Bronchitis physical examination: Difference between revisions

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==Overview==
==Overview==
 
[[Physical examination]] often reveals signs of airflow narrowing and irritation, which consists of the following: cough with or without [[sputum]], [[wheezing]], and prolonged expiratory phase. Abnormal breathing sounds, such as [[rhonchi]] and [[rales]], are common findings in bronchitis.
==Diagnosis==
==Physical Examination==
A [[physical examination]] will often reveal decreased intensity of breath sounds, wheeze (rhonchi) and prolonged [[Exhalation|expiration]].  Most doctors rely on the presence of a persistent dry or wet cough as evidence of bronchitis.
*Common physical examination findings of [[acute bronchitis]] are non specific and includes:<ref name="pmid21121518">{{cite journal |vauthors=Albert RH |title=Diagnosis and treatment of acute bronchitis |journal=Am Fam Physician |volume=82 |issue=11 |pages=1345–50 |year=2010 |pmid=21121518 |doi= |url=}}</ref><ref name="pmid17108344">{{cite journal |vauthors=Wenzel RP, Fowler AA |title=Clinical practice. Acute bronchitis |journal=N. Engl. J. Med. |volume=355 |issue=20 |pages=2125–30 |year=2006 |pmid=17108344 |doi=10.1056/NEJMcp061493 |url=}}</ref>
 
#[[Fever]]
 
#Prolonged expiration
The physical examination findings in acute bronchitis can be:  
#[[Wheezing]] due to [[bronchospasm]] and reduced [[FEV1]] has been shown in up to 40% of patients
 
#[[Rhonchi]]
===General physical examination===
#[[Rales]]
 
*Common physical examination findings of [[chronic bronchitis]] can be [[cyanosis]], [[tachypnea]], use of accessory respiratory muscles, paradoxical indrawing of lower intercostal spaces (known as the ''Hoover sign''), elevated jugular venous pulse, and peripheral [[edema]]. In pulmonary examination, [[barrel chest]] ([[emphysema]]), [[wheezing]], hyperresonance, [[rales]], and [[rhonchi]] may be found. ''Blue bloaters'', are plethoric (red face/cheeks due to a [[polycythemia]] secondary to chronic [[hypoxia]]) and cyanotic (due to decreased hemoglobin saturation) seen in advanced stages of disease.<ref name="pmid8430714">{{cite journal |vauthors=Badgett RG, Tanaka DJ, Hunt DK, Jelley MJ, Feinberg LE, Steiner JF, Petty TL |title=Can moderate chronic obstructive pulmonary disease be diagnosed by historical and physical findings alone? |journal=Am. J. Med. |volume=94 |issue=2 |pages=188–96 |year=1993 |pmid=8430714 |doi= |url=}}</ref>
* Clubbing on the digits
 
* Peripheral cyanosis
 
* Conjunctivitis
 
* Bullous myringitis
 
===Oropharyngeal examination===
 
* Pharyngeal erythema
 
* Rhinorrhea
 
* Lymphadenopathy
 
===Pulmonary system===
 
* Use of accessory muscles suggesting labored breathing.
 
* Rhonchi, and wheezes that change in location and intensity after a deep and productive cough.
 
* Presence of inspiratory stridor indicate obstruction of a major bronchi or the trachea.
 
===Cardiovascular examination===
 
* Sustained heave felt along the left sternal border, suggests right ventricular hypertrophy secondary to chronic bronchitis.
 
A variety of tests may be performed in patients presenting with cough and shortness of breath:
* A [[chest X-ray]] that reveals hyperinflation; collapse and consolidation of lung areas would support a diagnosis of [[pneumonia]]. Some conditions that predispose to bronchitis may be indicated by chest radiography.
* A sputum sample showing [[neutrophil granulocyte]]s (inflammatory white blood cells) and [[microbiological culture|culture]] showing that has pathogenic microorganisms such as [[Streptococcus|Streptococcus spp.]]
* A [[blood test]] would indicate inflammation (as indicated by a raised [[white blood cell]] count and elevated [[C-reactive protein]]).
*Neutrophils infiltrate the lung tissue, aided by damage to the airways caused by irritation.
*Damage caused by irritation of the airways leads to inflammation and leads to neutrophils being present
*Mucosal hypersecretion is promoted by a substance released by neutrophils
*Further obstruction to the airways is caused by more goblet cells in the small airways. This is typical of chronic bronchitis
*Although infection is not the reason or cause of chronic bronchitis it is seen to aid in sustaining the bronchitis.'''''


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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[[Category:Inflammations]]
[[Category:Pulmonology]]
[[Category:General practice]]

Latest revision as of 20:44, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]; Nate Michalak, B.A.

Bronchitis Main page

Patient Information

Overview

Causes

Classification

Acute bronchitis
Chronic bronchitis

Differential Diagnosis

Overview

Physical examination often reveals signs of airflow narrowing and irritation, which consists of the following: cough with or without sputum, wheezing, and prolonged expiratory phase. Abnormal breathing sounds, such as rhonchi and rales, are common findings in bronchitis.

Physical Examination

  1. Fever
  2. Prolonged expiration
  3. Wheezing due to bronchospasm and reduced FEV1 has been shown in up to 40% of patients
  4. Rhonchi
  5. Rales
  • Common physical examination findings of chronic bronchitis can be cyanosis, tachypnea, use of accessory respiratory muscles, paradoxical indrawing of lower intercostal spaces (known as the Hoover sign), elevated jugular venous pulse, and peripheral edema. In pulmonary examination, barrel chest (emphysema), wheezing, hyperresonance, rales, and rhonchi may be found. Blue bloaters, are plethoric (red face/cheeks due to a polycythemia secondary to chronic hypoxia) and cyanotic (due to decreased hemoglobin saturation) seen in advanced stages of disease.[3]

References

  1. ↑ Albert RH (2010). "Diagnosis and treatment of acute bronchitis". Am Fam Physician. 82 (11): 1345–50. PMID 21121518.
  2. ↑ Wenzel RP, Fowler AA (2006). "Clinical practice. Acute bronchitis". N. Engl. J. Med. 355 (20): 2125–30. doi:10.1056/NEJMcp061493. PMID 17108344.
  3. ↑ Badgett RG, Tanaka DJ, Hunt DK, Jelley MJ, Feinberg LE, Steiner JF, Petty TL (1993). "Can moderate chronic obstructive pulmonary disease be diagnosed by historical and physical findings alone?". Am. J. Med. 94 (2): 188–96. PMID 8430714.

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