Careful history taking with the skilful evaluation of symptoms is of the greatest importance in the diagnosis of disease. Certain symptoms associated with disorders of respiration will therefore be discussed in detail.
Dyspepsia. In health breathing is carried out automatically and without conscious effort. An early symptom of disturbed lung function is an uncomfortable awareness of respiration with shortness of breath known as dyspepsia. This symptom is not confined to diseases of the lungs and bronchi ; it occurs in heart failure and in severe anemia, and in addition may be present in anxiety states. Patients with emotional disturbances often feel that they cannot get sufficient air into their lungs and consequently take deep gasps with much sighing. Some hysterics breathe very deeply (hyperventilate) with the liberation of excessive amounts of carbon dioxide from the body; this disturbs the body chemistry with the production of severe cramp in the hands and feet (tetany).
Cough. A cough may be dry, irritant and unproductive or it may result in the expectoration of sputum. An irritant dry cough may result from the inhalation of a foreign body or from virus infections of the respiratory tract. In children it is often caused by enlarged infected tonsils or from secretions dripping down the back of the throat from Sputum. The walls of the bronchi contain a large number of glands which secrete sufficient mucus to form a protective layer over the epithelium. In disease this mucus is produced in excessive amounts and when expectorated is known as sputum. The mucoid type of sputum is a colorless, sticky jelly. In the presence of bacterial infection it becomes mixed with pus cells and this purulent type of sputum has a yellow or green colour with at times an offensive smell. On occasions sputum is bloodstained or there may be a large amount of almost pure blood expectorated which is then known as a hemophiliacs. The common causes of hemophiliacs are: carcinoma of the bronchus, pulmonary tuberculosis, bronchitis, pulmonary infarction, and mistral stenosis. A hemophiliacs is always frightening to a patient so those in attendance should behave in a calm and reassuring manner. It is better to encourage expectoration of the blood rather than to allow it to be retained in the lungs where it may obstruct the airways. The patient may require sedation. Blood transfusion is rarely necessary although occasionally a hemophiliacs may be massive and even fatal.
Wheezing. Narrowing of the air tubes from spasm of the muscle in the bronchial wall or because of partial obstruction from retained sputum leads to the production of a wheezing noise often audible to the patient and those nearby.
Pain. The character of this symptom depends on whether it arises from disease affecting the muscles, ribs, nerve roots, or pleura. Disease confined to the lung alone does not cause pain. Pain in the muscles of the chest wall due to fibrosis is common; it gives rise to an intermittent stabbing sensation or a continuous dull ache, often shifting from one place to another. Severe pain is experienced when the ribs are damaged; even when they are only bruised there is discomfort for many weeks, but when they are fractured or eroded by neoplasm the pain is agonizing and further aggravated by coughing or sneezing. Girdle pains radiating around the chest wall occur when nerve roots are affected by disease. Inflammation of the pleura (pleurisy) causes a severe knife-like pain, made worse by taking a deep breath
Clubbing of the fingers. The changes in the appearance of the fingers known as clubbing are of much diagnostic significance . It may be considered a symptom when complained of by the patient, but more frequently the patient is unaware of the changes and it is the doctor or nurse, who, as trained observers, first recognize clubbing as a physical sign of underlying pulmonary or cardiac disorders including bronchial carcinoma, bronchitis, lung abscess, bacterial endocarditis and cyanogen types of congenital heart disease.
No comments:
Post a Comment