hemoptysis and cough
TRANSCRIPT
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 [email protected]
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