(钩端螺旋体病)

RespiratorySymptomsZhaoLi,M.D.CommonsymptomsCoughExpectorationHemoptysisChestpainCyanosisDyspneaCough(aprotectivereflex):causesRespiratorydiseases___themostcommoncausesAirwayagentsBronchitis,bronchiectasis,asthma,endobronchialtuberculosis,tumor,pharyngitisLungagentsInfection,edema,fibrosis,tumorPleuralagentsPleurisy,pneumothorax,mesotheliomaofpleuraCough(aprotectivereflex):causesCardiovasculardiseasesCardiogenesisedema,pulmonaryembolismCentralnervoussystemagentsInitiativecough,encephalitis,meningitisCough:manifestationsCharacteristicsDrycough(non-sputum)Productivecough(sputum:infectious,edema)AttackTime(morning,midnight,earlymorning)Season(spring,summer,falland/orwinter)Motivation(fumeinhalation,exertion)ToneHoarsenessHighpitchWeakBrassyCough:accompanysignsFever(infection)Chestpain(infection,tumor,pleurisy,pneumothorax,pulmoembolism)DyspneaHemoptysis(bronchietasis,tuberculosis,tumor)Bulkpussputum(bronchietasis,lungabscess)Wheezing(asthma,foreignbody)Clubbingfingers(bronchietasis,lungcancer,chroniclungabscess)Sputum:amountBulkfrothysputumPulmoedemaBulkserofluidsputumAlveolarcellcarcinomaBulkpussputumBronchiectasisLungabscessLayeringupper:frothy,middle:mucoidormucopus,lower:necrosissubstanceSputum:consistencyMucoidsputumBronchitis(withoutbacterialinfection)AsthmaEarlystageofpneumoniaSerofluidsputumPulmoedemaPussputumAnybacterialinfectionBloodysputumSputum:colorWhitemucoidorserofluidsputumYellowgeneralbacterialinfectionGreenaeruginosusBacillusinfectionGreyorblackdustinhalationRustyLobarpneumoniaPinkcardiacedemaRedhemoptysisGreyorblackSputum:foulodoranaerobicbacteriuminfectionHemoptysisBleedingfromlowerrespiratorytractTheamountvariesfromblood-strainedsputumtoseveralhundredsmlpurebloodMild:100ml/dModerate:100-500/dSevere:500ml/d,or100-500ml/timeDifferentialdiagnosisBleedingfromupperrespiratorytractHematemesisDistinguishedhemoptysisfromhematemesisHemoptysisHematemesisCausesPulmoorcardiacdigestivesystemPrevioussymptomsCough,chesttightnessNausea,vomitingSpitupCoughupVomitedColorBrightredDarkredMixtureSputum,frothyGastriccontentspHalkalityacidityTarrystools-or++Post-bleedingSputumwithbloodNosputumHemoptysis:causesBronchialdisordersBronchiectasisBronchogeniccarcinomaendobronchialTBChronicbronchitisPulmoDisordersPulmoTBPeumoniaLungabscessPulmoembolismHemoptysis:causesCardiovasculardisordersAcuteleftheartfailureMitralstenosisOthersHematologicdisease,leptospirosis（钩端螺旋体病），epidemichemorrhagicfever，endometriosis（子宫内膜异位症）Hemoptysis:accompanysignsFeverInfectionorcarcinomaChestpainInfection，PulmoEmbolism，CarcinomaPussputumBronchiectasis，LungabscessClubbingfingersBronchiectasis，Lungabscess，CarcinomaHemorrhagicspotsHematologicdisease,leptospirosis,epidemichemorrhagicfeverChestpain:causesChestwallherpeszoster,ribfractureCardiovascularanginapectoris,myocardialinfarction,pericarditis,dissectinganeurysm（夹层动脉瘤）RespiratoryPleuraldisorders,pneumothorax,carcinomaMediastinalMediastinitis,mediastinalemphysema,mediastinaltumorOthersesophagealcarcinoma,liverabscess,subdiaphragmaticabscess,hiatalhernia（食道裂孔疝）Chestpain:characteristicslocationReferredpainfeatureBurningpain,pressingpain,burstingpain,prickingpainDurationInfluentialfactorsExertional,respiration,foodintake,administrationChestpain:accompanysignsCough,sputumand/orfeverRespiratorydiseaseDyspneaSeverepneumonia,pneumothorax,pleurisy,pulmoembolismHemoptysisCarcinoma,pulmoembolismShockmyocardialinfarction,dissectinganeurysm(rupture),largeareapulmoembolismDysphagia(吞咽困难)EsophagealdiseaseCyanosisAnexcessofdesaturatedhemoglobincausesabluecolorationoftheskinormucosae.methemoglobinemia(高铁血红蛋白血症）PoisoningbynitriteCyanosis:classificationCentral(warm)DeficientoxygenationRight-to-leftshuntPeripheral(cold)ReducedcardiacoutputLocalvasoconstrictionMixedHeartfailureCyanosis:accompanysignsDyspneaSeverecardiacorrespiratorydisorderClubbingfingersCongenitalheartdiseaseChronicrespiratorydiseaseUnconsciousnessPoisoning,shock,SeverecardiacorrespiratorydisorderDyspnea:causesRespiratorysystemObstruction:asthma,COPD,tumorPulmoDiseases:pneumonia,interstitiallungdisease,Chestwallorpleura:pleurisy,pneumothorax,traumaneuro-muscles:poliomyelitis(脊髓灰质炎),myastheniagravis(重症肌无力)Diaphragmamovementdisorder:obviouslyelevatedpressureinabdominalcavityDyspnea:causesCardiovascularsystemHeartfailurePulmoembolismPoisoningketoacidosisCentralnervoussystemcerebraltumor,trauma,abscess,hemorrhage,encephalitis,meningitishematologicalsystemSevereanemiaRespiratoryDyspneaInspiratorydyspnea____obstructioninlargeairwayThreedepressionsigndepressioninsuprasternalfossa,supraclavicularfossa,intercostalspaceExpiratorydyspnea____obstructioninsmallairwayoralveolarelasticitydecreasedProlongedexpiratorytimeExpiratoryrhonchiMixeddyspnea____deficientgasexchangeRespiratoryrateincreasedShallowbreathingCardiacdyspnea____HeartfailureMechanismofleftheartfailurePulmoedemadiffusioncap