Pathophysiology of Heart Disease – A Collaborative Project of Medical Students and Faculty 6th Edition [PDF] Ebook download
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Pathophysiology of Heart Disease Leonard S. Lilly- 6th Edition Aspirations
- Inhaling food, mouth or gastric secretions, or foreign bodies into the tracheobronchial tree causes acute, recurrent, or chronic cough.
- Interference with normal swallowing disrupts the coordination of swallowing and breathing that prevents aspiration.
- Structural causes of disordered swallowing include esophageal atresia (in neonates), strictures, webs, or congenital stenoses.
- Mediastinal lesions (tumors, lymph nodes), including vascular rings, may compromise the esophageal lumen and esophageal peristalsis, increasing the likelihood of aspiration. Functional disorders include central nervous system dysfunction or immaturity, dysautonomia, achalasia, and diffuse esophageal spasm.
- Prior neck surgery, including tracheostomy, may alter normal swallowing. Tracheoesophageal fistula and laryngeal clefts are congenital malformations with direct physical connections between the tracheobronchial tree and the upper gastrointestinal tract; thus oral contents enter the lungs directly.
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Making the diagnosis of aspiration as the cause of cough may be difficult. Barium contrast studies during swallowing may help characterize these disorders if barium enters the trachea. Because most patients aspirate sporadically, a normal barium swallow does not rule out aspiration.
Radionuclide studies can be helpful if ingested radiolabeled milk or formula is demonstrated over the lung fields at severalhour intervals after the meal. Bronchoscopy and bronchoalveolar lavage that recover large numbers of lipid-laden macrophages suggest that aspiration has taken place; however, the finding is neither sensitive nor specific for aspiration.
Pathophysiology of Heart Disease Aspiration Treatment
Treatment depends largely on the cause of aspiration. Because many patients who aspirate do so because of lack of neurologic control of swallowing and breathing, it is often difficult to prevent. Even gastrostomy feedings cannot prevent aspiration of oral secretions. In extreme cases, tracheostomy with ligation of the proximal trachea has been employed. This not only prevents aspiration but also prevents phonation, and it must be considered only in unusual situations. Aspiration pneumonia is often treated with intravenous ampicillinsulbactam or clindamycin to cover mouth flora of predominant anaerobes. Additional coverage against gram-negative organisms may be indicated if the aspiration is nosocomial.
Pathophysiology of Heart Disease – A Collaborative Project of Medical Students and Faculty [PDF] Ebook download