COUGH EXPECTORATION DR N SANKAR COUGH Defensive mechanism

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 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- 1 ST 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 UVULASINUSITIS 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, 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

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