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COUGH, SPUTUM, HEMOPTYSIS Prof. Dr. Bilun Gemicioğlu.

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Presentation on theme: "COUGH, SPUTUM, HEMOPTYSIS Prof. Dr. Bilun Gemicioğlu."— Presentation transcript:

1 COUGH, SPUTUM, HEMOPTYSIS Prof. Dr. Bilun Gemicioğlu

2 COUGH COUGH A 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).

3 Anatomic causes of cough Anatomic causes of cough Extra-thoracic İntra-thoracic CNS Head and neck Lower airways diseases Lung Parenchyma Mediastinum Cardiovascular Upper GIS Pleura Diaphragm Stomac

4 Cough receptors and related nerves RegionsAfferent nerves ParanasalTrigeminal (V) PharynxGlossofaringeus (IX) Larynx/tracheobronchial sys.Vagus (X) External ear way/ thympanic membrane Vagus (X) Eusophagus, stomac, pleuraVagus (X) Diaphragm, pericardPhrenic nerve Simpson CB. et al. Otolaryngology–Head Neck Surg 2006; 134: 693-700

5 Anamnesis: History While ? When ? Characteria ? Productive/non productive Additional symptoms? Risk factors: tabacco smoke additional diseases or use of drugs ?

6 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 suppl

7 Causes of acute cough Respiratory Causes: Inhaled gases or particule Mucus secretion Inflammatory exudate Foreing body Endobronchial lesion Bronchial boosts

8 Other causes of acute cough -acute heart failure -acute rhinosinusitis -Eusephageal reflux -Middle ear patologies and infections -Diaphragm, pleura and pericardium irritations

9 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: 693-700 Chung KF, Pavord ID Lancet 2008; 371: 1364-1374

10 Patogenic Triad Patogenic Triad PNDS GER ASTHMA Irwin RS et al. Chest 1998, 114:2 suppl Palombini BC et al. Chest 1999, 116:2,279-284

11 Anamnesis: When Morning Bed time; night After meal After irritant Only waking Talking Stress

12 Anamnesis: Characteria Like barking Larynx tm, inf. Metaliccough Trachea, brochies. Cow cough V.Chord paralisis Vomitig cough Whoopping cough Smoking cough tabacco smoke Irrıtative cough URTI

13 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; 997-1003

14 Anamnesis: Productive/Nonproductive ProductiveAirway diseases Non productivePleura, pericardium, Ear, GIS, heart, ACEI usage, diaphragm, mediastinum, thyroid… Irwin RS et al. Chest 1998, 114:2 suppl

15 Anamnesis: Additional symptoms Specific Dyspnea, wheezing, sputum, pyrosis, retronasal discharge….. Non specificEshaustion, insomnia, sweating, muscular pain, urine incontinence, headache, loss of appetite, axiety

16 Anamnesis: Specific additional symptoms PNDS post nasal drip, throat clearing runny nose, nasalcongestion, sputum Asthma Dispnea, thightness of breath, wheezing GER Burning, regurgitation, COPDsputum, effort dispnea BronchiectasiaSputum Heart failureEffort dispnea, tachycardia, edema

17 Anamnesis: Risk factors Smoking casesLung cancer, COPD, asthma, irritation Irwin RS et al. Chest 1998, 114:2 suppl Additional diseases AIDS, cancer, viral URI Drug usageACEI, Nitrofurantoin, Immunosupresives

18 Physical Examination Physical Examination Head and neck Thorax Upper GIS Heart ENT

19 Laboratory Laboratory 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

20 Treatment of cough NON SPECIFIC SPECIFIC ANTITUSSİVEPROTUSSIVE TARGET THERAPY CodeinDekstrometorfanDifenhidraminPseudoephedrineDekstrobromfeniramin İpratropium Bromid Naproxen Hipertonic saline ErdosteinAmilorid N acetylcysteine TerbutalinePhisiotherapy Postural drenage Irwin RS et al. Chest 1998, 114:2

21 SPUTUM Mucus glands and goblet cells of lower respiratory tract secrete 10ml mucus every day Exess of lower respiratory track expectoration is called sputum

22 General causes of sputum Exess of mucus production Changement in the quality of mucus Lacking activity of mucociliar clearance

23 Sputum:Anamnesis: Quantity of sputum Quality of sputum; density, calour Odor of sputum Time of expectoration

24 Sputum: Anamnesis Sputum QualitySuspect diseases Purulent; yellow-green mucoidPneumonia, asthma with eosinophilia RustyPneumonia (pneumoccocus) CherryPneumonia (klebsiella) Melanopthisis (black-grey)Air pollution, coal worker Rock water vomicEccinoccocus cystes ChocolateAmibe abscess Putrefactive; faol smellingLung abscess (anaerobic infections) < 600cc/day, morning expect.Bronchiectsasis

25 Sputum: Diagnosis Physical examination of the lungs Chest X-ray, CT, HRCT Sputum analysis Blood analysis Bronchoscopy

26 Sputum: Treatment Treat the causative disease Postural dranage Mucolytics Decongestant

27 HEMOPTYSIS Lower respiratory track bleeding below epiglottis Differential diagnosis with ENT ve GIS must be evaluated before saying hemoptysis

28 Causes of hemoptysis: Chest X Ray: Anormal I.Infections: -Pneumonia -Tbc -Lung abcess -Bronchiectasis -Fungal infections II.Lung tumours: -Bronchial Cancers -Metastatic cancers -B.adenoma

29 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

30 Causes of hemoptysis Normal X-Ray -Chronic bronchitis -Pulmonary Embolism -Bronchiectasis -Lung cancer -Mitral stenosis -Endometriosis

31 Massive hemoptysis Hemoptysis > 600 mL /24 h Cause is % 90 bronchial arteries causes:1-Tbc 2-Bronchiectasis 3-Malignity 4.Behçet disease

32 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)

33 Hemoptysis: Diagnosis Radiology: PA, Lat chest X-ray, BT, HRCT if needed PA Chest Xray and CT: normal => Angiography

34 Hemoptysis: Diagnosis Laboratory: -Blood analysis, blood goup -Electrolytes, liver and kidney function tests -PFT, ABG -PT, aPTT -ECG, Urine analysis - Bronchoscopy

35 Masif hemoptysis: Tedavi Prensipleri 1-Block asphyxia 2-Stop bleeding 3-Treat primary disaese


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