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