上海交通大学：《诊断学》课程PPT教学课件（英语版）Chapter 5 Cough and expectoration

Cough and expectoration a Coughing is an essential defense mechanism that it prevents the airways from the foreign substance and clear the excretion of respiratory tract Coughing is a reflex. permanent and frequent coughing indicates an abnormality

Cough and expectoration ◼ Coughing is an essential defense mechanism that it prevents the airways from the foreign substance and clear the excretion of respiratory tract. ◼ Coughing is a reflex. permanent and frequent coughing indicates an abnormality

Mechanism a Extrathoracic cough receptors( located in nose oropharynx larynx and upper trachea) intrathoracic cough receptors( located in low trachea and large central bronchi a Afferent( vague, trigeminal, superior laryngeal glosso-pharyngeal nerves ■ Efferent a recurrent laryngeal nerve -- closure of glottis a corticospinal tract and peripheral nerves ---- contraction of thoracic and abdominal musculature

Mechanism ◼ Extrathoracic cough receptors ( located in nose oropharynx larynx and upper trachea) ◼ intrathoracic cough receptors ( located in low trachea and large central bronchi) ◼ Afferent ( vague , trigeminal , superior laryngeal , glosso-pharyngeal nerves ) ◼ Efferent ◼ recurrent laryngeal nerve --- closure of glottis ◼ corticospinal tract and peripheral nerves ------- contraction of thoracic and abdominal musculature

The cough reflex a deep breath---glottic closure---relaxation of diaphragm, contraction of expiratory muscle- positive thoracic pressure--suddenly release of glottis open---thoracic positive pressure airflow out---cough reflex

The cough reflex A deep breath---glottic closure---relaxation of diaphragm, contraction of expiratory muscle--- positive thoracic pressure--suddenly release of glottis open---thoracic positive pressure airflow out--- cough reflex

Etiology ■ Respiratory pleural disease ■ cardioⅴ ascular disease central nerve system factor

Etiology ◼ Respiratory ◼ pleural disease ◼ cardiovascular disease ◼ central nerve system factor

Respiratory disease Stimulator -- extra and intrathoracic ---from nose, oropharynx ---bronchi---cough reflex such as 1. inhalation of foreign material 2. inflammation of respiratory tract 3. bleeding of respiratory tract 4. tumor of respiratory tract

Respiratory disease Stimulator --- extra and intrathoracic --- from nose,oropharynx --- bronchi --- cough reflex. such as: 1.inhalation of foreign material 2.inflammation of respiratory tract 3.bleeding of respiratory tract 4.tumor of respiratory tract

Pleural Disease Such as pleurisy, thoracic effusion pleural biopsy or pleuracentisis

Pleural Disease Such as: ◼ pleurisy, thoracic effusion ◼ pleural biopsy or pleuracentisis

Cardiovascular disease Mitral stenosis -- left heart failure pulmonary edema ---trausudate or exudate stimulates intra-thoracic-cough receptor cough Embolism of pulmonary can cause pulmonary venous pressure elevate pulmonary edema ---transudate or exudate stimulates intra thoracic cough receptor cough

Cardiovascular Disease ◼ Mitral stenosis --- left heart failure --- pulmonary edema --- trausudate or exudate --- stimulates intra-thoracic-cough receptor --- cough ◼ Embolism of pulmonary can cause pulmonary venous pressure elevate --- pulmonary edema ---transudate or exudate ---stimulates intra thoracic cough receptor ---cough

Central nerve system a Inflammatory of CNs can cause coughing such as: encephalitis and meningitis

Central nerve system ◼ Inflammatory of CNS can cause coughing ◼ such as: encephalitis and meningitis

Expectoration Expectoration is a pathological phenomenon that human being remove the pathological secretion from respiratory system by means of coughing

Expectoration Expectoration is a pathological phenomenon that human being remove the pathological secretion from respiratory system by means of coughing

Expectoration a The daily quantity of bronchial secretions produced by a normal person is unknown But it is sufficiently small to be removed by mucociliary action alone a Cough and expectoration are not required

Expectoration ◼ The daily quantity of bronchial secretions produced by a normal person is unknown. But it is sufficiently small to be removed by mucocillary action alone. ◼ Cough and expectoration are not required