COUGH & EXPECTORATION
DR.N.SANKAR
COUGH
• Defensive mechanism to clear lower air passages.
• Deeper the inspiration- more effective the cough
• Glottis close, soft palate raised, all accessory muscles in addition to ordinary are tensed for forced expiration.
• Then glottis relaxed & contents are expelled from the mouth
CLASSIFICATION OF COUGH
• DUE TO • 1. INFECTIONS• 2. MECHANICAL IRRITATION• 3. REFLEX CONDITIONS
INFECTIONS
• COMMON COLD- SHORT COUGH, DRY AT FIRST AND LATER PAROXYSMAL
• PHARYNGITIS-PERSISTENT, GENERALLY DRY• LARYNGITIS- NOISY, HUSKY, STRIDULOUS• TRACHEITIS- INTENSELY IRRITATING,
PAROXYSMAL; + WHEEZING• BRONCHITIS- PRODUCTIVE, FREE OR
PAROXYSMAL
• PNEUMONIA- 1ST DAY- DRY, THEN RUSTY SPUTUM, THEN FROTHY
• TUBERCULOSIS- FREQ, SHORT, SHARP DRY –EARLY; LATER ON- COPIOUS PURULENT
• PLEURISY- SOLITARY, DRY HACKING COUGH SUPPRESSED AS MUCH AS POSSIBLE TO AVOID PAIN.
• BRONCHIECTASIS- CONSTANT WITH COPIOUS OFFENSIVE PURULENT MORE ON MORN OR CHANGE OF PLACE
• LUNG ABCESS- LOOSE COUGH, OFFENSIVE BLOOD STAINED; AFFECTED BY CHANGE OF POSTURE
• PERTUSSIS- LONG DRAWN SRIDULOUS INSPIRATION SERIES OF SHORT, SHARP, EXPIRATORY COUGH WITH VOMITING OFTEN; FACE CONGESTED
MECHANICAL IRRITATION
• ENLARGED UVULA- • SINUSITIS• SMOKING• PRESSING UPON TRACHEA• ENLARGED HEART
REFLEX CONDITIONS
• IRRITATION OF PERIPHERAL NERVES• ENLARGED LIVER AND DIAPHRAGMATIC
DISORDERS• NERVOUSNESS- SINGLE SHORT DRY AND
EXPLOSIVE• HYSTERIA- LOUD BARKING WITH APHONIA
• SUDDEN COUGH- TRACHEITIS, BRONCHITIS, BRONCHOPNEUMONIA
• COUGH WITH PAIN- PNEUMONIA, PLEURISY,• COUGH ON LYING DOWN- ENLARGED UVULA, ENLARGED
HEART• COUGH WITH VOMITING- WHOOPING COUGH• DRY COUGH- PHTHISIS, LARYNGITIS, NEUROSIS• LOOSE COUGH- BRONCHITIS, BRONCHIECTASIS, PTHISIS• SUDDEN PAROXYSM IN A CHILD- FOREIGN BODY, IF WITH
FEVER---- LARYNGEAL DIPTHERIA• SHORT AND SUPPRESSED- DRY PLEURISY
• IRRITABLE- EARLY PTHISIS, PHARYNGITIS• PAROXYSMAL- ASTHMA, BRONCHITIS, PERTUSSIS• EXPLOSIVE- NEUROSIS, LARYNGITIS• BRASSY- ANEURYSM, MEDIASTINAL GROWTH• BOVINE- PROLONGED WITH WHEEZING- RL.N
INVOLVEMENT• BARKING- HYSTERIA• HACKING- PHTHISIS, LARYNGITIS, PHARYNGITIS• STRIDOR- PERSISTENT THYMUS, LARYNGEAL
DIPHTHERIA
EXPECTORATION
LOOK FOR
• QUANTITY• QUALITY & COLOUR• CONSISTENCY• ODOUR• MICROSCOPIC EXAMINATION
QUANTITY(24 HRS)
• MODERATE(2 OUNCES)- ACUTE BRONCHITIS• LITTLE LARGER AMOUNT- CHRONIC BRONCHITIS,
RESOLVING PNEUMONIA, B.CA• LARGER QUANTITY(OVER 10 OUNCES)- LUNG ABSESS,
EMPYEMA, BRONCHIECTASIS• FROTHY- ACUTE PULMONARY CONGESTION• SUDDEN SEVERAL OUNCES-LUNG ABSCESS,
SUBPHRENIC ABSCESS, EMPYEMA• SUDDEN CLEAR WATERY SALT TASTING- HYDATID
CYST
QUALITY & COLOUR
• MUCOID• SEROUS• FIBRINOUS• FROTHY• PURULENT• MUCOPURULENT• BLOOD STAINED• BLACK
• RUSTY• RED CURRANT JELLY• ANCHOVY SAUCE PUS• GREENISH
CONSISTENCY
• METHOD ---• LOOK FOR FOLLOWING:• BRONCHIAL CASTS• DITTRICH’S PLUGS• CURSCHMANN’S SPIRALS• LUNG STONES• LAYER FORMATION
ODOUR
• OFFENSIVE
MICROSCOPIC EXAMINATION
• CELLULAR STRUCTURES• PUS CELLS• EPITHELIUM(HEART FAILURE CELLS)• RED CELLS • EOSONOPHIL CELLS
• ELASTIC FIBRES• DESTRUCTION OF LUNG TISSUE- ABSCESS, PTHISIS,
GANGRENE
• ORGANISMS• PARASITES(HYDATID CYST, LUNG FLUKE, ECHINICOCCI)• TB BACILLI• COCCI AND BACILLI
• CURSCHMANN’S SPIRALS• ASTHMA
• CHARCOT LEYDEN CRYSTALS• ASTHMA
• NEOPLASTIC CELLS- CA• ASBESTOSIS- GOLDEN YELLOW DUMBELLS
Bibliography
• How to examine a patient; a guide for student of medicine
menino de souza
THANK YOU
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