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

2. Discuss the pathophysiologic changes causing the signs and symptoms and any tests required to clarify the effects on Sammy.

3. Suggest some reasons for Sammy’s difficulty breathing and wheezing.

4. Discuss the potential complications of aspiration of vomitus.

Answer 1

1. One of the most common complication of vomiting is aspiration.Usually in normal condition aspiration of fluid is not possible ,because when fluid enter into the airpassages the epiglottis block the passage.When the protective cough reflex is weakened the risk of aspiration is high.When a small amount of saliva or food content enters the airway it causes intermittent or persistent symptoms such as recurrent wheezing,chronic cough,apnea and pneumoniaChildren affected by aspiration syndrome may present with symptoms shortly after eating.The usual site for aspiration pneumonia is apical and posterior lobes of the right lung.As the lumen of the right main bronchus is more vertical and of slightly wider diameter than that of the left,aspirated material is more likely to end up in this bronchus or one of its subsequent bifurcation.Since Sammy was lying down in supine position the aspirated material might have entered into the posterior segment of the upper lobes.

2 The incidence of aspiration pneumonia is higher in young children and the cause of the incidence is unknown.Following aspiration if patient shows acute inflammmatory signs such as fever,tachycardia,tachypnoea or respiratory symptoms such as cough then it should be clarified with chest Xrays

3 it is quite common to find this condition in children from 1 to 3 years old during the oral stage development,and the solid particles result in airway obstruction and result in acute hypoxaemia. When we eat food sometimes the food may go into the wrong way and this does happen even if we have a normal gag reflex and at most times this could be prevented by coughing.If there is impaired coughing ability they may not be able to do so.it may be due to a numberof reasons such as neurological disorders,a weakened immunesystem,esophageal disorders or due to dental problems.T

4 if left untreated it may result in bacterial aspiration pneumonia which may progress to lung abscess or bronchiectasis and acute respiratory distress.in most cases we will not know we have developed pneumonia or pulmonary edema until you experience symptoms such as difficulty breathing and coughing.