Question

Sammy, age 3 years, ate his dinner and then said his tummy hurt. His mother suggested he lie down in the adjacent room while his parents finished dinner. A few minutes later, they heard Sammy vomiting. His mother rushed in to lift Sammy up. When vomiting ceased, they noticed Sammy continued to cough and seemed to be choking. He was struggling to breathe and a wheezing sound was obvious. It appeared that he had aspirated some vomitus. His parents drove him to a nearby hospital for examination.

1. Analyze the specific effects of aspirating vomitus on Sammy, including the probable effects on his bronchi and lungs, and why might one lung be affected more than the other.

2. Appraise explanations for Sammy’s difficulty breathing and wheezing.

3. Discriminate the pathophysiologic changes causing the manifestations.

Answer 1

1.When particles of vomitus enter into bronchi, and then to it reaches to lungs, it stimulates cough reflex to clear the foreign particles from respiratory tract. The severity of symptoms will depends on the material aspirated. The symptoms include sudden cough, wheezing may be present, have trouble breathing, typical chocking sign holding the neck and unable to talk. If the person or child unable to clear the vomitus, it will reach into lungs and may cause pneumonia, lung consolidation, etc. If gastric acid aspirated into lungs it will damage the lung paranchyma due to its acidity.

The right middle-lower lobe is the most common site affected due to the large caliber and vertical base of the right mainstem bronchus.

2. After the dinner, the indigested food materials or gastric contents may aspirated into the Sammy's lower respiratory tract and lungs. It may partially block the respiratory tract or may stimulates the inflammatory process which leads to increased mucus production and bronchospasm. Because of that Sammy experiencing breathing difficulty and wheezing.

3. Signs and symptoms of aspiration vary based on the site of obstruction, the size of the foreign particles, and the severity of obstruction. Classically the patient present with acute onset of choking, in this case obstruction may be partial or complete. Partial obstruction is characterized by chocking with drooling, stridor, and the patient maintains the ability to speak. In complete obstruction, patient is unable to speak, cough. Increased respiratory rate may be the only sign of aspiration in a child who cannot verbalize or report.

If they swallowed foreign particles. If the foreign particles remains in the airway, which may lead to severe complications. Patient may develop inflammation of airway or lung abscess from foreign particles. It can also cause pneumonia. Complications such as chemical bronchitis, mucosal reactions, and development of granulation tissues may develop if large amounts of gastric acids aspirated.