Emphysema physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
Emphysema can result in hyperventilation and respiratory distress. A physical examination may reveal signs of "pink puffers" and distress in the lungs. | Emphysema can result in hyperventilation and respiratory distress. A physical examination may reveal signs of "pink puffers" and distress in the lungs. Emphysema is a disease of the [[lung]] tissue caused by destruction of structures feeding the [[alveoli]], in some cases owing to the consequences of [[alpha 1-antitrypsin deficiency]]. Smoking is one major cause of this destruction, which results in the collapse of small airways in the [[lungs]] during forced [[exhalation]]. As a result, airflow is impeded and air becomes trapped, just as in other obstructive lung diseases. Symptoms include shortness of breath ("[[dyspnea]]") on [[exercise|exertion]], and an [[expanded chest]]. People with this disease do not get enough [[oxygen]] and suffer a buildup of [[carbon dioxide]] in their [[blood]], which generates dyspnea. At first, when emphysema is mild, dyspnea occurs only during physical activity. Eventually, as the disease worsens, dyspnea will occur after even small amounts of physical exertion. Once the lungs are compromised badly enough, the victim may feel short of breath all the time - even when at rest, relaxing. Because breathing is more difficult, the person must use accessory muscles to help them breathe; the increased work of breathing, use of additional muscles, and blood gas abnormalities then combine to cause "[[tachypnea]]" (rapid breathing), which may continue in a "vicious cycle". Individuals with severe emphysema eventually may have trouble coughing and decreased amounts of [[sputum]]. They may also lose weight. The [[Anteroposterior#Anterior_and_posterior|anteroposterior]] diameter of their chest may increase; this sign is sometimes referred as "barrel chest." Patients may lean forward with arms extended and/or resting on something to help them breathe ("orthopenic breathing"). When lung [[auscultation]] and [[chest]] [[Percussion (medicine)|percussion]] is performed a hyperresonant sound is heard. The patient may also exhibit symptoms of [[hypoxia (medical)|hypoxia]]-induced [[cyanosis]], or the appearance of a blue-to-purplish discoloration of the skin, due to increased levels of [[Hemoglobin#Deoxyhemoglobin|deoxyhemoglobin]] in the blood. | ||
==Physical Examination== | ==Physical Examination== | ||
Revision as of 17:02, 2 March 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Emphysema can result in hyperventilation and respiratory distress. A physical examination may reveal signs of "pink puffers" and distress in the lungs. Emphysema is a disease of the lung tissue caused by destruction of structures feeding the alveoli, in some cases owing to the consequences of alpha 1-antitrypsin deficiency. Smoking is one major cause of this destruction, which results in the collapse of small airways in the lungs during forced exhalation. As a result, airflow is impeded and air becomes trapped, just as in other obstructive lung diseases. Symptoms include shortness of breath ("dyspnea") on exertion, and an expanded chest. People with this disease do not get enough oxygen and suffer a buildup of carbon dioxide in their blood, which generates dyspnea. At first, when emphysema is mild, dyspnea occurs only during physical activity. Eventually, as the disease worsens, dyspnea will occur after even small amounts of physical exertion. Once the lungs are compromised badly enough, the victim may feel short of breath all the time - even when at rest, relaxing. Because breathing is more difficult, the person must use accessory muscles to help them breathe; the increased work of breathing, use of additional muscles, and blood gas abnormalities then combine to cause "tachypnea" (rapid breathing), which may continue in a "vicious cycle". Individuals with severe emphysema eventually may have trouble coughing and decreased amounts of sputum. They may also lose weight. The anteroposterior diameter of their chest may increase; this sign is sometimes referred as "barrel chest." Patients may lean forward with arms extended and/or resting on something to help them breathe ("orthopenic breathing"). When lung auscultation and chest percussion is performed a hyperresonant sound is heard. The patient may also exhibit symptoms of hypoxia-induced cyanosis, or the appearance of a blue-to-purplish discoloration of the skin, due to increased levels of deoxyhemoglobin in the blood.
Physical Examination
Ear, nose and throat
Examination of the face reveals a plethoric complexion (if there is a secondary polycythemia), pursed-lipped breathing, and central cyanosis.
Lungs
Examination of the chest reveals increased percussion notes (particularly over the liver) and a difficult to palpate apex beat (all due to hyperinflation), decreased breath sounds, audible expiratory wheeze. Classically,clinical examination of an emphysematic patient reveals no overt crackles, however, in some patients the fine opening of airway 'popping' (dissimilar to the fine crackles of pulmonary fibrosis or coarse crackles of mucinous or oedematous fluid) can be auscultated. This is known as "Barclay's sign".
Extremities
Clinical signs on at the fingers include cigarette stains (although actually tar) and asterixis (metabolic flap) at the wrist if they are carbon dioxide retainers (NOTE: Finger clubbing is NOT a general feature of emphysema). Fluid overload can be seen in advanced disease, with pitting peripheral edema.
Signs
Emphysema patients are sometimes referred to as "pink puffers". This is because emphysema sufferers may hyperventilate to maintain adequate blood oxygen levels. Hyperventilation explains why mild emphysema patients do not appear cyanotic as chronic bronchitis (another COPD disorder) sufferers often do; hence they are "pink puffers" (able to maintain almost normal blood gases through hyperventilation) and not "blue bloaters" (cyanosis; inadequate oxygen in the blood). However, any severely chronically obstructed (COPD) respiratory disease will result in hypoxia (decreased blood partial pressure of oxygen) and hypercapnia (increased blood partial pressure of Carbon Dioxide); so called Blue Bloaters. Blue Bloaters are so named as they have almost normal ventilatory drive (due to decreased sensitivity to carbon dioxide secondary to chronic hypercapnia), are plethoric (red face/cheeks due to a polycythemia secondary to chronic hypoxia) and cyanotic (due to decreased hemoglobin saturation).