal edema, laryngeal paralysis, stenotic nares, etc) -pneumothorax -pleural effusions -diffuse pneumonia
INSPIRATORY DYSPNEA signs
(prolonged and labored inspiration) Inspiratory phase is longer, extension of the head and neck, nostril dilatation, labial respiration, spreading of the scapules, exaggerated intercostal activity, slack or sunken flanks and sagging belly
EXPIRATORY DYSPNEA Caused by
- compression or obstruction of lower air passages
- microbronchitis
- (pulmonary emphysema)
- fibrous pleuritis
- rarely neoplasms in larynx and pharynx
EXPIRATORY DYSPNEA signs
(prolonged and labored exspiration)
Expiratory phase is longer,
the work of abdominal muscles is more severe,
extension of the head and neck,
thorax very fasten collapsed during expiration.
Expiratory dyspnea is abdominal,
duplicate or strongly held “heave line”
mixed dyspnea caused by
- decreased compliance
- pulmonary edema
- pulmonary emphysema
- neoplasma
- compressed diaphragm
mixed dyspnea signs
Forced inspiration and expiration
normal respiration:
both the abdomen and chest move in and out together, allowing maximum expansion of the lungs
Paradoxical respiration:
Chest movement is restricted, not able to expand properly
– The intercostal muscles may collapse inwards with inspiration as they fatigue,
and as greater negative pressures are created within the
thoracic cavity;
• Abdominal wall move in the opposite direction to that expected
Paradoxical respiration: reasons
pleuralfluid,
pneumothorax,
diaphragma paralysis,
broken ribs
Abnormal breathings
Cheyne-stokes
Kussmaul
Biots
EXAMINATION of THORAX
• PALPATION
- Temperature of the skin comparing the symmetrical areas, look for painful places palpating all intercostal spaces from up to down
- Fremitus pectoralis we can find it during dry pleurisy, bronchitis, fibrinous pericarditis, stenotic cardial valves or valve insufficiency
- Painfullness
- Deformities
Fremitus pectoralis
we can find it during dry pleurisy,
bronchitis,
fibrinous pericarditis,
stenotic cardial valves or valve insufficiency
Resp tract history
signs (exact complain, duration, progression)
nasal discharge, coughing, abnormal sounds associated with breathing, abnormal vocalization, dyspnoe, sneezing, stridor
• vaccination
• deworming program
• medications
• type of housing
• health stage and performance of other animals
• age
• type of environment
resp. tract general impression
level of consciousness • behavior • posture • locomotion • nutritional condition • grooming state • abnormal sounds • abnormal respiration
resp tract STEPS of the EXAMINATION
- nose and paranasal sinuses
- coughing
- larynx and pharynx
- trachea
- thorax
nose and paranasal sinuses methods
- external and internal inspection
- palpation
- percussion
- smelling
nose and paranasal sinuses FURTHER EXAMINATIONS
- cytological, bacter., mycologic and parasitic examination of the nasal fluid
- probing nasal passages
- X-ray
- endoscopy (rhinoscopy, sinuscopy in horse) -diagnostic punction
- biopsy
- diagnostic rhinotomy
- CT, MRI
nose and paranasal sinuses What to check
- Shape, form of the nose
- Occurrence of nasal stridor
- Expired air
- Occurrence of nasal discharge
- Nasal plane
- Nasal openings (nostrils), mucous membranes 7. Palate, nasopharynx
- Paranasal and frontal sinuses
- Guttural pouches in equide
Occurrence of nasal stridor
normally:
faint regular noise during expiration
in pigs, brachycephal dogs the noise is more intensive
Occurrence of nasal stridor
Abnormally:
- stridor (during inspir. or expir. or both)
- narrowed air passages (localiz. and side of narrowing)
- sneezing (important reflex which protect the respir. syst) -in dogs, young horses: often normal, cats: rhinotracheitis -in rabbits: about rhinitis
- snoring, stertor (in pigs and brachycephal dogs) -reverse sneezing
- singultation ( in puppies and young thoroughbreds)
Nasal stridor
sniffing sound
Pharyngeal stridor
snorring sound
Laryngeal stridor
soft „sawing” sound
Collapsed trachea
expiratory! tooting sound
Larynx paralysis
inspiratory stridor
Narrow trachea, bronchus
mixed stridor
Occurrence of nasal stridor
- purring (in cats)
- noises caused pain
- groaning (in horses rarely, in cows often) -signing (in cows)
- puling, howling (in dogs)
- shrieking (in pigs)
- alteration of voice (rabies) -noiseless
- panting (in dogs)
Expired air
- strength
- symmetry
- temperature
- odor
Occurrence of nasal discharge
-continuity (permanent/periodic)
-side (left/right/both)
-quantity
-quality: consistency
(watery, mucous, mucopurulent, hemorrhagic, foamy, contains food intake, foreign material, or debris)
color
-odor
Further examination: lower the head of the horse
Nasal plane
-surface (intactness)
-colour
-moisturness
in most animals usually moist, intact, pigmented
Nasal openings, nostrils
- shape of the nostrils
- width
- movability of the nasal alae
- symmetricy
- mucous membranes
Palate, nasopharynx
(examination by opening the animal’s mouth)
- with or without optical instruments
- dental mirror, endoscopy (in horse ONLY by endoscopy)
paranasal and frontal sinuses
- inspection
- palpation
- percussion
- endoscopy (in horse)
- X-ray
- diagnostic punction
All of them sinuses
• sinus maxillares • sinus frontalis • sinus lacrimalis • sinus palatinus • sinus sphenoidalis sinus maxillares sinus frontalis sinus ethmoidale sinus sphenopalatinae
Guttural pouches in horse
- localization
- examination
- inspection
- palpation
- percussion
- endoscopy
- X ray
Normal finding for the nose
The outline of the nose is characteristic on the breed, symmetrical.
The temperature is the same as the surroundings,
the palpation is not painful.
The percussion sound is sharp, bone-like above the bones Faint regular noise during expiration.
The expired air is medium strong, warm, symmetrical, the odor is characteristic on the breed.
The nostrils have regular shape and symmetrical width. The nasal alae are not moving during in- and expiration. The outer inspection and palpation of the paranasal sinuses don’t prove any abnormalities,
any sign of swelling or asymmetry,
the skin is intact,
the temperature is the same as the surroundings,
the palpation is not painful,
the percussion sound of the paranasal sinuses is sharp, bone-like sound.
The nasal plane is moist, intact, has black color, there is no nasal discharge.
The soft and hard palate are intact, moist, pinkish red.
The mm of the nose is intact, smooth, shiny, light pink.
COUGHING
Important reflex by which the respiratory system protects itself against injury and foreign material
• the reflex can occur via stimulation of the airways anywhere from the larynx to the larger bronchi
coughing Standpoints of examination
-origin (spontaneous or stimulated)
-frequency (rare, frequent, paroxysmal)
-strength (weak, medium intense, intense, with or
without snap)
-tone (sharp, dull, barking, rattling, roaring, hoarse)
-occurrence (during night, mornings, in the daytime, continuously, only in special environment)
-duration (short, medium long, long, held) -secretion content (dry, medium wet, wet)
-painful or painless
-deepness (superficial or deep or medium deep)
-localization of origin -the quality of sputum
Larynx cough
– episodical,heavy,gagging/retching,tendencytovomit
– Larynx paralysis: deep, long, hars
– Tracheitis cough
loud, explosive barking like
tracheal collapse cough
goose honking cough
Bronchi cough
– acute phase: pattern tracheitis
– chronic phase: mucus, pus, wet, rough
Lung emphysema, chronic bronchitis cough
short, weak, dry
Pneumonia cough
soft
Cardiac disease cough
wet, hacking
Horse cough stimulation
press the larynx with one hand or two hands if it unsuccessful, press the tracheal rings near to the larynx
healthy horse doesn’t cough spontaneously, cough stimulation is difficult, hardly can be done. Stimulated coughing is intensive, sharp, high, short, dry, painless, snapping, does not recur
Cow cough stimulation
close mouth and nasal occlusion with hands or
plastic bag until air hunger
healthy cow doesn’t cough spontaneously, cough stimulation is difficult. Stimulated coughing is medium intensive or week, medium deep, more dull, held, dry, painless, unsnapping, does not recur
SMALL RUMINANTS and DOG -CATS
• stimulation cough
pressing the tracheal rings or pressing the thorax
very rapidly during expiration
• characteristics: sheep and goat
Stimulated cough is weak, deep, groaning-like, dry, medium held, painless, does not recur
dog and cat
Stimulated cough is medium held, unsnapping, medium intensive, medium deep, dry, sharp, painless, does not recur
LARYNX and PHARYNX
• METHODS
-external and internal examination
-inspection -palpation -auscultation
• FURTHER EXAMINATION -X-ray
-endoscopy
LARYNX and PHARYNX
• EXTERNAL EXAMINATION
- inspection
- skin, deformity, swelling, symmetricy -palpation
- form, outline, muscles, surface of larynx, abnormal masses
- compressionability and press sensitivity of the arytenoids
- temperature, painfulness -fremitus
- auscultation
- normally weak stridor under inspiration and expiration
LARYNX and PHARYNX
• INTERNAL EXAMINATION
- inspection
- epiglottis
- nasopharynx
- symmetry and synchronous movement of the arytenoids
- rima glottidis
- color, capillaries and deformation of mucous membranes
TONSILLA
• size, shape •Semilunar fold •Colour •Surface symmetry
TRACHEA
• METHODS
- external inspection
- palpation
- auscultation
• FURTHER EXAMINATION
-X-ray
-endoscopy
-tracheal fluid sample
-via endoscope or transtracheal aspiration
-tracheal fluid analysis
(quality, cytological, bacteriologic, mycological, virologic and parasitologic examination)
Physical basis of the origin of the respiratory sounds
- Air flow from the higher to the lower pressure place
- Narrowing in the way of air
Turbulence in the airways +
resonance of the connective tissue
Turbulence depends on the diameter of the airways and the speed of the airstream
Physiologic basic (normal) respiratory sound
Blow-like sound,developed in the upper airways
Stronger during inspiration and
slighter during expiration
Contains:
1. Weak stenotic noise originated from the nose and pharynx conducted through the bronchus, lung, chest wall
2. Weak blow noise turbulence before tracheal bifurcation or branch of larger bronchi, after bifurcation laminar spread
• In small bronchi and alveoli do not originate respiratory sounds!
How can reach the respiratory sound our ears?
Resonance
soundlungchest wall diminish
some of it reflected from bordering places depending on acoustic impedance
• Acoustic impedance
(density of the material x speed of the sound)
- if the impedance of the tissues are quite similar (as when an infiltrated lung lies against the thoracic wall) large part of the sound is transmitted
- if different, the intensity of the sound is diminished/reduced (healthy lung, chest wall)
Directly audible sounds (ear)
– Nose (discharge, tumour, polyp, nasopharyngeal stenosis)
– Larynx (paralysis, collapse, oedema, laryngitis, tumour)
– Trachea (collapse, trauma, tumour)
Indirect auscultation (stethoscope)
– Larynx
– Trachea
– Thorax
Normal (physiological) respiratory sound
Soft, blowing sound
Stronger in carnivores, sometimes bronchial like
Bovine: strong, rugged
“f” sound (air sucking)
Bronchial sound
Strong, audible blowing sound
“h” sound during ex/inspiration
Above the normal larynx and trachea Lung contains less air
Bronchial like sound
Deeper, softer, harsher than the bronchial sound
“f” - “h” sounds together
carnivores: physiologic
Above the normal larynx and trachea Lung contains less air
Weaker than normal resp.sound
Decreased airflow/ conduction shallow breathing
Thickened chest wall, decreased elasticity of the lung, hampered expansion of the lung
Missing resp.sound
No conduction
Pleural adhesion or fluid accumulation,
obstruction of pr. br. atelectasia of the lung
Louder (harsher) than normal resp.sound
Increased airflow / conduction
Exercise, dyspnea, bronchitis, thin chest wall
Bronchial resp. sound 1
can be heard above the larynx and trachea under physiological conditions
• produced by a stenotic effect of the relatively solid (cartilagineous) airway of the larynx, trachea
• it is due to vortex formation of the inhaled air within the gradually narrowing passages of the upper respiratory tract
• blowing in character and resembles a prolonged syllable “ch„
Bronchial-like resp. sound:
between normal and bronchial sounds
• quieter, deeper, rougher than bronchial
• can be normal during inhalation in cow/ dog/ cat/ swine
• always abnormal during exhalation
Bronchial respiratory sound II.
Normally audible: only during inhalation
- over the larynx and trachea
- in small animals and in very thin large animals only over the largecranial bronchi
- in other large animals less distinctly heard
- best heard over the anterior part of the respiratory area where the larger bronchi are relatively near to the surface of the body (large bronchial area)
Bronchial respiratory sound III.
Caused: stiffer bronchial wall/infiltration around the bronchial wall +/- more powerful airflow („pipe resonance”)
Abnormal:• during exhalation always
• during rapid respiration above narrower upper airways
(the turbulence is so intensified that the borders of turbulence are extended, therefore it can be heard more caudally)
• when peribronchial lung tissue contains less air (increased structural density) e.g.
• bronchitis / pneumonia / pulmonary neoplasia
• over air-containing cavities
• dorsal to the pleural fluid level
• pneumothorax
Stridor
Strong stenotic sound
Upper airway stenosis
Rubbing sound
friction sound
Rubbing of pleural surfaces
Splasing sound
Gas and fluid movement
Metallic sound
Fluid drops on fluid
Ichorous exudate in caverns (aspiration pneumonia)
sonorous/resonant:
fairly low, strongly resonant
air containing organ, e.g. normal lungs
damped/dull:
short sound of low intensity
any organ not containing gas: liver, heart, muscle
tympanic
(stronger, longer, higher than sonorous,
higher in pitch)
(striking a hollow organ containing gas under
pressure, e.g. gastric volvulus)
Indications of thoracic percussion
determination the caudal borders of the lungs
- estimation the gas content of the organs
(increased or decreased)
- comparative percussion
(left and right side)
normal percussion sound of the thorax (lungs
large animals
(40-500 bwkg): sharp, low, (non)sonorous (non)resonant and short percussion sound
normal percussion sound of the thorax (lungs Small animals (25-40 kg bwkg):
sharp,
high or low,
sonorous (resonant)
and long percussion sound
Horse lung borders
ribs 18 back muscles 17 tuber coxae 16 tuber ischiadicum 14 shoulder 10
Ruminants lung borders
ribs 13 back muscles 12 tuber coxae 11 tuber ischiadicum NO shoulder 8
Swine lung borders
ribs 14 back muscles 12 tuber coxae 11 tuber ischiadicum 9 shoulder 7
lung borders dog cat
ribs 13 back muscles 12 tuber coxae 11 tuber ischiadicum 10 shoulder 8
Displacement of the caudal border backwards and downwards:
alveolar and interstitial lung emphysema
COPD = RAO
Decrease of the percussion area of the lungs:
abdominal distention due to •distention of stomach or intestine •enlarged liver •pregnancy •ascites •large intraabdominal tumor
„Elevation” of the caudoventral border:
increase of the cardiac dullness (cardiomegaly or pericardial effusion)
Relative or incomplete dullness
weak, high, short, nonmusical sound
Absolute (complete) dullness:
even weaker and shorter sound than relative dullness
thickened thoracic wall (edema, pleural adhesions, ++ conjective tissue decreased gas content of the lungs (pneumonia, edema, neoplasm)
pleural effusion (horizontal dorsal border!) caused by hydrothorax, pleuritis, haemothorax or chylothorax atelectatic abdominal organs (full stomach, spleen, liver)
atelectatic solid masses or masses filled with fluid within the thorax
Diernhofer triangle including
air-containing lung lobe between the diaphragm and the caudal border of the heart
