Bone crepitus (page ossea) K. when feeling the area of \u200b\u200bthe fracture in early dates after trauma due to mutual friction of bone fragments.

Large Medical Dictionary. 2000 .

See what "bone crepitation" is in other dictionaries:

ICD 9 719.60719.60, 756.0756.0 Crepitation is a characteristic crunchy sound of importance in medical diagnosis. The term "crepitus" in medicine describes several different sounds ... Wikipedia

I Crepitation (crepitatio; lat. Crepitare, creak, crunch) crackling or crunching, detected by auscultation or palpation. Distinguish between alveolar, subcutaneous and bone crepitus. Alveolar crepitus is determined by ... ... Medical encyclopedia

CREPITUS - (from Lat. crepito - creak, crackle), sound or sensation of creak or crackling in some diseases, perceived by palpation or auscultation. Distinguish K. bone, fibrinous, gas and air. Bone K. is observed with fractures ... ... Veterinary encyclopedic dictionary

FRACTURES - FRACTURES, any complete violation of the integrity of a solid object (Wegner), in this case a bone. P., being the result of the most severe injuries, constitute one of the most serious chapters of traumatology. According to Bruns' statistics (London Hospital 300,000 ... ...

BONE - BONE. Contents: I. HISTOLOGY AND EMBRIOLOGY .......... 130 II. Bone pathology ............... w III. Clinic of bone diseases ......... 153 IV. Operations on bones .............. Jub I. Histology and embryology. The composition of K. of higher vertebrates includes ... ... Big medical encyclopedia

Bone fracture Appearance and corresponding X-ray image of the fracture ICD 10 T14.2 ICD 9 ... Wikipedia

The appearance and the corresponding X-ray image of the fracture ... Wikipedia

I Shoulder joint (articulatio humeri) is a spherical joint formed by the head of the humerus and the glenoid cavity of the scapula. The articular surface of the scapula is surrounded by a ring of fibrous cartilage called the articular lip. Through the joint cavity ... ... Medical encyclopedia

I Shoulder (brachium) is the proximal segment of the upper limb. Its upper boundary is a circular line drawn at the level of the lower edges of the large pectoral muscle and the broadest muscle of the back, the lower one runs along a circular line 5 6 cm higher ... ... Medical encyclopedia

I Spine The spine (columna vertebralis; synonym for the vertebral column). It is an axial skeleton, consists of 32 33 vertebrae (7 cervical, 12 thoracic, 5 lumbar, 5 sacral, connected to the sacrum, and 3 4 coccygeal), between which ... ... Medical encyclopedia

Sep 3 2013

Auscultation of the lungs: additional breathing sounds (crepitus, wheezing, pleural friction noise)

MINISTRY OF HEALTH OF UKRAINE

National Medical University named after A.A. Bohomolets

“Approved "

at the methodological meeting of the department

propedeutics of Internal Medicine No. 1

Head of the Department

Professor V.Z. Netyazhenko

________________________

(signature)

Minutes No. ________

“______” _____________ in 2011

INSTRUCTIONS

FOR INDEPENDENT WORK OF STUDENTS

IN PREPARATION FOR A PRACTICAL LESSON

Academic discipline	Propedeutics of Internal Medicine
Module No. 1	The main methods of examination of patients in the clinic of internal diseases
Substantive module number 2	Physical and instrumental methods for studying the state of the broncho-pulmonary system
Lesson topic	Auscultation of the lungs: additional breathing sounds (crepitus, wheezing, pleural friction noise)
Course	3 course
Faculty	ІІ, ІІІ medical, FPVVSU

Lesson duration - 3 academic hours

1. Relevance of the topic

Throughout the world, the pathology of the respiratory system occupies an important place among the causes of loss of working capacity and mortality, at the same time, there is a persistent trend towards an increase in morbidity. Therefore, the study of the fundamentals of objective examination of patients, in particular the auscultatory differentiation of side respiratory noises, will make it possible to achieve the required professional level in the diagnosis of diseases of the bronchopulmonary system.

2. Ultimate goals:

- Methodically correct lung auscultation

- Determine the main and additional breathing sounds

- Classify additional breathing sounds by the place of formation and the nature of the sound

- Explain the mechanism of formation and auscultatory signs of dry and wet wheezing

- Interpret the auscultatory signs of crepitus and the conditions for its occurrence

- Explain the mechanism of formation and auscultatory signs of pleural friction noise;

- Demonstrate knowledge of the mechanisms of formation of additional auscultatory phenomena: pleuropericardial noise, Hippocratic splash noise, falling drop noise.

- To detect auscultatory signs of pleuropericardial murmur, Hippocratic splash noise, falling drop noise

- Differentiate side respiratory sounds in patients with pathology respiratory system

- Make a conclusion about the state of the respiratory system based on a physical examination chest

3. Basic knowledge, abilities, skills necessary to study the topic

(interdisciplinary integration)

Names of previous disciplines	Skills acquired
human anatomy	- Explain the anatomical structure of the lungs, pleura - Describe the projection of the lung lobes onto the chest wall - Determine topographic landmarks on the surface of the chest
Physiology	- Describe the arch of the cough reflex - Explain the mechanisms of respiration regulation, influence on the respiratory center - Represent the circulation of interpleural fluid, analyze the conditions of its synthesis and filtration
Histology, cytology and embryology	- Describe the structure of the mucous membrane of the respiratory tract and pleura - Explain the structural features of the trachea and bronchi of different caliber
Biochemistry	- Describe the composition of the surfactant, explain its physiological role in ensuring the normal functioning of the lungs - Describe the composition of the pleural fluid, its quantity and characteristics are normal.
Latin language and medical terminology	Apply Latin medical terminology when designating the main complaints of patients with respiratory pathology, topographic landmarks on the chest
Deontology in medicine	Demonstrate possession of the moral and deontological principles of a medical specialist and the ability to apply them in communication and physical examination of a patient with respiratory pathology

1. 4. Assignment for independent work during preparation for the lesson:

4.1 List of basic terms to be learned by a student

in preparation for the lesson:

№	Term	Definition
	Wheezing	- additional breathing sounds that arise in the bronchi when they narrow or have pathological content
	Crepitus	- additional breathing noise that occurs in the alveoli in case of impaired surfactant function or accumulation of a small amount of liquid pathological contents
	Pleural friction noise	- additional respiratory noise that occurs when the pleural leaves are damaged and resembles crunching of snow during auscultation
	Hippocrates splash noise	- an additional auscultatory phenomenon that occurs when the patient is shaking, provided that liquid and gas are simultaneously present in the pleural cavity
	Falling drop noise	- an additional auscultatory phenomenon that occurs when the patient's body position changes over the cavity in the lungs, which contains both liquid and gas
	Water pipe noise	- an additional auscultatory phenomenon that occurs above the cavity in the lungs, partially filled with fluid, provided it connects with the bronchus, which flows into the cavity below the fluid level
	Bronchophonia	- the method of physical examination of the patient, based on auscultatory determination of conducting whisper speech on the chest wall

4.2. Theoretical questions for the lesson:

1. What are additional breath sounds?
2. What additional breathing sounds do you know?
3. What is wheezing when it occurs?
4. How is wheezing classified?
5. What dry wheezes are there? What is the mechanism of dry wheezing?
6. What kinds of wet wheezing are there? What are the mechanisms of their occurrence?
7. What is the diagnostic value of dry and wet wheezing?
8. What is crepitus, supportive wheezing?
9. Under what pathological conditions is crepitus heard?
10. What are the auscultatory features of pleural friction murmur?
11. How can crepitus be distinguished from pleural friction rub?
12. What are the differences between dry wheezing and pleural rub?
13. What is bronchophonia and what is its diagnostic value?

4.3. Practical work that is performed in the lesson

1. Conducting questioning and examination of a patient with broncho-pulmonary pathology, highlighting the main symptoms of the disease.
2. Conducting percussion of the chest of a representative patient, analysis and interpretation of the data obtained, highlighting the main symptoms.
3. Auscultation of the main respiratory sounds, determination of their qualitative and quantitative changes.
4. Auscultation of additional respiratory sounds, performing techniques regarding their differentiation, analysis and generalization of the data obtained.

Side (additional) breathing sounds- these are wheezing, crepitus, pleural friction noise, pleuropericardial murmur, Hippocratic splash noise, the noise of a falling drop.

Wheezingarise in the trachea, bronchi and cavities. They are divided into dry and wet, and are heard in both phases of breathing. Dry wheezing. The cause of dry wheezing is narrowing of the lumen of the bronchi as a result of inflammatory edema of the mucous membrane or total spasm of the smooth muscles of the small bronchi (an attack of bronchial asthma), as well as the accumulation of viscous secretion in the bronchi, which can also narrow their lumen. All this leads to the fact that during breathing, air passes with a noise. Depending on where dry rales are formed, they are divided into sibilant, treble, high and bass, low, humming, humming. Whistling rales are formed in the case of narrowing of the small bronchi, bass - in the case of fluctuations of viscous sputum in the large bronchi. According to the English pulmonologist A. Forgach (1980), the occurrence of dry wheezing is based on the collapse of the walls of small bronchi as a result of increased intrathoracic pressure during exhalation (expiratory collapse of the bronchi); during the passage of air at different speeds through the formed slots, sounds like whistling and buzzing are generated. The height and timbre of dry wheezing depend not so much on the caliber of the bronchi as on the speed of the air stream. Dry rales can be heard over the entire surface of the lungs (bronchitis, bronchial asthma) or in a limited area, which is of more important diagnostic value (tuberculosis, tumors, scars, etc.). Sometimes dry wheezing can be heard at a distance or can be felt with the palm of your hand on your chest.

Wet rales are formed in the trachea, bronchi and lung cavities in the presence of liquid secretions (exudate, transudate, blood) in them. The passage of air through the liquid leads to the formation of bubbles, which float to the surface and burst. Moist wheezing is also called blistering.

Depending on the caliber of the bronchus, in which moist rales occur, there are fine bubbly (formed in small bronchi and bronchioles), medium bubbly (in the bronchi of medium size) and large-bubble(in large bronchi, cavities and large bronchiectasis) wheezing. Listening to large bubbling rales in the upper parts of the lungs, where there are no large bronchi, may indicate the presence of a cavity in the lungs (tuberculous cavity). Means of wheezing is usually heard if bronchitis develops. The presence of fine bubbling rales in a limited area may indicate a transition inflammatory process from the bronchioles to the alveoli (focal pneumonia).

Depending on the nature of the changes in the lungs, moist rales can be divided by sound quality into loud, sonorous (consonant) and dissonant (non-consonant). Voiced moist rales occur in the bronchi or cavities that are surrounded by compacted lung tissue, especially in smooth-walled cavities as a result of resonance in them. While listening to the sonorous rales, it seems as if they are formed close to the ear.

The appearance of ringing rales in the lower parts of the lungs may indicate inflammation of the lung tissue that surrounds the bronchi, and in the upper ones - the presence of a tuberculous infiltrate or cavity. In some cases, over large cavities against the background of amphoric breathing, voiced rales may have a metallic hue.

Unvoiced rales are heard in case of bronchitis, acute edema lungs (an unconsolidated lung drowns out the bursting of bubbles in the bronchi). After coughing, they can change (increase, decrease).

According to A. Forgach, the occurrence of moist rales is also due to the mechanisms of expiratory collapse: during exhalation, the walls of the bronchi close, and during inhalation they open, which is accompanied by the appearance of short sounds - "chips", which have a traditional name - wet rales. Based on the concept of A. Forgach, the American Association for Breast Diseases classifies all wheezing into "whistle" and "crackle" (rough, tender), which, in turn, are divided into inspiratory and expiratory.

Sometimes a sound is produced that resembles that of a falling drop. Such a phenomenon is heard over the cavity or pleural cavity, which contains fluid (usually pus), in case of a change in position, lying on a sitting position, when drops of liquid fall down and knock on the surface of purulent exudate.

Crepitus resembles a special crack, which occurs as a result of the separation of the glued walls of the alveoli during their filling with air at the moment of inhalation. Therefore, unlike wheezing, crepitus can be heard only at the height of inspiration. Crepitus is similar to the sound that occurs when a clump of hair is rubbed against the ear with the fingers. Basically, crepitation is observed in the presence of inflammation of the lung tissue, which is noted during the development of group pneumonia in the initial stage (crepitatio indux) and in the final, that is, the stage of resolution (crepitatio redux), as well as in the case of pulmonary infarction, compression atelectasis. If more secretions appear in the alveoli, crepitus may disappear.

Sometimes crepitus can be short-lived. For example, in people of advanced age, weakened after being in a lying position, during the first breaths (then disappears).

In patients with severe heart disease, so-called congestive crepitus can be heard on both sides of the lower lungs, and it is sometimes difficult to distinguish crepitus from small bubbling rales. It must be remembered that wheezing is heard on inhalation and exhalation, they are varied, change after coughing (sometimes they can disappear); crepitus is audible only at the height of inspiration, it is monotonous, constant (in case of inflammation), does not change after a cough.

Pleural rubbing noise. In healthy people, the sliding of the visceral layer of the pleura along the inner surface of the parietal layer occurs without any noise. Pleural friction noise occurs in the case of pleural inflammation (dry pleurisy), when it becomes covered with fibrin and its surface becomes uneven, rough, during the formation of infiltration cells, adhesions, cords, rashes, and also in case of excessive dryness of the pleura during dehydration , uremia). It resembles the crunch of snow or the sound that is generated when rubbing the back of the hand with a finger near the ear. The pleural friction noise is intermittent and is heard in both phases of breathing; best defined in places of significant excursion of the pulmonary edges (along the middle, posterior axillary and scapular lines). Depending on the nature of the pleural changes, the rubbing noise of the pleura can be tender or rough (sometimes it can be felt with the hand during palpation of the chest).

Pleural rubbing noise may resemble crepitus or wet wheezing. The following signs help to establish the nature of the noise:

1) after coughing, wheezing changes its character or disappears completely for a while, the pleural friction noise does not change

2) during pressing with a stethoscope on the chest, the pleural friction noise increases, wheezing does not change;

3) crepitus is heard only at the height of inspiration, the noise of pleural friction is heard both during inhalation and during exhalation;

4) if you close your mouth and pinch your nose, then during the retraction and protrusion of the abdomen, you can only hear the noise of friction of the pleura (as a result of the movements of the diaphragm, the pleural sheets begin to slide).

It must be remembered that the pleural friction noise is often accompanied by pain during breathing. In the case of significant pain, the patient can spare breathing, the pleural friction noise can weaken, disappear or acquire an intermittent nature (resembling saccadic breathing).

During the lesion of the pleura, which covers the mediastinum or lies close to the heart, the so-called pleuropericardial murmur. It can be heard not only during breathing, but also synchronously with the work of the heart (during systole and diastole).

Often the pleural friction noise disappears not only after recovery, but also if fluid or air appears in the pleural cavity. After the disappearance of fluid or air, the noise of pleural friction may occur again. In some cases, it can be noted for a long time.

Sometimes in patients with the simultaneous appearance of fluid and air in the pleural cavity (hydropneumothorax), you can hear the so-called splash noise in the chest ("The noise of the splash of Hippocrates"), first described by Hippocrates. To do this, you need to put your ear to the chest over the site of the hydropneumothorax and shake the patient. Sometimes the splashing noise can be felt by the patient himself (during a sharp change in body position).

The sound of a falling dropis also a symptom of hydro- or pyopneumothorax. This phenomenon is explained by the fall of a drop of liquid in the case of the patient's transition from a lying position to a sitting position.

Self-test materials:

A. Tasks for self-control.

1) Give a short answer to the following questions:

1. The mechanism of formation and auscultatory signs of wheezing.

2. Classification of wheezing.

3. The mechanism of formation and auscultatory signs of crepitus, its types.

4. The mechanism of formation and auscultatory signs of pleural friction noise .

5. The mechanism of formation and auscultatory signs of a falling drop noise, Hippocratic splash noise, pleuropericardial noise.

6. Differential diagnosis between wheezing, crepitus, pleural friction noise.

2) Determine the correct sequence of occurrence of side respiratory sounds in patients with group pneumonia:

crepitatio redux - crepitatio indux - bronchial breathing

Correct answer:2–3–1.

3) Select concepts that are logically related to each other:

Adverse respiratory noise Place of formation

1. Wheezing a) in the bronchi

2. Crepitation b) in the pleura, between its leaves

3. Noise of friction of the pleura c) in the pleura with hydropneumothorax

4.Gram splash noise) in cavities

5.Noise of a falling drop e) in the alveoli

Correct answer:1-a, d; 2-d; 3-6; 4-in; 5-c.

4) Fill in the table:

Wet wheezing classification:

Correct answer:1 -, 2 - sonorous, 3 - dissonant, 4 - by the caliber of the bronchi, 5 - large-bubble, 6 - medium-bubble, 7 - small-bubble

5) Extend phrases:

- "The noise of the splash of Hippocrates is formed when ... ...."

Correct answer: hydropneumothorax

- "Consonant wet rales are formed in the bronchi and cavities, which ... ...."

Correct answer: surrounded by hardened lung tissue, especially in smooth

- "The sound of a falling drop" is a symptom of ……. "

Correct answer: hydropneumothorax

- "Pleuropericardial murmur is formed in the case of ……."

Correctanswer: lesions of the pleura, which covers the mediastinum or lies close to the heart

B. Test tasks

1) Name the diseases in which crepitus can be heard auscultatory:

1.acute bronchitis

2.chronic bronchitis

3.dry pleurisy

4.focal pneumonia

5.cruppous pneumonia at the height of

8.congestive heart failure

9.compression atelectasis

Correct answer:6, 7, 8, 9

2) Name the diseases in which wheezing can be heard auscultatory:

1.acute bronchitis

2.chronic bronchitis

3.dry pleurisy

4.vagnischeva pneumonia

5.bronchiectasis

6.cruppous pneumonia in resolution

7.cruppous pneumonia at the initial stage

8.exudative pleurisy

9.cruppous pneumonia at the height of

Correct answer:1, 2, 4, 5, 9.

3) Name the diseases in which the pleural friction noise can be auscultated:

1.chronic bronchitis

2.dry pleurisy

3.focal pneumonia

4.bronchiectasis

7.cruppous pneumonia in the initial stage

8.tuberculous seeding of the pleura

Correct answer: 2, 5, 6.

4) When there are sonorous (consonant) wet wheezing:

1. When bronchitis is combined with compaction of lung tissue around the inflamed bronchus (bronchopneumonia).

2. With emphysema of the lungs.

3. With the accumulation of exudate in the pleural cavity.

4. With the accumulation of transudate in the pleural cavity.

Correct answer: 1.

5) What lies at the heart of crepitus:

1. Stenosis of the lumen of the bronchi.

2. The presence of a cavity that contains liquid and air.

3. Disintegration of alveoli on inspiration, on the walls of which fibrin is deposited.

4. The presence of pus-filled bronchiectasis.

5. Friction of the inflamed pleura.

Correct answer: 3.

6) When moist fine bubbling rales occur:

1. In the presence of liquid exudate in the small bronchi.

2. In the presence of viscous thick exudate in the small bronchi.

3. In the presence of large cavities with a liquid content.

4. With lung abscess.

5. With an attack of bronchial asthma.

Correct answer: 1.

7) How does crepitation differ from fine bubbling rales:

1. Auscultation is no different.

2. Listening better on exhalation

3. Unlike wheezing, it is heard in both phases of respiration.

4. Disappears after coughing.

5. It is heard only on inhalation, does not disappear after coughing.

Correct answer: 5.

8) Above the cavity, which has been emptied, the following breathing can be heard:

1. Rigid vesicular breathing.

2. Weakened breathing in combination with crepitus.

3. Amphoric breathing.

4. Dry humming rales.

5. Wet fine bubbling rales.

6. Breathing returns to the unchanged vesicular.

Correct answer: 3.

9) Where crepitation occurs:

1. In small bronchi.

2. In the large bronchi.

3. In the cavity of the cavity.

4. In the pleural cavity.

5. In the alveoli.

Correct answer: 5.

10) Which of the diseases causes affrictus pleuricus:

1. Pneumonia.

2. Dry pleurisy.

3. Bronchial asthma.

4. Emphysema of the lungs.

5. Exudative pleurisy.

Correct answer: 2.

11) What additional breathing noise is heard during bronchial narrowing:

1. Dry wheezing.

2. The noise of a falling drop.

3. Pleural friction noise.

4. Wet wheezing.

5. Crepitation.

Correct answer: 1.

12) Which of the phenomena known to you can indirectly indicate the presence of compaction of lung tissue:

1. Dry wheezing rales.

2. Dry humming rales.

3. Fine bubbling, moist, unsonic wheezing.

4. Fine bubbling, moist sonorous wheezing.

5. Rigid vesicular breathing.

Correct answer: 4.

13) The mechanism underlying the occurrence of wet wheezing is:

1. Stenosis of the bronchi.

2. Appearance of viscous thick secretion in the bronchi.

3. Appearance of liquid secretion in the bronchi, blood.

4. The appearance of uneven relief of the bronchi.

5. The appearance of infiltrative processes in the bronchi.

Correct answer: 3.

14) Strengthening of bronchophonia can be observed when:

1. Accumulation of fluid in the pleural cavity.

2. Formation of a cavity connected to the bronchus.

3. Accumulation of gas in the pleural cavity.

4. Increasing the airiness of the lungs.

5. Respiratory failure.

Correct answer: 2.

15) Pleural friction noise, in contrast to crepitus:

1. Disappears after coughing.

2. Heard only at inspiratory height.

3. Strengthens when speaking.

4. Heard in both phases of breathing.

5. Does not increase when pressed with a phonendoscope.

Correct answer: 4.

B. Situational tasks.

1) Patient I., 56 years old, complains of chest pain on the left. When auscultation of the lungs on the anterior chest wall in the lower left sections, we listen to a noise that resembles crunching snow, ”occurs both on inhalation and exhalation, associated with cardiac activity, does not change when coughing.

What is the type of additional breathing noise?

Correct answer: Pleuropericardial murmur

2) Patient B., 43 years old, is being treated for ischemic disease heart, which is accompanied by heart failure, for 15 years. When auscultation of the lungs at the height of inspiration, we listen to a gentle noise, which resembles rubbing a clump of hair with fingers near the ear, does not change when coughing.

Indicate what side respiratory murmur is heard in the indicated patient?

Correct answer:Crepitus.

3) During auscultation of patient V., 45 years old, scattered dry wheezing and buzzing are heard, which change the character and localization after coughing and moist fine-bubble consonant wheezing on the right below the angle of the scapula. The local doctor assessed the auscultatory data as a sign of chronic obstructive pulmonary disease and prescribed treatment.

Do you agree with the doctor's conclusions? Justify your answer.

Correct answer: No, because moist fine bubbling rales on the right below the angle of the scapula may indicate focal pneumonia.

4) During auscultation of the lungs of patient A., 43 years old, moist large-bubble loud rales are heard over the apex of the right lung.

List the diseases for which the indicated auscultatory picture is characteristic and justify the most reliable diagnosis.

Correct answer: Wet large-bubble loud rales indicate the presence of a cavity in the lungs, which is characteristic of a lung abscess after a breakthrough in the bronchus, tuberculous cavity, bronchiectasis, and localization in the upper lobe of the right lung, most reliably, is a sign of a tuberculous process, namely a tuberculous cavity.

5) Patient L., 91 years old, is hospitalized in the gastroenterology department for peptic ulcer disease 12-p. At the same time, during auscultation of the lungs, we hear a noise similar to rubbing a clump of hair with fingers near the ear, at the height of inhalation.

Comment on the auscultatory picture in the indicated patient.

Correct answer: crepitus in the elderly.

1. Propedeutics of internal ailments / under the editorship of prof. Yu. I. Decica. - Ki] in: Zdorov'ya, 1998.-P.94-97.

2. Propedeutics of internal diseases / under. ed. V.Kh. Vasilenko et al. - M.: Medicine, 1989. -C.106-110.

3. Shklyar B.S. Diagnostics of internal diseases. - К .: Higher school, 1972. - С.63-83.

4. Shelagurov A.A. Research methods in the clinic of internal diseases. -M.: Medicine, 1964.-S.90-95.

5. Etc. Nikula, S.G. Shevchuk, V.O. Moiseenko, V.A. Khomazyuk. Propedeutics of Internal Diseases, Kiev, 1996. - C.88-92.

Materials for methodological support of self-training of students:

An indicative map for organizing independent work of students with educational literature:

Study assignments	Task instructions
Learn: 1. The mechanism of formation and auscultatory signs of dry wet rales.	Indicate the main mechanisms of wheezing. Make a wheezing classification. List the main differential signs of wheezing. Name the main diseases that are accompanied by wheezing.
2. The mechanism of formation and auscultatory signs of crepitus	Indicate the main mechanisms of crepitus. Make a classification of crepitus. List the main differential signs of crepitus. Name the main diseases that are accompanied by crepitus.
3. The mechanism of formation and auscultatory signs of pleural friction noise	List the main differential signs of pleural friction noise. Name the main diseases that are accompanied by pleural friction noise.
4. The mechanism of formation and auscultatory signs of pleuropericardial murmur, Hippocratic splash murmur, noise of a falling drop.	List the main signs of pleuropericardial murmur, Hippocratic splash noise, falling drop noise. Name the main diseases that are accompanied by pleuropericardial murmur, Hippocratic splash noise, and falling drop noise.

Crepitus I Crepitation (crepitatio; lat. crepitare to creak, crunch)

crackling or crunching, detected by auscultation or palpation. Distinguish between alveolar, subcutaneous and bone crepitus.

Bone crepitus is a crunch that occurs by mutual friction of contacting bone fragments; comes to light, as in subcutaneous K., by palpation and auscultation. It is a specific symptom of a fracture, it is used to diagnose fractures during the examination of the victim on the spot (before X-ray examination). With complex injuries (for example, a combination of rib fracture with rupture of lung tissue), the simultaneous appearance of bone and subcutaneous crepitus is possible.

II Crepitation (crepitatio; lat. crepito creak, crunch)

a crunching or crackling sensation that occurs on palpation or auscultation.

Gas crepitation (page gasea; K. subcutaneous) - K. when palpating soft tissues or when pressing on them with the head of the phonendoscope, observed with subcutaneous emphysema.

Bone crepitation (page ossea) - K. when feeling the area of \u200b\u200bthe fracture in the early stages after, due to mutual friction of bone fragments.

Subcutaneous crepitation (c. subcutanea) - see Gas crepitation.

Crepitation of the pad (p. umbilici) - K. under the skin in the navel with perforation of the stomach or intestines in a patient with an umbilical hernia.

Tendon crepitus (S. tendinea) - K. in the area of \u200b\u200bthe synovial sheaths of the tendons, arising from movement; fibrinous tendovaginitis.

1. Small Medical Encyclopedia. - M .: Medical encyclopedia. 1991-96 2. First aid. - M .: Great Russian Encyclopedia. 1994 3. Encyclopedic Dictionary of Medical Terms. - M .: Soviet encyclopedia. - 1982-1984.

Synonyms:

See what "Crepitation" is in other dictionaries:

- (lat., from crepitare). 1) a special kind of crackling produced by the broken ends of the bone, when feeling them. 2) a special crunching sound heard on auscultation of the lungs, proving that there is fluid in the lung cells. 3) special rattling ... Dictionary of foreign words of the Russian language

ICD 9 719.60719.60, 756.0756.0 Crepitation is a characteristic crunchy sound of importance in medical diagnosis. The term "crepitus" in medicine describes several different sounds ... Wikipedia

CREPITUS - (from Lat. crepitus crackling), a sound reminiscent of the crackle of toasted salt (Laennec), friction of hair against each other, etc. In the lungs K. is caused by the penetration of a strong stream of air into the alveoli, the walls to the rye are stuck together due to compression or the presence of ... ... Big medical encyclopediaExplanatory Dictionary of Medicine

- (crepitatio; lat. crepito creak, crunch) a crunching or crackling sensation arising from palpation or auscultation ... Large Medical Dictionary

Crepitus, crepitus, crepitus, crepitus, crepitus, crepitus, crepitus, crepitus, crepitus, crepitus, crepitus, crepitus, crepitus (

Wheezing in the lungs is an unhealthy breathing noise that comes from one or both lungs and is intermittent and of varying frequency. They are often caused by respiratory problems and can be felt on inhalation or exhalation, with or without coughing. A person may have more noticeable wet wheezing when lying down. This condition may be accompanied by a dry cough.

Pathological noises in the lungs in most cases can only be heard with a stethoscope during a physical examination. Therefore, you should not try to engage in self-diagnosis.

When wheezing occurs in both lungs, it is referred to as bilateral. And when they come from the base of the lung, they are known as basal or basal rales. In this case, wheezing is caused by a narrowing of the airways, the presence of contents in the alveoli, or a lack of aeration during exhalation.

Wheezing is common in people with respiratory conditions such as pneumonia, pulmonary fibrosis, bronchitis, and other conditions.

They are more common during inhalation than during exhalation. In most cases, wheezing is associated with inflammation and infection of the small bronchi, alveoli and bronchioles. If wheezing does not improve after coughing, it can sometimes also be a sign of pulmonary edema, a condition characterized by fluid in the alveoli due to heart failure.

Wheezing of the lungs can be roughly divided into weak, medium and strong. Weak wheezes can be soft, high-pitched, and very short. On the other hand, severe wheezing is louder, lower in sound and often lasts longer.

What do they mean?

Wheezing in the lungs is an abnormal murmur heard from one or both lungs. Most form at the base of the lungs and can only be heard with a stethoscope. They usually reflect the accumulation of mucus, pus, or fluid in the airways and lungs.

Wheezing often means respiratory diseasessuch as pneumonia, bronchitis and others. They can also indicate a serious heart condition that causes an accumulation or blockage of blood flow between the heart and lungs.

This symptom is serious enough and can become dangerous to health and life, urgent medical diagnosis, taking into account medical history, blood tests and x-rays may be required to identify and treat its underlying cause.

In medical terminology

In fact, such a concept as "wheezing in the lungs" (English "rhonchi", "rales") in medicine in most of Europe, North America and Australia has not been considered suitable for decades for describing auscultation of the chest. The main reason was the confusion of its application in the medical literature. More appropriate now are terms such as crepitus of the lungs, wheezing, pleural friction noise.

Therefore, this article should not be considered as a guide for medical professionals... In it, some of the terminology is not very accurate or does not apply to domestic medicine (taken from the English-language medical literature). But this made it possible to make the article more understandable and simpler.

What are they?

Wheezing in the lungs can be divided into four types, all of which can help diagnose what may be the underlying cause. These types are:

• Wheezing or crepitus of the lungs (rales)which can be described as rumbling, gurgling, or bubbling sounds, more often at the end of inhalation.
• Sibilant wheezes - high-pitched dry sounds from the airways when they are narrowed. The sounds are so high that they can be heard without a stethoscope.
• Creaking (stridor) - whistling-like, resulting from narrowing or blockage of the upper airways.
• Dry (rhonchi) - harsh rattling respiratory sounds, usually caused by secretions in the bronchial airways. Usually heard more strongly during exhalation.

Please note that the Russian translation of this classification is very approximate. English variants of names in brackets are more correct.

The description is also found separately pleural friction sound... This is a skin-like sound that is often accompanied by severe pain that interferes with breathing. Normally, the pleura is covered with protective mucus, but with inflammation, this membrane can stick together, then a characteristic sound arises on auscultation (listening).

Classification based on materials from ausmed.com

Wheezing and dry cough

A dry cough is a cough that is not accompanied by the production of phlegm (a viscous substance secreted by the mucous membrane of the respiratory tract in excess with a cold).

A dry cough with wheezing in the lungs can be a symptom of a variety of health problems. For some people, this can be the result of environmental irritations such as allergies or the inhalation of very dry, heated air.

If a dry cough becomes chronic, it could be a sign of other conditions, such as the flu, whooping cough, a viral infection, or a side effect of taking heart medications.

Wheezing on exhalation

The sound in the lungs when you exhale in English is often popularly described as "death rattle". However, this can be caused by various conditions, some of which are harmless. Although it is more normal to have it while inhaling than exhaling.

Exhalation wheezing can be a sign of pneumonia, blockage, or fluid accumulation in the lungs. On the other hand, while inhaling, they can be a sign of asthma, bronchitis, or other causes.

An urgent medical diagnosis may be required to determine what the underlying cause may be. You should see your doctor as soon as you notice such a noise coming from both or one of your lungs.

Wheezing when lying down

As mentioned, light wheezing sounds can only be heard with a stethoscope during a medical examination. However, some cases can be so severe that they can be heard even without this instrument.

Wheezing in the lungs while lying down may indicate a blockage of the nasal passages and airways with mucus. During this time, the lungs are under increased pressure, they collapse over time, causing a condition known as atelectasis.

In such cases, other symptoms may occur, such as shortness of breath, chest pain, shortness of breath, cough, and a feeling of choking. If any of these signs are present, you should seek emergency medical attention.

The reasons

1. Bronchitis

Bronchitis is an inflammation of the bronchi. Most people develop acute bronchitis after a cold. This often happens in a day or two, depending on how strong the body's immune system is.

Chronic bronchitis does not go away without medical care... Common symptoms include coughing, wheezing, fatigue, shortness of breath, and chills. A doctor should be consulted if any of these symptoms persist for a long time.

2. Obstructive pulmonary disease

This is a serious condition that requires treatment as soon as possible. Obstructive pulmonary disease, such as asthma or cystic fibrosis, can cause wheezing and wheezing. If left untreated, it can lead to more serious conditions such as bronchiectasis.

These illnesses affect breathing and can cause carbon dioxide and fluids to build up inside the lung. The continuous build-up of these products can lead to scarring, which can be manifested by airway noises.

3. Interstitial lung disease

This disease is associated with air sacs and tissues in the lungs. It includes conditions such as sarcoidosis and rheumatoid arthritis. These conditions are known to cause scarring in the lungs where fluid accumulates, causing wheezing.

4. Heart failure

Heart failure, caused by a weakened heart muscle, a viral infection, or a genetic disorder, can also cause lung sounds. Because the function of the heart is impaired, there is increased pressure in the arteries between the heart and the lungs, which can lead to leakage of blood into the lungs.

5. Pneumonia

Pneumonia is an infection that causes inflammation in one or both lungs (unilateral or bilateral). When pneumonia is the cause of wheezing, it is usually heat, cough, tiredness, headache and severe pain in the chest.

Antibiotics can be used to treat bacterial pneumonia, according to the Mayo Clinic. Aspirin and ibuprofen can be used to relieve chest pain. It is recommended that you see your doctor for proper treatment and diagnosis.

6. Pulmonary edema

Pulmonary edema is caused by the presence of excess fluid in them, which accumulates in the air sac, making it difficult to breathe. Common cause Fluid buildup is a heart problem, but it can also be caused by other causes, such as pneumonia, chest trauma, and exposure to certain toxins.

7. Pulmonary fibrosis

Pulmonary fibrosis occurs due to scarring of the lungs (usually after inflammation). This condition can manifest as shortness of breath, chest discomfort and fatigue. Steroids and natural amino acids can be used to treat this problem.

Other treatment options include oxygen therapy, lung rehabilitation, and breathing support. In severe cases, a surgical procedure can be used to remove fibroids and other symptoms.

8. Atelectasis

Atelectasis occurs when part of the lung collapses. This makes it difficult to inhale and exhale. Atelectasis can result from trauma or an underlying lung infection.

Treatment for this condition must begin at early stage... It will unblock the airways, helping to open the collapsed lung.

9. Asthma

Asthma is a respiratory disorder that causes the airways to swell and produce more mucus. This disease is characterized by wheezing, shortness of breath, and coughing.

An inhaler may be used to relieve asthma symptoms such as coughing, wheezing, and shortness of breath.

10. Lung infection

A viral infection in the lungs can also lead to noise, shortness of breath, and coughing due to blockages, irritation, and inflammation of the airways.

A wheezing sound can be a result of the accumulation of fluids, mucus, inside the lungs. With a lung infection, sounds are often heard even without a stethoscope.

Treatment

Treatment can vary depending on what is the underlying cause. When diagnosing a condition, the doctor uses a stethoscope to listen for breathing. Although rare, in severe cases, wheezing can sometimes be heard without a stethoscope.

To confirm the diagnosis, the doctor may need to order a chest x-ray, blood test, sputum test, or an electrocardiogram to check for heart problems. The cessation of wheezing is associated with the elimination of the underlying cause.

When the reason is chronic diseases the lungs, you need to make some lifestyle changes in addition to the prescribed medication to control your symptoms. This applies to people who smoke. A common treatment option may include:

• Using inhaled steroids to reduce inflammation
• Oxygen therapy helps make breathing easier
• Using a bronchodilator to relax and open up blocked airways.

Folk remedies

When a problem is accompanied by other symptoms, such as back pain, shortness of breath, or a runny nose, there are some effective home remedies that can be used to relieve some of these symptoms. If symptoms persist, the underlying cause should be diagnosed and treated as soon as possible.

1. Steam inhalation

Inhalation is one of the best methods to use in this case. Moisture and heat will help break down and dissolve mucus that is blocking your airways.

• Take a basin or bowl of hot water
• Add a few drops of eucalyptus oil
• Bend over the container and cover with a dry towel so as not to lose heat or moisture
• Carry out the procedure until relief is felt.

Ginger is a great remedy to try when treating respiratory problems. In addition to strengthening the immune system to speed up healing, it has anti-inflammatory properties and polyphenols that can help inhibit mucus production.

• 5. Anamnesis and its sections. Major and minor complaints. Detailing complaints.
• 6. Anamnesis and its sections. The priority of domestic medicine in the development of anamnestic method. The concept of leading questions: direct and indirect.
• 8. Scheme of the medical history. The priority of domestic medicine in the development of a case history. The value of passport (personal) data.
• 9. Examination of the chest. Changes in the shape of the chest in various diseases. Palpation of the chest: determination of resistance and voice tremor, diagnostic value of changes.
• 10. Chest lines used for topographic percussion of the lungs.
• 12. Types of percussion: loud and quiet percussion; when to use loud, when to use quiet percussion.
• 13. Comparative and topographic percussion of the lungs. Task, execution technique.
• 1) Dumb
• 2) Tympanic
• 3) Boxed
• 14.Topographic lung percussion. The height of the standing tops of the lungs, the width of Krenig fields. The lower borders of the lungs (along the topographic lines) on the right and left are normal. Changes in the boundaries of the lungs in pathology.
• 15. Active mobility of the lower pulmonary margin, technique, standards. Diagnostic value of changes in active mobility of the lower pulmonary margin.
• 16. Auscultation as a research method. The founders of the method. Auscultation methods.
• 17. Vesicular respiration, the mechanism of its formation, areas of auscultation. Laryngo-tracheal (or physiological bronchial) breathing, the mechanism of its formation, areas of auscultation are normal.
• 19. Absolute dullness of the heart: concept, method of definition. The boundaries of the absolute dullness of the heart are normal. Changes in the boundaries of absolute dullness of the heart in pathology.
• 21. Pulse, its properties, method of determination. Pulse deficit, method of determination, clinical significance. Auscultation of the arteries.
• 22. Blood pressure (hell). Methodology for determining Hell by the auscultatory method of N. S. Korotkov (sequence of actions of the doctor). The values \u200b\u200bof systolic blood pressure and diastolic blood pressure are normal.
• 23. Auscultation as a research method. The founders of the method. Auscultation methods.
• 24. Places of projections of heart valves and mandatory points of auscultation of the heart (main and additional)
• 25. Heart sounds (I, II, III, IV), the mechanism of their formation.
• 26. Differences between I tone and II heart tone.
• 28. Methods for determining ascites.
• 29. Deep methodical sliding palpation of the abdomen according to V.P. Obraztsov and N.D.Strazhesko. Four moments of the doctor's actions when palpating the intestines.
• 30. Auscultation of the abdomen.
• 31. Determination of the lower border of the stomach by methods of percussion palpation (causing a splash noise) and auscultation.
• 32. Palpation of the sigmoid colon. The sequence of actions of the doctor during its implementation. Characteristics of the normal sigmoid colon and its changes in pathology.
• 33. Palpation of the cecum. The sequence of actions of the doctor during its implementation. The characteristic of the cecum is normal and its changes in pathology.
• 34. Palpation of 3 sections of the colon. The sequence of actions of the doctor during its implementation. Characteristics of the normal colon and its changes in pathology.
• 36. Liver percussion. Determination of the size of the liver. Borders and sizes of the liver according to Kurlov (on average, in cm) in norm and in pathology. The clinical significance of the detected changes.
• 42. Complaints of patients with liver and biliary tract diseases, their pathogenesis.
• 43. Complaints of patients with kidney disease, their pathogenesis.
• 44. The sequence of the general examination of the patient. Body type. Constitution: definition, types.
• 45. Diagnostic value of examination of the face and neck.
• 46. \u200b\u200bExamination of the skin: discoloration of the skin, diagnostic value.
• 47. Examination of the skin: moisture, turgor, rashes (hemorrhagic and non-hemorrhagic).
• 53. General condition of the patient. The position of the patient (active, passive, forced).
• 54. State of consciousness. Changes in consciousness: quantitative and qualitative changes in consciousness.
• 55. Type, rhythm, frequency and depth of respiratory movements in the norm and their changes in pathology.
• 56. Palpation of the chest. What is revealed by palpation of the chest? Voice tremor is normal and pathological.
• 57. Changes in the percussion sound over the lungs in pathology (dull, dull, dull-tympanic, tympanic, boxed). The mechanism of the formation of these sounds. Clinical significance.
• 58. Changes in vesicular respiration. Quantitative changes. Qualitative changes (hard breathing, saccadic breathing). The mechanism of these changes. Clinical significance.
• 62. Classification of incidental respiratory sounds. Crepitus. The mechanism of formation of crepitus. Clinical significance. The difference between crepitus and other collateral respiratory sounds.
• 63. Classification of wheezing. Sound and non-sound wheezing. The mechanism of wheezing. Clinical significance. Differentiation of wheezing from other adverse respiratory sounds.
• 64. Pleural friction noise. The mechanism of formation of pleural friction noise. Clinical significance. Differentiation of pleural friction noise from other side respiratory sounds.
• 66. Splitting and bifurcation of heart sounds. Quail rhythm, gallop rhythm. The mechanism of formation. Clinical significance.
• 72. Characteristics of noise in stenosis of the aortic opening (aortic stenosis)
• 73. Croupous pneumonia. The main complaints of patients. Changes in physical data for 3 stages of croupous pneumonia. Laboratory and instrumental diagnostics.
• 74. Hypertension (ie primary, essential arterial hypertension) and secondary (ie symptomatic) arterial hypertension. Definition
• 81. Stenosis of the left atrioventricular foramen (mitral stenosis). Changes in intracardiac hemodynamics. Physical and instrumental diagnostics.
• 82. Insufficiency of the semilunar aortic valves (aortic insufficiency). Changes in intracardiac hemodynamics. Physical and instrumental diagnostics.
• 83. Stenosis of the aortic opening (aortic stenosis). Changes in intracardiac hemodynamics. Physical and instrumental diagnostics.
• 84. Insufficiency of the tricuspid valve - relative (secondary) and primary (what is the essence of the differences). Changes in intracardiac hemodynamics. Physical and instrumental diagnostics.
• 85. Heart failure: acute and chronic, right and left ventricular. Clinical manifestations.
• 87. Ecg. Definition. Graphical recording of ecg is a characteristic of its elements (tooth, segment, interval, isoline). Scientists are the founders of electrocardiography.
• 88. ECG-leads (bipolar and unipolar): standard, reinforced from the limbs and chest
• 94. ECG is normal: electrical systole of the ventricles (qt interval). Normalized indicators of the qt interval. The current clinical significance of changing the qt interval.
• 95. ECG: determination of the heart rate.
• 96. The electrical axis of the heart (eos). Variants of the position of the eos in health and disease.
• Sound phenomena arising in connection with the act of breathing are called breathing noises. Distinguish between main and additional, or side, breathing sounds. The main breathing sounds are vesicular, bronchial and hard breathing. Additional (side) noises include wheezing, crepitus and pleural friction noise. caused by their spasm and mucosal edema. They are most typical for an attack of bronchial asthma.

  Crepitation ("crepitare" - creak, crunch) - collateral respiratory noise, which is formed when the walls of the alveoli, which are more humid than usual, have lost their elasticity, which are heard exclusively at the height of inspiration as a short sound "flash" or "explosion". It resembles the sound produced by kneading a bundle of hair near the ear with your fingers. Usually crepitus is a sign of croupous pneumonia, accompanying the phases of appearance and resorption of exudate; can occasionally be heard at the very beginning of the development of pulmonary edema .. Unlike wheezing, crepitus occurs not in the bronchi, but in the alveoli, when there is exudate in them. It is a very important diagnostic sign that indicates damage to the pulmonary parenchyma itself. Crepitation (crepitus - crackle). Unlike wheezing, crepitus does not occur in the bronchi, but in the alveoli, when there is exudate in them. It is a very important diagnostic sign that indicates damage to the pulmonary parenchyma itself. This sound can be compared to that heard when a strand of hair is rubbed over the ear.

  The mechanism of crepitation is as follows: if there is exudate in the alveoli, their walls stick together during exhalation, with subsequent inhalation they break apart and give a sound phenomenon at the height of inhalation, which is called crepitation, that is, it is the sound of the sticking together walls of the alveoli ... Distinguishing Crepitus from Other Adverse Respiratory Noises... Crepitation is sometimes incorrectly referred to as crepitant or sub-crepitant rales. This is not true, since these auscultatory phenomena are different both in the mechanism of their origin and in auscultatory characteristics. So, crepitus is heard only at the inspiratory height, while wet rales - in both phases. After coughing, wheezing changes, may disappear, but crepitus does not change. Crepitation occurs in alveoli of uniform size and is the same in its caliber (one-caliber), more monotonous, while wheezing is formed in the bronchi of different calibers and, therefore, are of different caliber. Crepitation appears as an explosion, instantly, while wheezing is more prolonged in time. In the listening area, crepitus is always more than wheezing, because there are more alveoli than wheezing in a given acoustic sphere .

  Clinical significance... The appearance of crepitus is very characteristic of croupous pneumonia. Sometimes crepitus is heard in elderly people without lung pathology, if they were in a horizontal position or with very shallow breathing, and physiological atelectasis occurs. During the first deep breaths, the alveoli, which are in a collapsed state, are straightened and transient crepitus is heard. This is a very common occurrence in the elderly, weak and bedridden patients.