Перелік екзаменаційних питань

Дата добавления: 2015-10-15; просмотров: 467

Acute bronchitis, like other inflammatory affections of the chest, generally arises as the result of exposure to cold, particularly if accompanied with damp, or of sudden change, from a heated to a cool atmosphere.

It may also arise as the result of inhaling irritating dust or vapours. Great numbers of bacteria are commonly found in the expectoration, and the formed by these are presumably responsible for aggravating the condition. Symptoms.The symptoms vary according to the severity of the attack, and more especially according to the extent to which the inflammatory action spreads in the bronchial lubes.

The disease usually manifests itself at first in the form of a catarrh, or common cold; but the accompanying feverishness and general constitutional disturbance proclaim the attack to be something more severe, and symptoms denoting the onset of bronchitis soon present themselves. A short, painful, dry cough, accompanied with rapid respiration, a feeling of rawness and pain in the throat and behind the end of oppression or tightness throughout the chest, mark the early stages of the disease.

After a few days, expectoration begins to come with the cough, at first scanty and viscid or frothy, but soon becoming copious and of purulent character. In general, after free expectoration has been established the more urgent and distressing symptoms abate; and, while the cough may persist for three or four weeks, in the majority of instances convalescence advances, and the patient is ultimately restored to health, although there is not infrequently left a tendency to a recurrence of the disease on exposure to its exciting causes.

When the ear or the stethoscope is applied to the chest of a person suffering from such an attack as that now described, there are heard in the earlier stages snoring or cooing sounds, mixed up with others of wheezing or fine whistling quality, accompanying respiration. These are named dry sounds or bronchi, and they are occasionally so abundant and distinct as to convey their vibrations to the hand applied to the chest, as well as to be audible to a bystander at some distance.

As the disease progresses these sounds become to a large extent replaced by bubbling character, which are termed moist sounds or râles. Both if abnormal sounds are readily explained by a reference to the pathological condition of the parts.

One of the first effects of inflammation upon the bronchial mucous membrane is to cause some degree of swelling, which together with the presence of a tough secretion closely adhering to it, tends to narrow the tubes. The respired air as it passes over this surface gives rise to the dry or sonorous breath sounds, the coarser being generated in the large, and the finer or wheezing sounds in the small divisions of the bronchi.

Before long, however, the discharge from the bronchial mucous membrane becomes more abundant and less glutinous, and accumulates in the tubes till dislodged by coughing. The respired air as it passes through this fluid causes the moist râles above described. In most instances both moist and dry sounds are heard abundantly in the same case, since different portions of the bronchial tubes are affected at different times in the course of the disease.

Such are briefly the main characteristics presented by an ordinary attack of acute bronchitis running a favourable course.

The case is, however, very different when the inflammation spreads into, or when it is primarily in the minute ramifications of the bronchial tubes which are in immediate relation to the air-cells of the lungs, giving rise to that form of the disease known as capillary bronchitis.

The surface of the body is pale or dusky, the lips are livid, while breathing becomes increasingly difficult, and is attended with suffocative paroxysms which render the recumbent posture impossible.

Unless speedy relief is obtained by coughing and expectoration, the patient’s strength gives way, somnolence and delirium set in, and death ensues. All this may be brought about in a few days, and such cases, particularly among the very young or the aged, sometimes prove fatal within forty-eight hours.

Acute bronchitis must at all times be looked upon as a severe and serious ailment but there are certain circumstances in which its occurrence is a matter of special anxiety of the physician. It is preeminently dangerous at the extremes of life, and mortality statistics show it to be one of the most fatal diseases of those periods. This is to be explained not only by the well-recognized fact that all acute diseases tell with great severity on the feeble frames alike of infants and aged people, but more particularly by the tendency which bronchitis undoubtedly has, in them, to assume the capillary form, and when it does so to prove quickly fatal. The importance, therefore, of early attention to the slightest evidence bronchitis among the very young or the aged can scarcely be overrated.

Bronchitis is also apt to be very severe when it occurs in persons who suffer from anydisease affecting directly or indirectly the respiratory functions, such as consumption orheart disease; the supervention of an attack of acute bronchitis is an alarming complication, increasing, as it necessarily does, the embarrassment of breathing. The same remark is applicable to those numerous instances of its occurrence in children who are, or have been, suffering from such diseases as have always associated with them a certain degree of bronchial irritation, such as measles and whooping-cough.

TreatmentWith respect to the treatment of acute bronchitis in those mild cases which are more of the nature of a simple catarrh little else will be found necessary than confinement in a warm room, or in bed, for a few days, and the use of light diet, together with warm diluent drinks, warm milk being specially beneficial.

Additional measures are, however, called for when the disease is more markedly developed. Medicines to allay fever and promote perspiration are highly serviceable in the earlier stages. Later on, with the view of soothing the pain of the cough, and favouring expectoration, mixtures with the addition of some opiate may be advantageously employed. The use of opium, however, in any form should not be resorted to in the case of young children without medical advice, since its action on them is much more potent and less under control than it is in adults. From the outset of the attack the employment of warm applications to the chest in the form of fomentations or poultices affords great relief. In the earlier stages few remedial measures are of greater value than the frequent inhalation of steam. The relief to the cough and breathing, and the aid to expectoration afforded by this simple plan are often surprising.

During the whole course of any attack of bronchitis attention must be paid to the due nourishment of the patient by light, warm articles of diet; and during the subsequent convalescence, which, particularly in elderly persons, is apt to be slow, tonics and stimulants may have to be prescribed.