Transcript 幻灯片 1 - 上海交通大学医学院精品课程

Cough and expectoration
zhengcuixia
Concept
A protective reflex act
clean excessive secretion & foreign material
Initiated by miscellaneous stimuli or by
voluntary exertion.
The most common respiratory symptom.
Severe cough is a serious clinical problem.
Cough reflex
 Afferent
inform.from: larynx,
trachea, bifurcation of the bronchi
 Irritant type: mechanical, chemical,
inflammation
 Afferent fibers are in the vague
nerve
cough center.
Cough reflex
Efferent signals
larynx, muscles of diaphragm, chest
wall, abdomen
 A coordinated series of movement
complete the cough. Deep inspiration –
expiration effort with glottis closedglottis open abruptly – high volocity of
airflow brings out screations from
airways.
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Influencing factors
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Suppressed afferent or efferent nerve
function
Failed glottis function (laryngopharynx dis)
Diminished muscle force
Obstructed airway seen in severe COPD
Trachea intubation
Chest or abdominal pain limit cough
movement
Causes
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Airway stimulation by chemicals & foreign
material (smoker & occupational exposure)
Airway infection & inflammation
Lung parenchyma disorders
Pleural & chest wall disorders
Cardiovascular abnormalities
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Other causes Psychiatric cough
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classify
Non production ( dry cough )
 Production (with sputum)
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Acute
 Chronic or acute on chronic
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Clinical appearance in common
diseases
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Acute respiratory infection or excesobation of
chronic infectious illnesss
Neoplasms
Pleural disease
Cardiovascular diseases
General disease affecting the respiratory system
Chronic cough: postualnasal drip syndrom, cough
type asthma, smoker, occupational exposure
Accompanied abnormalities
 Fever
 Chest
pain
 Dyspnea & wheeze
 Sputum production
Accompanied CXF abnormalities
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Neoplasm
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Mediastinum
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Efussional
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Cardiovascular
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interstinal
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Pleural or chest wall
complication
Cough syncope syndrom
 Fatigue
 Fractures due to severe persistent cough
 Pneumomediastinum, pneumothorax, and
subcutaneous emphysema due to high
intrathoracic pressure during cough.
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Investigation
General condition of the patient
 Time specialties
 Voice specialties
 Productive or not
 In relation with posture
 Accompany with chest pain; with dyspnea,
or other complications
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Sputum production
(expectoration)
 Characters:
mucoid, tenasious,
purulent, blood stained, with
special odor, rusty, serous
 Volume:
 Accompanied manifestation
Laboratory examination
Rutine
 Microbiologic test ( including culture )
 Cellular
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hemoptysis
Bleeding below the level of the larynx
that being coughed out
 Degrees: from blood-tinged sputum to
massive gross blood, even leading to
airway occlusion (apnea ) & shock. The
latter is much less seen.
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Common causes
Infectious respiratory disease: TB,
bronchiactesis, bronchitis
 Neoplasm:
 Cardiovascular disease: MS, PE, PAH,
deformity of blood vessle
 Other less seen disease leading to
hemoptysis.
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Clacification
Small
 Moderate
 Massive
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Differentiating from hematemesis
hemoptysis
Coughed up & frothy
Preceded by
stimulating cough
Bright red
alkaline
History of coughing
Blood-tinged sputum
Mixed with sputum
Anemia variable
hematemesis
Vomited without frothy
Preceded nausea,
vomiting
Dark red or brown
acid
Gastric, liver disease
Tar stool
Mixed with food
Blood loss common
Differentiating from upper airway
bleeding
Post nasal bleeding
 Mouth and farynxil membrane bleeding
 by intenssive investigation and
examination
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Investigation
 If
coughed out or vomitted out
 Volume: how much
 Time duration
 Any accompanied appearances