Chronic obstructive pulmonary disease physical examination: Difference between revisions
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!Specific Features of Emphysema | !Specific Features of Emphysema | ||
!Specific Features of Chronic Bronchitis | !Specific Features of Chronic Bronchitis | ||
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!Appearance of the Patient | |||
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* General appearance: Pursed lips, adopting a tripod position, using accessory muscles. | * General appearance: Pursed lips, adopting a tripod position, using accessory muscles. | ||
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* Pink puffers | * Pink puffers | ||
**This is because emphysema sufferers may hyperventilate to maintain adequate blood oxygen levels. Hyperventilation explains why mild emphysema patients do not appear [[Cyanosis|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) | **This is because emphysema sufferers may hyperventilate to maintain adequate blood oxygen levels. Hyperventilation explains why mild emphysema patients do not appear [[Cyanosis|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) | ||
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* Blue bloaters they 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). | * Blue bloaters they 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). | ||
* Signs of [[right heart failure]] or [[cor pulmonale]] such as [[edema]] and [[cyanosis]] can be seen. | * Signs of [[right heart failure]] or [[cor pulmonale]] such as [[edema]] and [[cyanosis]] can be seen. | ||
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!Lungs | |||
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====Inspection==== | ====Inspection==== | ||
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*Coarse [[crackles]] with inspiration | *Coarse [[crackles]] with inspiration | ||
*Coarse [[rhonchi]] | *Coarse [[rhonchi]] | ||
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!HEENT | |||
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* Elevated [[jugular venous pulse]] (JVP) | * Elevated [[jugular venous pulse]] (JVP) | ||
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* Elevated [[jugular venous pulse]] (JVP) | * Elevated [[jugular venous pulse]] (JVP) | ||
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!Heart | |||
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*Signs of right heart failure | *Signs of right heart failure | ||
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* Muffled heart sounds | * Muffled heart sounds | ||
**Due to overdistention of lungs | **Due to overdistention of lungs | ||
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!Extremity | |||
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* Peripheral edema can be observed | * Peripheral edema can be observed | ||
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* [[Peripheral edema]] | * [[Peripheral edema]] | ||
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Revision as of 17:46, 13 November 2017
Chronic obstructive pulmonary disease Microchapters |
Differentiating Chronic obstructive pulmonary disease from other Diseases |
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Risk calculators and risk factors for Chronic obstructive pulmonary disease physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Philip Marcus, M.D., M.P.H. [2]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [3]
Overview
Chronic obstructive pulmonary disease can be diagnostically evaluated by physical examination through auscultation. Physical examination are quite specific and sensitive for severe disease. The signs are usually difficult to detect in cases of mild to moderate diseases. Findings on general physical examination can be cyanosis, tachypnea, use of accessory respiratory muscles, paradoxical indrawing of lower intercostal spaces is evident (known as the Hoover sign), elevated jugular venous pulse and peripheral edema. Pulmonary examination in can be barrel chest (emphysema), wheezing, hyperresonance, crackles and rhonchi
Physical Examination
Physical examinations are quite specific and sensitive for severe disease. The signs are usually difficult to detect in cases of mild to moderate diseases.
Appearance of the Patient
- Cyanosis
- Tachypnea
- Respiratory distress indicated by use of accessory respiratory muscles. Hoover sign presenting as paradoxical indrawing of lower intercostal spaces is evident (known as the Hoover sign)
- Elevated jugular venous pulse (JVP)
- Peripheral edema can be observed.
Lungs
Inspection
- Hyperinflation (barrel chest)
Percussion
- Hyperresonance
Auscultation
- Prolonged expiration; wheezing
- Diffusely decreased breath sound
- Additional sounds - coarse crackles with inspiration
Specific Features of Chronic Bronchitis
Appearance of the Patient
- Blue bloaters they 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).
- Signs of right heart failure or cor pulmonale such as edema and cyanosis can be seen.
Lungs
Ausculatation
- Coarse rhonchi on auscultation
Appearance of the Patient
- General appearance: Pursed lips, adopting a tripod position, using accessory muscles.
- Thin patient with barrel chest
- Barrel chest may cause distant heart sound
- Pink puffers
Specific Features of Emphysema | Specific Features of Chronic Bronchitis | |
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Appearance of the Patient |
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Lungs |
Inspection
Percussion
Auscultation
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Inspection
Auscultation |
HEENT |
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Heart |
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Extremity |
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