COUGH & EXPECTORATION

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

COUGH & EXPECTORATION