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Flashcards in Upper Respiratory system Deck (30)
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1

signs

(exact complain, duration, progression) nasal discharge, coughing, abnormal sounds associated with breathing, abnormal vocalization, dyspnoe, sneezing, stridor

2

GENERAL IMPRESSION

level of consciousness 
behavior 
posture 
locomotion 
nutritional condition 
grooming state 
abnormal sounds 
abnormal respiration

3

STEPS of the EXAMINATION

1. nose and paranasal sinuses 2. coughing 3. larynx and pharynx 4. trachea 5. thorax

4

EXAMINATION METHODS

-external and internal inspection
-palpation
-percussion
-smelling 
FURTHER EXAMINATIONS
-nasal discharge: cytologic, bacter., mycologic and parasitic examination
-X-ray
-endoscopy (rhinoscopy, sinuscopy in horse)
-diagnostic punction
-biopsy
-diagnostic rhinotomy
-CT, MRI
-nasogastric tubing

5

1. NOSE and PARANASAL SINUSES

1. Shape, form of the nose 2. Occurrence of nasal stridor 3. Expired air 4. Occurrence of nasal discharge 5. Nasal plane 6. Nasal openings (nostrils), mucous membranes 7. Palate, nasopharynx 8. Paranasal and frontal sinuses

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1. 2. Stridor

normal: faint regular noise during expiration (in brachycephalic dogs the noise is more intensive) Abnormal sounds:
-stridor(during inspir. or expir. or both)
-narrowed air passages(localization & side of narrowing)
-sneezing (important reflex which protect the resp. syst)
-in dogs: often normal,
-cats: rhinotracheitis -
rabbits: about rhinitis
-snoring, stertor (in brachycephalic dogs)
-reverse sneezing
-singulation ( in puppies)


Nasal stridor => sniffing sound 
Pharyngeal stridor => snoring sound 
Laryngeal stridor =>soft „sawing” sound 
Collapsed trachea => expiratory! tooting sound
Larynx paralysis => inspiratory stridor
Narrow trachea, bronchus => mixed stridor

7

1. 2.1 abnormal sounds

-purring (in cats)
-noises caused pain
-groaning (in dog, horses rarely, in cows often)
-howling (in dogs)
-alteration of voice (rabies)
-noiseless
-panting (in dogs)

8

1. 3+4

3.Expired air
strength  symmetry  temperature  odor, smell

4. 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, smell

9

1. 5+6+7

5.Nasal plane
surface (intactness)  colour  moistures' in most animals usually moist, intact, pigmented 

6.Nasal openings, nostrils 
shape of the nostrils  width  movability of the nasal alae  symmetricy  mucous membranes, inside examination 

7.Palate, nasopharynx (examination by opening the animal’s mouth)
-with or without optical instruments: dental mirror, endoscopy 
abnormalities, mm

10

1. 8.

Paranasal and frontal sinuses
-inspection -palpation -percussion -endoscopy (in horse) -X-ray, CT, MR -diagnostic punction 

sinus maxillares - sinus maxillares 
sinus frontalis - sinus frontalis 
sinus lacrimalis
sinus ethmoidale 
sinus palatinus
sinus sphenopalatinae 
sinus sphenoidalis

11

1. Physiological finding of the region of 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.

12

2. COUGHING

Important reflex by which the respiratory system protects itself against injury & foreign material
-the reflex can occur via stimulation of the airways anywhere from the larynx to the larger bronchi

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

stimulation: pressing the tracheal rings or pressing the thorax very rapidly during expiration 
=>Stimulated cough is medium held, unsnapping, medium intensive, medium deep, dry, sharp, painless, does not recur

13

2.1. Origin

Larynx 
episodical, heavy, gagging / retching, tendency to vomit 
Larynx paralysis: deep, long, hars

*Trachea 
-Tracheitis: loud, explosive barking like 
-trachea collapse: goose honking cough 

*Bronchi:
-acute phase: pattern m/l tracheitis;
-chronic phase: mucus, pus, wet, rough 

-Lung emphysema, chronic bronchitis: short, weak, dry 
-Pneumonia -soft
-Cardiac disease -wet, hacking cough

14

3. LARYNX and PHARYNX

PHYSICAL EXAMINATION METHODS
-external and internal examination -inspection -palpation -auscultation 
FURTHER EXAMINATION -X-ray -endoscopy -CT, MR

15

3.1. external exam

inspection
-skin, deformity, swelling, symmetricity 
palpation
-form, outline, muscles, surface of larynx, abnormal masses -compressibility and press sensitivity of the arytenoids -temperature, painfulness -fremitus  auscultation
normally weak stridor under inspiration and expiration

16

3.2. internal exam

inspection
-epiglottis -nasopharynx -symmetry and synchronous movement of the arytenoids -rima glottidis -color, capillaries and deformation of mucous membranes

17

3.3. tonsils

•size, shape •semilunar fold •colour •surface •symmetricy

18

4. TRACHEA

PHYSICAL EXAMINATION METHODS
-external inspection -palpation -auscultation 
FURTHER EXAMINATION
-X-ray -endoscopy -CT, MR -tracheal fluid sampling -via endoscope or transtracheal aspiration -tracheal fluid analysis quality, cytological, bacteriologic, mycological, virologic and parasitological examination

19

5. THORAX

EXAMINATION METHODS
-inspection -palpation -auscultation -percussion

FURTHER EXAMINATIONS
-X-ray -ultrasonography -endoscopy
-bronchial fluid sample (BAL) -via endoscope or transtracheal wash
-bronchial fluid analysis (quality, cytological,bacteriological, mycological, virological, parasitological) -thoracocentesis, biopsy -CT, MR, scintigraphy -thoracotomy -lung function testing -blood count, acid-base analysis

20

5.1 Inspection

CHEST
-skin -size, shape -bilateral symmetry -local deformities
RESPIRATORY MOVEMENTS (RM) a) frequency b) rhythm c) type d) depth

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5.1 aFREQUENCY 30/min!!!!

Increase (polypnea or tachypnea)
-Normal: under movement, excitement, work, high temperature, obesity, pregnancy
-Abnormal: fever, hypoxia, hypercapnia, pain, in respiratory organs

Decrease (olygopnea or bradypnea)
Abnormal: CNS diseases, barbiturate toxicosis, shock, agony

22

5.1.b 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 disorder

23

5.1.c TYPE

Normal: costal-costoabdominal in dogs & cats 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

Abdominal respiration
-painy chest diseases and paralysis of intercostal muscles

24

5.1.c DEPTH

Normal: medium deep
Abnormal
*Shallow (superficial) respiration
-cases of severe dyspnea -painful diaphragm and chest diseases -respiratory center damage
*Deep respiration -after fast movement -at hypoxia -may the characteristic sign of dyspnea

25

5.1.c 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 1. Inspiratory dyspnea 2. Expiratory dyspnea 3. Mixed dyspnea

26

5.1.c-i INSPIRATORY DYSPNEA

Caused by
-narrowed upper airways (stridor) (laryngeal edema, laryngeal paralysis, stenotic nares, etc)
-pneumothorax
-pleural effusions
-diffuse pneumonia

Signs: prolonged and labored inspiration
Inspiratory phase is longer, extension of the head and neck, nostril dilatation, labial respiration, spreading of the scapulae, exaggerated intercostal activity, slack or sunken flanks and sagging belly

27

5.1.c-ii EXPIRATORY DYSPNEA

Caused by
-compression or obstruction of lower air passages
-micro-bronchitis -(pulmonary emphysema)
-fibrous pleuritis
-rarely; neoplasms in larynx and pharynx

Signs prolonged and labored expiration
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

28

5.1.c-iii MIXED DYSPNEA

Caused by
-decreased compliance
-pulmonary edema
-pulmonary emphysema
-neoplasma
-compressed diaphragm

Signs
Forced inspiration and expiration

29

5.1.c.iv Paradoxical breathing

-normal respiration:both the abdomen and chest move in and out together, allowing maximum expansion of the lungs. The diaphragm normally moves downwards during inspiration and upwards during expiration
-Paradoxical respiration: the diaphragm moves opposite to the normal directions of its movements..
-Chest movement is restricted, not able to expand properly 
-Abdominal wall move in the opposite direction to that expected 
-reason: pleural fluid, pneumothorax, diaphragma paralysis, broken ribs etc

30

5.2.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 vave insufficiency -Painfullness
-Deformities