Download - Cough, Sputum Hemoptisis
![Page 1: Cough, Sputum Hemoptisis](https://reader035.vdocument.in/reader035/viewer/2022062412/577cce181a28ab9e788d4c42/html5/thumbnails/1.jpg)
COUGH, SPUTUM, COUGH, SPUTUM, HEMOPTYSISHEMOPTYSIS
Prof. Dr. Bilun Gemicioğlu
![Page 2: Cough, Sputum Hemoptisis](https://reader035.vdocument.in/reader035/viewer/2022062412/577cce181a28ab9e788d4c42/html5/thumbnails/2.jpg)
COUGHCOUGHA cough is an action your body takes to get rid of
substances that are irritating to your air passages, which carry the air you breathe in from the nose and mouth to the lungs.
A cough occurs when special cells along the air passages get irritated and trigger a chain of events. The result? Air in your lungs is forced out under high pressure; an explosive expiration
You can choose to cough (a voluntary process), or your body may cough on its own (an involuntary process).
![Page 3: Cough, Sputum Hemoptisis](https://reader035.vdocument.in/reader035/viewer/2022062412/577cce181a28ab9e788d4c42/html5/thumbnails/3.jpg)
Anatomic causes of coughAnatomic causes of cough
Extra-thoracicExtra-thoracic İntra-thoracicİntra-thoracic
CNSCNS Head and neckHead and neck
Lower airways Lower airways diseasesdiseases
Lung ParenchymaLung Parenchyma
MediastinumMediastinum
CardiovascularCardiovascular
Upper GISUpper GIS
PleuraPleura
DiaphragmDiaphragm
StomacStomac
![Page 4: Cough, Sputum Hemoptisis](https://reader035.vdocument.in/reader035/viewer/2022062412/577cce181a28ab9e788d4c42/html5/thumbnails/4.jpg)
Cough receptors and related nervesRegions Afferent nervesParanasal Trigeminal (V)
Pharynx Glossofaringeus (IX)
Larynx/tracheobronchial sys. Vagus (X)External ear way/ thympanic membrane Vagus (X)
Eusophagus, stomac, pleura Vagus (X)Diaphragm, pericard Phrenic nerve
Simpson CB. et al. Otolaryngology–Head Neck Surg 2006; 134: 693-700Simpson CB. et al. Otolaryngology–Head Neck Surg 2006; 134: 693-700
![Page 5: Cough, Sputum Hemoptisis](https://reader035.vdocument.in/reader035/viewer/2022062412/577cce181a28ab9e788d4c42/html5/thumbnails/5.jpg)
Anamnesis: HistoryWhile ? When ?Characteria ?Productive/non productiveAdditional symptoms?Risk factors: tabacco smoke
additional diseases or use of drugs ?
![Page 6: Cough, Sputum Hemoptisis](https://reader035.vdocument.in/reader035/viewer/2022062412/577cce181a28ab9e788d4c42/html5/thumbnails/6.jpg)
Anamnesis: While
Shorter then 3 weeks acute cough
3 to 8 weeks subacute cough
Longer then 8 weeks chronic cough
Irwin RS et al. Chest 1998, 114:2 supplIrwin RS et al. Chest 1998, 114:2 suppl
![Page 7: Cough, Sputum Hemoptisis](https://reader035.vdocument.in/reader035/viewer/2022062412/577cce181a28ab9e788d4c42/html5/thumbnails/7.jpg)
Causes of acute coughRespiratory Causes:
Inhaled gases or particuleMucus secretionInflammatory exudate Foreing bodyEndobronchial lesionBronchial boosts
![Page 8: Cough, Sputum Hemoptisis](https://reader035.vdocument.in/reader035/viewer/2022062412/577cce181a28ab9e788d4c42/html5/thumbnails/8.jpg)
Other causes of acute cough
-acute heart failure-acute rhinosinusitis-Eusephageal reflux-Middle ear patologies and infections-Diaphragm, pleura and pericardium
irritations
![Page 9: Cough, Sputum Hemoptisis](https://reader035.vdocument.in/reader035/viewer/2022062412/577cce181a28ab9e788d4c42/html5/thumbnails/9.jpg)
Chronic cough causes in adult PNDS
Allergic rhinitis chronic sinusitis
GER cough-variant asthma ACE Inhibitors tabacco smoke Whoopping Neurogenic
Travmatic vagal injury After upper respiratory tract infection Psychogenic chronic aspiration Zenker diverticule
Foreign body Tracheobronchial tree Laryngopharingeal Sinonasal External ear way
Chronic bronchitis, COPD Bronchiectasis Lung Cancer Subglottic stenosis Tracheomalasia Tracheosephageal fistula Tuberculosis Sarkoidosis Congestive heart disease
Simpson CB. et al. Otolaryngology–Head Neck Surg 2006; 134: 693-700Simpson CB. et al. Otolaryngology–Head Neck Surg 2006; 134: 693-700Chung KF, Pavord ID Lancet 2008; 371: 1364-1374Chung KF, Pavord ID Lancet 2008; 371: 1364-1374
![Page 10: Cough, Sputum Hemoptisis](https://reader035.vdocument.in/reader035/viewer/2022062412/577cce181a28ab9e788d4c42/html5/thumbnails/10.jpg)
Patogenic TriadPatogenic Triad
Irwin RS et al. Chest 1998, 114:2 supplIrwin RS et al. Chest 1998, 114:2 suppl
Palombini BC et al. Chest 1999, 116:2,279-284Palombini BC et al. Chest 1999, 116:2,279-284
![Page 11: Cough, Sputum Hemoptisis](https://reader035.vdocument.in/reader035/viewer/2022062412/577cce181a28ab9e788d4c42/html5/thumbnails/11.jpg)
Anamnesis: When
MorningBed time; nightAfter mealAfter irritant Only wakingTalkingStress
![Page 12: Cough, Sputum Hemoptisis](https://reader035.vdocument.in/reader035/viewer/2022062412/577cce181a28ab9e788d4c42/html5/thumbnails/12.jpg)
Anamnesis: Characteria
Like barking Larynx tm, inf. Metalic cough Trachea, brochies.Cow cough V.Chord paralisisVomitig cough Whoopping coughSmoking cough tabacco smoke Irrıtative cough URTI
![Page 13: Cough, Sputum Hemoptisis](https://reader035.vdocument.in/reader035/viewer/2022062412/577cce181a28ab9e788d4c42/html5/thumbnails/13.jpg)
Anamnesis: Characteria
In prospective adult studies time and character of the coughing cannot guide the diagnosis.
Mello CG et al. Arch Intern Med 1996,156; 997-1003Mello CG et al. Arch Intern Med 1996,156; 997-1003
![Page 14: Cough, Sputum Hemoptisis](https://reader035.vdocument.in/reader035/viewer/2022062412/577cce181a28ab9e788d4c42/html5/thumbnails/14.jpg)
Anamnesis: Productive/Nonproductive
Productive Airway diseases
Non productive Pleura, pericardium, Ear, GIS, heart, ACEI usage, diaphragm, mediastinum, thyroid…
Irwin RS et al. Chest 1998, 114:2 supplIrwin RS et al. Chest 1998, 114:2 suppl
![Page 15: Cough, Sputum Hemoptisis](https://reader035.vdocument.in/reader035/viewer/2022062412/577cce181a28ab9e788d4c42/html5/thumbnails/15.jpg)
Anamnesis: Additional symptoms
Specific Dyspnea, wheezing, sputum, pyrosis, retronasal discharge…..
Non specific Eshaustion, insomnia, sweating, muscular pain, urine incontinence, headache,
loss of appetite, axiety
![Page 16: Cough, Sputum Hemoptisis](https://reader035.vdocument.in/reader035/viewer/2022062412/577cce181a28ab9e788d4c42/html5/thumbnails/16.jpg)
Anamnesis: Specific additional symptoms
PNDS post nasal drip, throat clearing runny nose, nasalcongestion, sputum
Asthma Dispnea, thightness of breath, wheezing GERBurning, regurgitation,COPD sputum, effort dispneaBronchiectasia SputumHeart failure Effort dispnea, tachycardia, edema
![Page 17: Cough, Sputum Hemoptisis](https://reader035.vdocument.in/reader035/viewer/2022062412/577cce181a28ab9e788d4c42/html5/thumbnails/17.jpg)
Anamnesis: Risk factorsSmoking cases Lung cancer, COPD,
asthma, irritation
Irwin RS et al. Chest 1998, 114:2 supplIrwin RS et al. Chest 1998, 114:2 suppl
Additional diseases AIDS, cancer, viral URI
Drug usage ACEI, Nitrofurantoin, Immunosupresives
![Page 18: Cough, Sputum Hemoptisis](https://reader035.vdocument.in/reader035/viewer/2022062412/577cce181a28ab9e788d4c42/html5/thumbnails/18.jpg)
Physical ExaminationPhysical Examination
Head and neckThoraxUpper GISHeartENT
![Page 19: Cough, Sputum Hemoptisis](https://reader035.vdocument.in/reader035/viewer/2022062412/577cce181a28ab9e788d4c42/html5/thumbnails/19.jpg)
LaboratoryLaboratory Chest X Ray Pulmonary function tests Paranasal sinus X-Ray Blood analysis Sputum examination Bronchoscopy ECG, ECO Thorax CT, HRCT Rhinoscopy Barium eseuphagography Allergy prick tests
![Page 20: Cough, Sputum Hemoptisis](https://reader035.vdocument.in/reader035/viewer/2022062412/577cce181a28ab9e788d4c42/html5/thumbnails/20.jpg)
Treatment of coughNON SPECIFICNON SPECIFIC SPECIFICSPECIFIC
ANTITUSSİVEANTITUSSİVE PROTUSSIVEPROTUSSIVE TARGET TARGET THERAPYTHERAPY
CodeinCodein
DekstrometorfanDekstrometorfan
DifenhidraminDifenhidramin
PseudoephedrinePseudoephedrine
DekstrobromfeniraminDekstrobromfeniramin
İpratropium Bromidİpratropium Bromid
NaproxenNaproxen
Hipertonic salineHipertonic saline
ErdosteinErdostein
AmiloridAmilorid
N acetylcysteineN acetylcysteine
TerbutalineTerbutaline
PhisiotherapyPhisiotherapy
Postural drenagePostural drenageIrwin RS et al. Chest 1998, 114:2Irwin RS et al. Chest 1998, 114:2
![Page 21: Cough, Sputum Hemoptisis](https://reader035.vdocument.in/reader035/viewer/2022062412/577cce181a28ab9e788d4c42/html5/thumbnails/21.jpg)
SPUTUM
Mucus glands and goblet cells of lower respiratory tract secrete 10ml mucus every day
Exess of lower respiratory track expectoration is called sputum
![Page 22: Cough, Sputum Hemoptisis](https://reader035.vdocument.in/reader035/viewer/2022062412/577cce181a28ab9e788d4c42/html5/thumbnails/22.jpg)
General causes of sputum
Exess of mucus production
Changement in the quality of mucus
Lacking activity of mucociliar clearance
![Page 23: Cough, Sputum Hemoptisis](https://reader035.vdocument.in/reader035/viewer/2022062412/577cce181a28ab9e788d4c42/html5/thumbnails/23.jpg)
Sputum:Anamnesis:
Quantity of sputum
Quality of sputum; density, calour
Odor of sputum
Time of expectoration
![Page 24: Cough, Sputum Hemoptisis](https://reader035.vdocument.in/reader035/viewer/2022062412/577cce181a28ab9e788d4c42/html5/thumbnails/24.jpg)
Sputum: AnamnesisSputum Quality Suspect diseasesPurulent; yellow-green mucoid Pneumonia, asthma with
eosinophiliaRusty Pneumonia (pneumoccocus)Cherry Pneumonia (klebsiella)Melanopthisis (black-grey) Air pollution, coal workerRock water vomic Eccinoccocus cystesChocolate Amibe abscessPutrefactive; faol smelling Lung abscess (anaerobic
infections)< 600cc/day, morning expect. Bronchiectsasis
![Page 25: Cough, Sputum Hemoptisis](https://reader035.vdocument.in/reader035/viewer/2022062412/577cce181a28ab9e788d4c42/html5/thumbnails/25.jpg)
Sputum: Diagnosis
Physical examination of the lungs
Chest X-ray, CT, HRCT
Sputum analysis
Blood analysis
Bronchoscopy
![Page 26: Cough, Sputum Hemoptisis](https://reader035.vdocument.in/reader035/viewer/2022062412/577cce181a28ab9e788d4c42/html5/thumbnails/26.jpg)
Sputum: Treatment
Treat the causative disease
Postural dranage
Mucolytics
Decongestant
![Page 27: Cough, Sputum Hemoptisis](https://reader035.vdocument.in/reader035/viewer/2022062412/577cce181a28ab9e788d4c42/html5/thumbnails/27.jpg)
HEMOPTYSIS
Lower respiratory track bleeding below epiglottis
Differential diagnosis with ENT ve GIS must be evaluated before saying hemoptysis
![Page 28: Cough, Sputum Hemoptisis](https://reader035.vdocument.in/reader035/viewer/2022062412/577cce181a28ab9e788d4c42/html5/thumbnails/28.jpg)
Causes of hemoptysis:Chest X Ray: Anormal
I.Infections: -Pneumonia -Tbc -Lung abcess -Bronchiectasis -Fungal infectionsII.Lung tumours: -Bronchial Cancers
-Metastatic cancers -B.adenoma
![Page 29: Cough, Sputum Hemoptisis](https://reader035.vdocument.in/reader035/viewer/2022062412/577cce181a28ab9e788d4c42/html5/thumbnails/29.jpg)
Causes of hemoptysis:III. Alveolar hemorrhage: -Vasculitis
-Goodpasture’s syndrome -Wegener granulomatosis -Behçet Disease -SLE -Drugs (penicillamine)
IV.Other -Thorax trauma-A-V malformations-P.E-Disorders of coagulation
![Page 30: Cough, Sputum Hemoptisis](https://reader035.vdocument.in/reader035/viewer/2022062412/577cce181a28ab9e788d4c42/html5/thumbnails/30.jpg)
Causes of hemoptysis
Normal X-Ray
-Chronic bronchitis-Pulmonary Embolism-Bronchiectasis-Lung cancer-Mitral stenosis-Endometriosis
![Page 31: Cough, Sputum Hemoptisis](https://reader035.vdocument.in/reader035/viewer/2022062412/577cce181a28ab9e788d4c42/html5/thumbnails/31.jpg)
Massive hemoptysis
Hemoptysis > 600 mL /24 h Cause is % 90 bronchial arteries
causes:1-Tbc 2-Bronchiectasis 3-Malignity
4.Behçet disease
![Page 32: Cough, Sputum Hemoptisis](https://reader035.vdocument.in/reader035/viewer/2022062412/577cce181a28ab9e788d4c42/html5/thumbnails/32.jpg)
Hemoptysis: Physical examination
-Vital signs -Telengiectasia (Osler-Weber-rendu Syndrome) -Clubbing -Deep venous thrombosis -ENT (URT haemorrhage) -Oral ulcer =>Behçet ? -Chest exanination -Cardiovascular system examination (mitral
stenosis)
![Page 33: Cough, Sputum Hemoptisis](https://reader035.vdocument.in/reader035/viewer/2022062412/577cce181a28ab9e788d4c42/html5/thumbnails/33.jpg)
Hemoptysis: Diagnosis
Radiology:PA, Lat chest X-ray,
BT, HRCT if needed
PA Chest Xray and CT: normal => Angiography
![Page 34: Cough, Sputum Hemoptisis](https://reader035.vdocument.in/reader035/viewer/2022062412/577cce181a28ab9e788d4c42/html5/thumbnails/34.jpg)
Hemoptysis: Diagnosis
Laboratory: -Blood analysis, blood goup -Electrolytes, liver and kidney
function tests -PFT, ABG -PT, aPTT -ECG, Urine analysis
- Bronchoscopy
![Page 35: Cough, Sputum Hemoptisis](https://reader035.vdocument.in/reader035/viewer/2022062412/577cce181a28ab9e788d4c42/html5/thumbnails/35.jpg)
Masif hemoptysis: Tedavi Prensipleri
1-Block asphyxia
2-Stop bleeding
3-Treat primary disaese
![Page 36: Cough, Sputum Hemoptisis](https://reader035.vdocument.in/reader035/viewer/2022062412/577cce181a28ab9e788d4c42/html5/thumbnails/36.jpg)