الرحمن الله بسمالرحیم

Hemoptysis

Coughand

Prepared by Dr.Maihan (yousufi) Instructor: professor Dr.Hayatullah

Ahmadzai Total slides: 33 6/2/2017 University hospital,nangarhar,Afghanistan Maihan_yousufi@yahoo.com

Reference: Respiratory and heart valves

Reheumatismal diseases of professor Dr.Moh. Tayab Neshat

Harrison 19edition Davidson 22 edition Current medical diagnosis 2017 Washington manual 35edition

Definition of hemoptysis Classification of hemoptysis Epidemiology of hemoptysis Causes of hemoptysis Diagnosis of hemoptysis

Main objectives:

…continuous Main objectives: Definition of cough Types of cough Origin and Causes of cough Investigation Treatment

Hemoptysis

Hemoptysis

Definition:

Hemoptysis is expectoration of blood from the lower respiratory tree, below the glottis.

Classification According to amount of blood:

Massive/life threatening

Not massive

Massive hemoptysis

Blood>600ml/24hrs Blood>200-600ml/24hrs(harison)Blood>100ml/24hrs associated with

gas exchange abnormality, air way obstruction or hemodynamic instability.

Classification according to anatomic location:

AirwayParenchymaVascularcombination

Epidemiology:

Bronchiectasis: 1-37%Bronchitis: 2-37%Malignancy: 2-24%TB/ cavitary lung disease: 2-69%Pneumonia: 1-16%Idiopathic:2-22%

Causes:

Airway: bronchitis, bronchiectasis, malignancy, foreign body, Trauma

Pulmonary endometriosis,Parenchyma: pneumonia,pulmonary

hemorrhage syndromes(ANCA positive vasculitis,Goodpasture syndrome,SLE, diffuse alveolar hemorrhage,ARDS)

…continuous causes of hemoptysis

Vascular: elevated pulmonary Venus pressure(LV failure, Mitral stenosis),pulmonary embolism,arteriovenus malformation, pulmonary arterial trauma(exp: pulmonary arterial catheter balloon over inflation)

…continuous causes of hemoptysis

Combination: Cavitory lung disease(TB, aspergilloma,lung abscess)

…continuous causes of hemoptysis

Idiopathic/undiagnosed up to 25% prognosis usually favorable

Diagnosis

1.History taking: amount of

hemoptysis Age smoking history

prior lung disease Renal disease(good pasture s) risk for coagulopathy (anti

coagulant) prior episodes of hemoptysis malignancy

…continuous DiagnosisIII. Physical examination:

general state of health

Vital signs oxygen saturation Lung exam noting focal or diffuse abnormal

findings such as bronchial breath sounds, crackles , inspiratory or expiratory wheezes

Diagnostic testing

I. Lab and ECG:ECG to assess for underlying

structural heart diseaseCBC, coagulation studiesBlood grouping and cross match if

massive hemoptysis is present

…continuous Diagnostic testing

Sputum studies: Gram stain and culture for AFB,fungal infections.

Immunologic studies: Anti nuclear ab/Ant neutrophil cytoplasmic ab screen,anti glomerular basement membrane antibodies.

BNP: CHF

…continuous Diagnostic testing

II. Imaging: CXR: PA and lateral CXR should be

perform for all causes of hemoptysis.(1.normal up to 50% of causes. 2. normal up to 10% of causes by bronchogenic carcinoma.)

…continuous Diagnostic testing

Chest CT scan:

If initial evaluation is doubt.

Echo: If suspect structural heart disease.

…continuous Diagnostic testing

Fiber optic/Rigid bronchoscopyBronchial and pulmonary

arteriography(AV malformation)

Cough

Definition:

Cough is an explosive expiration that provides a normal protective mechanism for clearing of tracheobronchial tree of secretion and foreign body.

Types of cough

I. Acute cough (less than 3weeks) Exp: viral respiratory tract infectionII. Persistent cough(3-8 weeks) Exp: pertussisIII. Chronic cough(more than 8 weeks). Exp:

post nasal drip,GERD,asthma,bronchogenic carcinoma,pul.TB, ACE inhibitors.

Origin and Causes of cough:origin Common causes Clinical features

Pharynx Post nasal drip History of Ch. Rhinitis

Larynx 1.Laryngitis,tumour, 2.whooping cough, croup

1.Voice or swallowing altered, harsh or painful cough2.Paroxysmal cough with stridor

Trachea Tracheitis Raw retro sternal pain with cough

Bronchi 1.A.bronchitis,COPD, 2.asthma3.Eosinophilic bronchitis4.Bronchial carcinoma

1.Dry or productive cough, worse in morning2.Usually dry, worse at night3.Feature similar to asthma but Air way hyper reactivity absent, sputum eosinophilia is present.4.Chronic cough often with hemoptysis.

…continuous Origin and Causes of cough:

origin Common causes Clinical features

Lung parenchyma 1.Pulmonary TB

2.Pneumonia

3.Bronchiectasis

4.Pulmonary oedema

5.Interstitial fibrosis

1.Productive often with hemoptysis

2.Dry initially, productive later

3.Productive, excessive sputum production mal odors.

4.Often at night may be productive pink frothy sputum.

5.Dry and distressing

Gastro intestinal disorders

GERD History of gastro intestinal disorders (regurgitation, heart burn),Dry cough

Drug side effect ACE inhibitors Dry cough

Investigation

Chest x ray(pneumonia, COPD, pul.TB...) Sputum exam(Pul.TB) PCR(pertussis) nasopharyngeal swab Bronchoscopy CT scan(chest, sinus) Pulmonary function test(asthma,COPD) Gastric investigation(endoscopy)

Treatment:

Underline cause treatment.Symptomatic treatment with

codeine and Dextromethorphan Idiopathic cough: gabapentin,

amitriptyline

Thank you