A symptom of a cough impulse with an external abdominal hernia. Strangulated hernia: are there any contraindications to surgery?

A sudden onset of cough is the body’s response to the influence of some irritant. Due to cough shocks, the cough may be convulsive. If the shocks are repeated one after another, the patient cannot even take a breath.

There are cases in which, after such attacks, a person’s heart and breathing rhythms are disrupted. They can also cause vomiting and even fainting. The coughing itself is not a disease. They represent a symptom, which in turn indicates some kind of malfunction or disorder in the body.

Coughing as symptoms of illness

Before you relieve a coughing attack, you first need to find out what symptoms of what disease it can be attributed to. If the cause of the cough is not eliminated, treatment of the attacks themselves is ineffective.

In an adult, coughing attacks can be signs of acute respiratory infections, viral or bacterial infections, problems of the nervous or cardiovascular system, allergies or respiratory diseases (lung diseases, bronchial asthma, tuberculosis).

There are certain characteristics that are used to describe cough. If you correctly decipher the combination of these signs, you can find out what pathology is causing strong coughing tremors.

A cough without sputum is dry. It often manifests itself as the cause of pathologies in organs that are not related to the respiratory system (heart disease, diseases of the nervous system, pericarditis, inflammation of the external ear).

A wet cough can only be caused by pathologies of the respiratory system. Due to the fact that the formation of bronchial secretions is increased, such a cough is accompanied by strong sputum production.

Depending on the frequency of occurrence and duration of cough, it can be:

• periodic (single urges);
• constant (severe attacks).

Acute and chronic cough are determined by duration of existence. A cough that lasts about 3 months is called acute, and a cough that lasts more than 3 months is called chronic.

Factors that cause a coughing attack (in adults):

• Allergic and inflammatory: swelling, increased sputum production, inflammation of the mucous membrane of the respiratory tract, bronchial spasms.
• Thermal: damage or irritation of the airways from too hot or cold air.
• Mechanical: enlarged lymph nodes, the appearance of tumors compressing the trachea and bronchi, foreign bodies in the ear canal or larynx.
• Chemical: inhalation of gaseous substances or drugs along with air.

Coughing attacks in children

Cough attacks in a child must be treated very carefully, since young children cannot always describe their condition and symptoms in detail and correctly. The most common causes of cough in children are inflammatory and mechanical factors.

If the cough is accompanied by fever, general weakness, increased frequency of breaths, and suffocation, then most likely the cause of its occurrence is a cold. If you notice similar symptoms in your child, be sure to consult a doctor.

If the attacks are not accompanied by the above symptoms, but the cough only gets worse at night, then the cause of this problem may be excessive salivation during teething.

How to get rid of it?

As we mentioned earlier, before taking any measures, you must first find out the nature of the cough. The main task in the treatment of cough attacks is not their complete treatment, but only relief.

In order for sputum to be separated more easily and removed from the lungs more quickly, it is recommended to take agents that help liquefy it. It is also necessary to drink plenty of fluids and use syrups with guaifenesin.

If a cough interferes with sleep, causes vomiting or suffocation, then it would be advisable to get rid of it as soon as possible. For this, antitussive drugs can be used within reasonable limits.

To reduce irritation and pain, it is recommended to gargle with a saline solution. To prepare it, just dilute half a teaspoon of salt in a glass of water.

Cough can also occur due to smoking tobacco. Therefore, if you want to get rid of a cough, then you must give up this bad habit first!

Dry air also leads to increased coughing. The use of household appliances that are designed to humidify the air will help to significantly alleviate your condition.

Attention! If your cough is accompanied by the following symptoms, be sure to consult a doctor as soon as possible.

1. Increased body temperature.
2. Weight loss.
3. General weakness.
4. Attacks of suffocation.
5. The duration of periodic attacks is more than a week.
6. Thick sputum mixed with blood.
7. Chest pain.

One of the complications of the development of an umbilical hernia is a strangulated hernia. This disease is most common among adults (up to 10% of the population), with women mainly at risk. About why a strangulated hernia develops, what methods are available for diagnosing it, and whether surgery is always necessary - right now.

Incarcerated hernias are a violation of an internal organ located in the abdominal cavity as a result of its instant or gradual compression. Thus, if we answer what a strangulated hernia is, we can say: it is a mechanical effect on the abdominal cavity, as a result of which sharp and aching pain develops. The part of the body through which the pinched fragment communicates with the rest of the organ (for example, the intestines) is called the hernial orifice.

The main reasons include the following:

1. With hernias, a person’s weight is of great importance. Excessive obesity almost always leads to the fact that almost the entire weight load falls on the stomach, so the intestines and internal organs receive additional mechanical pressure, which greatly increases the risk of developing such diseases.
2. Pregnancy can be a prerequisite for a strangulated hernia. However, only in cases where a woman suffers from quite noticeable obesity, as well as in the development of multiple pregnancies.
3. Abdominal injuries, severe mechanical stress as a result of heavy physical labor.
4. Constant constipation, due to which feces exert strong pressure on the intestines (the so-called fecal strangulation of the hernia develops).
5. Ascites is the accumulation of excess fluid in the abdominal area.
6. Rapidly developing tumors in the abdominal area, benign or oncological in nature.
7. Finally, provoking factors that enhance the development of an existing disorder include the so-called cough impulse - a strong, intense attack of coughing or sneezing, which causes injury to the peritoneum.

The consequences of this phenomenon become especially negative if timely measures are not taken:

1. First, there is a gradual deterioration in the blood supply to the organ.
2. As a result, tissue begins to die (necrosis), which can subsequently lead to the decomposition of entire intestinal fragments.

You should pay attention to which organs are most often affected as a result of the formation of a strangulated hernia:

• oil seal;
• various outgrowths of the small intestine in the form of loops;
• colon and cecum;
• bladder.

In rare cases, the following organs may also be affected:

• stomach;
• lower part of the esophagus;
• uterus;
• seminal canal.

Anatomical features, as well as the physiological development of the disease, explain the different types of strangulated hernias. The classification is based on various grounds.

First of all, all pinching can be divided into 2 large groups:

1. External – this is the most common category. Most commonly encountered are inguinal pinching, various forms of femoral hernia and umbilical hernia. Particularly rare types are hernia of the lumbar triangle and the so-called Spigelian line.
2. Internal strangulated hernias are less common. They are located above and below the diaphragm (the muscular wall that separates the respiratory organs from the digestive organs), as well as above the bladder, inside the peritoneum (the so-called pouch of Douglas) or in the pelvis.

For example, depending on the stage of development, the following types of infringement are distinguished:

1. Primary is a very rare category of diseases, since in this case the cause of occurrence is related to the fact that the person suddenly lifted a load or sharply tensed his abdominal muscles. It is especially dangerous if the patient has individual predispositions to such disorders.
2. A secondary strangulated hernia is a strangulated hernia that forms against the background of an existing disorder.

There are various forms of the disease:

1. Elastic infringement develops mainly due to constant heavy physical labor. This is a rather characteristic, pronounced type of disease, which is mainly observed in young people. Almost always, the pathology is accompanied by severe pain, attacks of nausea and vomiting. Elastic strangulation can be treated quite quickly if you consult a doctor in a timely manner.
2. Fecal strangulated hernia occurs most often in patients over 60 years of age, in whom the pathology develops over a long period of time. Gradually, the affected area grows in size, and in particularly advanced cases, treatment of a strangulated hernia is associated only with supportive therapy, since reduction of the protrusions becomes impossible.

Depending on the anatomical features, several special types of pathology are distinguished:

1. Retrograde strangulation of a hernia is due to the fact that due to mechanical pressure, 2 intestinal protrusions (loops) are formed in the so-called hernial sac - a foreign formation that appears due to stress. Retrograde strangulation of the hernia leads to the fact that the third loop, which connects the first two, is supplied with blood much worse, which is why inflammatory processes and necrosis (death) of tissue develop.
2. Parietal strangulation (Richter's hernia) - part of the intestine is partially compressed, precisely in the area adjacent to the surface, opposite the mesenteric edge. Thus, if retrograde strangulation of a hernia is more dangerous, since almost the entire part of the intestine is not supplied with blood, then in this case the intestinal lumen is only partially narrowed. In most cases, this pathology is associated with the small intestine - these are different types of femoral hernia, umbilical hernia. Also, often we are talking about a hernia of the so-called white line of the abdomen.
3. Littre's hernia is essentially also a parietal strangulation, but in this case the blood supply to the affected area becomes noticeably worse. Thus, retrograde strangulation of the hernia and Littre strangulation are the most dangerous.

Depending on the degree to which compression of the organ occurred, 2 forms of pathology are distinguished:

1. Complete is the most dangerous option, since the blood supply to the damaged area is almost completely suspended.
2. Incomplete – these are all varieties of this type of disease such as parietal strangulation.

Mostly, patients are diagnosed with external forms of the disease: umbilical hernia, postoperative hernia, and others. The most common types of pathology are discussed below.

This type of pathology occurs in 10 patients out of 100 cases of such diseases. It is diagnosed quite simply, since the signs of a strangulated hernia are obvious enough to detect. In this case, there is a certain danger, since it is umbilical pinching that often turns out to be irreparable - damaged parts of the intestine that have gone beyond their natural boundaries cannot be returned to their place.

Surgery in this case involves 3 types of operations:

1. Direct dissection of the navel.
2. Sapezhko's operation, which is considered a more progressive method.
3. Grekov's operation for a pinched hernia is also considered a fairly effective measure.

Most often, we are not talking about ordinary infringement, but rather compression of the fat layer in the abdominal cavity. In this case, diagnosis is of great importance, which allows you to determine whether there is a so-called hernial sac - an extraneous protrusion of the intestine or other internal organ. Further treatment depends on this:

1. If there is a bag, it is opened, the organ is examined for damage, appropriate measures are taken and the bag is removed.
2. If it is not there, then only foreign formations that arise due to compression are cut off.

Postoperative ventral hernia

This type of disorder is also called strangulated ventral hernia. It does not develop very often and is distinguished by fairly large hernial orifices. In this case, treatment also involves surgery:

1. First, the relevant area is dissected.
2. Then all products of inflammatory processes are removed.
3. The hernial sac is removed.

Subsequently, during recovery, patients undergo a course of antibiotic therapy to prevent decay.

Clinical signs of a strangulated hernia, some of which the patient can easily identify at home, mainly include the following manifestations of pathology:

1. Pain is a mandatory symptom of a strangulated hernia. Usually pain does not manifest itself in a calm state. However, at the time of severe coughing or sneezing, heavy lifting and other stress, it may arise and not even subside. Often the pain can become very acute, as a result of which the skin turns pale, the heart rate increases significantly and a painful shock reaction develops. In rare cases, the sensations are similar to contractions.
2. The symptom of a cough jerk is a very important sign. This phenomenon is due to the fact that the hernial sac, in which part of the compressed organ is located, becomes a kind of isolated part. Because of this, when coughing, the load is transferred to almost the entire abdominal cavity (which is normal), but not to this area.
3. Intestinal obstruction, problems with bowel movements.
4. Unexpected difficulty passing gas.
5. Nausea and vomiting, and the secretion comes out in an unpleasant dark green color. Vomit poisoning often smells like feces, which in most cases indicates the development of pinching.
6. A noticeable increase in size of the protrusion, painful sensations when touching it.

PLEASE NOTE

To determine whether the cough impulse is transmitted to all areas of the peritoneum, you need to place both palms on the painful area and clasp the entire pinching with them. Then cough sharply. If tension is not felt in this area, it means that a hernial sac has already formed there.

First of all, it is important to understand that self-treatment of such a disease is excluded, since in most cases we are talking about a simple surgical operation. Your actions can harm the body:

1. You cannot reduce a hernia with your hands or objects, as you can cause rupture of its membranes and blood vessels, which will lead to extremely severe pain with possible loss of consciousness and even internal bleeding.
2. You should not take hot or even warm baths, or place a heating pad on the damaged area and try to warm it.
3. It is unacceptable to take laxatives and antispasmodics.

Thus, as an emergency, it is better to immediately call an ambulance, but in general, you need to immediately consult a doctor who will make a diagnosis based on:

• collecting complaints;
• external examination and palpation (palpation);
• taking blood, urine, and stool tests;
• Ultrasound of the abdominal organs.

It should be understood that a pinched hernia can be treated exclusively through surgery, but the operation is not complicated and has virtually no contraindications.

Preparation for surgery and anesthesia

As a rule, an emergency operation is prescribed, so preparations are carried out quickly:

• if necessary, the contents of the stomach are emptied;
• Urine is drained using a catheter.

Most often, only local anesthesia is performed, although in some cases (for example, treatment of a strangulated hernia using laparoscopy) general anesthesia is required. Sometimes spinal anesthesia is also given, which temporarily blocks the work of certain areas of the spinal cord.

There are no contraindications for traditional pinching removal surgery. In this case, any hernia with a strangulation time of no more than 6 hours is treated, even with the presence of complications (poisoning of the body, the development of peritonitis).

In general terms, this procedure involves performing the following actions:

1. A skin incision directly in the pinched area.
2. Incision of the hernial sac, removal of excess fluid.
3. Repositioning an organ into the desired position (for example, loops of the small intestine). Fixing its position and suturing the damaged area.
4. If the organ has received quite severe damage due to compression, and its tissues have mostly died off, this part is cut off, and all the rest are sewn together.
5. Subsequently, the hernial orifice is removed by tensioning the patient’s tissues or a special supporting mesh is inserted.

The advantages of such an intervention are obvious:

• you can see with your eyes how much the area of ​​the organ has died and make the appropriate decision to remove it;
• Thanks to this intervention, the development of internal inflammatory processes is excluded.

This type of operation is performed under general anesthesia, so it has its contraindications:

• any stage of pregnancy;
• severe obesity (grade 3 and 4);
• obvious signs of intestinal obstruction.

This intervention is carried out in cases where the patient is taken to the hospital as quickly as possible - the pinching period should not exceed 3 hours. Also important are the minor nature of the protrusion and the absence of complications associated with peritonitis.

The intervention technique is as follows:

1. Punctures are made through which special instruments are inserted, allowing one to monitor the entire progress of the process using a magnified image.
2. The tissues are dissected.
3. The hernial sac is removed and the organ is realigned.
4. The tissues are tightened using a medical stapler.

Thanks to precise control of the operation progress, it is possible to ensure:

• minimal injury;
• absence of scars;
• reducing the risk of complications and traumatic effects on neighboring tissues.

A separate category of diseases is associated with pregnant women. In this case, most often the operation is performed exclusively after childbirth. As for the prenatal period, the woman is prescribed to wear a special bandage, which is selected depending on the size and individual characteristics of the patient.

Usually the operation is performed 7-8 months after birth. The positive effect of the intervention is associated not only with the treatment of the underlying disease, but also with the elimination of some birth consequences - tightening the skin or removing excess fat.

Disease Prevention

Preventive measures should be taken especially carefully by patients who have a certain predisposition to obesity, as well as pregnant women.

In general, prevention is quite simple and includes compliance with the following rules:

1. Eating a balanced diet to prevent developing too much excess belly fat.
2. Abdominal muscle training – periodic exercises on the abdominal muscles perfectly prevent pinching and help strengthen the abs themselves.
3. Finally, pregnant women can be recommended to wear a bandage, since such a measure practically eliminates the development of the disease.

You should not neglect the basic rules of a healthy lifestyle, since a pinched hernia never goes away without a trace. A hernia is treated urgently and only surgically, and there are practically no contraindications to the intervention.

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Clinical examination

Diagnosing a strangulated hernia in typical cases is not difficult. First of all, it is necessary to take into account anamnesis, from which it is possible to find out that the hernia was reducible and painless before the onset of pain. It should be taken into account that the moment of infringement is usually preceded by strong physical stress: lifting weights, running, jumping or defecation.

For strangulated hernia There are 4 clinical signs:

• sharp pain in the hernia area or throughout the abdomen;
• irreducible hernia;
• tension and pain of hernial protrusion;
• absence of cough impulse transmission.

Pain- the main symptom of infringement. It occurs, as a rule, at a moment of strong physical stress and does not subside, even if it stops. The pain is so severe that it becomes difficult for the patient to refrain from moaning and screaming. He is restless, his skin turns pale, and pain shock with tachycardia and decreased blood pressure often develops.

The pain is most often localized in the area of ​​the hernial protrusion; when the mesentery is pinched, irradiation is observed in the center of the abdomen and epigastric region. In the vast majority of cases, the pain remains very severe for several hours until necrosis of the strangulated organ occurs with the death of intramural nerve elements. Sometimes the pain syndrome can take on a cramping nature, which is associated with the development of intestinal obstruction.

In elderly patients suffering from a hernia, after many years of using a bandage, they develop an addiction to painful and other unpleasant sensations in the hernia area. In such patients, if there is a suspicion of infringement, it is important to identify changes in the nature of the pain syndrome, the moment of the onset of intense pain and other unusual symptoms.

Irreversible hernia- a sign that can only be important when a free, previously reducible hernia is strangulated. Then the patient usually associates the appearance of pain with the release of a hernia, which ceases to be reduced. With the development of strangulation of an irreducible hernia, this anamnestic sign is uninformative.

The following symptoms of a strangulated hernia are detected when: physical examination of the patient. At the onset of the disease, the patient’s condition is usually satisfactory, the body temperature is normal. Hyperthermia occurs only with the development of destruction of strangulated organs and secondary inflammation of the hernia membranes.

Upon examination hernial protrusion it is clearly visible does not disappear or change shape when the patient’s body position changes. On palpation, tension and sharp pain in the protrusion are determined, especially in the area of ​​the hernial orifice. Tension of the hernial protrusion and a slight increase in its size accompany strangulation of both reducible and irreducible hernia. This sign is more important for recognizing strangulation than the irreducibility of the hernia itself. Usually the protrusion becomes not only tense, but also sharply painful when palpation, which is often noted by patients themselves when they feel the hernia and try to perform a reduction.

Lack of transmission of cough impulse in the area of ​​hernial protrusion - the most important sign of strangulation. It is due to the fact that at the moment of strangulation, the hernial sac is disconnected from the free abdominal cavity and becomes, as it were, an isolated formation. In this regard, the increase in intra-abdominal pressure that occurs at the time of coughing is not transmitted to the cavity of the hernial sac (a negative symptom of a cough impulse). This symptom is difficult to assess in large ventral hernias, which contain a significant part of the abdominal organs. In such situations, when coughing, it is difficult to determine whether the cough impulse is transmitted to the hernia or whether it shakes along with the entire abdomen. To correctly interpret this symptom in such cases, you should not place your palm on the hernial protrusion, but grasp it with both hands. With a positive cough impulse symptom, the surgeon feels an enlargement of the hernia.

Percussion over a strangulated hernia, dullness due to hernial water is determined (if the hernial sac contains intestine, then tympanitis is heard in the first hours of strangulation).

Infringement is often accompanied by one-time vomiting, which at first is reflexive in nature. Further, as intestinal obstruction and intestinal gangrene develop, it becomes permanent. The vomit acquires a greenish-brown color and an unpleasant odor. Since intestinal strangulation (excluding Richter's hernia) is complicated acute intestinal obstruction, it is accompanied by all the symptoms characteristic of it.

Partial strangulation of the large intestine, for example, the cecum in a sliding inguinal hernia, does not cause obstruction, but soon after strangulation, along with pain, a frequent false urge to defecate (tenesmus) appears. Parietal entrapment of the bladder in a sliding hernia is accompanied by dysuric disorders: frequent painful urination, hematuria.

Long-term infringement leads to the development phlegmon of the hernial sac. A systemic inflammatory reaction and local signs of inflammation occur: swelling and hyperemia of the skin, severe pain and fluctuation over the hernial protrusion.

Ultimately, prolonged infringement ends in the development diffuse peritonitis due to the transition of the inflammatory process to the abdominal cavity or due to perforation of the sharply stretched and thinned adductor section of the strangulated intestine.

The picture inherent in elastic infringement was outlined above. Fecal strangulation has the same patterns of development, but is less violent. In particular, with fecal strangulation, the pain syndrome is not as pronounced, intoxication develops more slowly, and necrosis of the strangulated intestine occurs later. Nevertheless, fecal strangulation is just as dangerous as elastic strangulation, since the final outcome of these two types of strangulation is the same. That is why the treatment tactics for them are the same.

The physical examination of the patient must be carried out very carefully, since the initial clinical picture of strangulation is similar to some other acute diseases of the abdominal organs. In this regard, in case of abdominal pain, first of all, it is necessary to examine all those “weak” places of the abdominal wall that can serve as a hernial orifice. The need for such an examination arises because so-called primary strangulated hernias sometimes occur. This concept includes hernias that are strangulated immediately at the time of their appearance, without a previous hernia history. Especially often, hernias of rare localizations are subject to primary infringement: the semilunar line, lumbar regions, and the obturator canal. When examining the abdomen, it is sometimes possible to note a “splashing noise”, Val’s sign and other symptoms of acute intestinal obstruction.

Laboratory diagnostics

Depending on the severity of destructive changes in the injured organ general blood test demonstrates one or another degree of leukocytosis, a shift in the leukocyte formula to the left. At the same time, the absence of these signs for several hours immediately after the injury does not exclude this pathological condition.

Instrumental methods

Instrumental examination in the diagnosis of strangulated hernia is of secondary importance. X-ray examination allows you to identify signs of intestinal obstruction if there is a loop of intestine in the hernial sac. By using Ultrasound distinguish a strangulated hernia from inflammatory or malignant tumors of the abdominal wall, identify thrombosis of the venous node at the mouth of the great saphenous vein (sometimes it imitates a strangulated femoral hernia).

Differential diagnosis

Differential diagnosis of a strangulated hernia must be carried out with a number of pathological conditions associated both with the hernial protrusion itself and not directly related to it. Of course, in typical cases, the diagnosis of strangulation is not difficult, but sometimes, due to a number of circumstances (primarily strangulated hernia, concomitant pathology of the abdominal organs), its recognition is very difficult.

First of all, it is necessary to differentiate a strangulated hernia from irreducible hernia. It is not tense, has little pain, and transmits the cough impulse well. In addition, completely irreducible hernias are rare; usually, part of the hernial contents can still be reduced. Particular difficulties in differential diagnosis may arise with a multi-chamber hernia, when strangulation occurs in one of the chambers. Nevertheless, in this case, the obligatory signs of infringement are observed: pain, tension and lack of transmission of the cough impulse.

In practical surgery, sometimes it becomes necessary to differentiate strangulated hernia from coprostasis. A similar condition occurs mainly with irreducible hernias in elderly patients who have a physiological slowdown in peristalsis and a tendency to constipation. This leads to stagnation of the contents in the intestinal loop located in the hernial sac, but, unlike fecal strangulation, with coprostasis there is never compression of the intestinal mesentery. Manifestations of coprostasis increase gradually, they are not preceded by physical stress, and pain develops slowly. The pain is never intense, the first place is retention of stool and gases, the tension of the hernial protrusion is not expressed, the cough impulse symptom is positive. Coprostasis does not require surgical treatment; a conventional siphon enema is used to eliminate it. However unresolved coprostasis can lead to fecal strangulation of the hernia.

In clinical practice, there is a pathological condition that is usually referred to as “ false prejudice" This condition occurs in patients with external abdominal hernias, and is manifested by symptoms reminiscent of strangulation, but caused by some other acute disease of the abdominal organs. This situation can cause an erroneous diagnosis of a strangulated hernia, while the true nature of the disease remains hidden. Most often, diagnostic errors occur with intestinal obstruction, pancreatic necrosis, peritonitis of various natures, hepatic and renal colic. An incorrect diagnosis leads to incorrect surgical tactics, in particular, to hernia repair instead of the necessary wide laparotomy or unnecessary surgical intervention on the hernia for urolithiasis or biliary colic. The only guarantee against such an error is a careful examination of the patient. You should pay special attention to pain outside the hernia and carefully check the cough impulse symptom.

The doctor may also encounter a situation where a strangulated hernia as the true cause of acute intestinal obstruction remains unrecognized, and the disease is regarded as a consequence of intestinal strangulation in the abdominal cavity. The main reason for such an error is an inattentive examination of the patient. It should be remembered that a strangulated hernia does not always look like a clearly visible protrusion on the anterior abdominal wall. In particular, with an initial inguinal hernia, there is an infringement in the inner ring of the inguinal canal. In this case, an external examination, especially in obese patients, does not give any results; only with careful palpation in the thickness of the abdominal wall, slightly above the inguinal ligament, can a dense, painful formation of a small size be detected. We should also not forget about the possibility of strangulation of rare hernias: obturator canal, semilunar line, lumbar, perineal and others, which, when strangulated, most often give a picture of acute intestinal obstruction. Here it is appropriate to recall the statement of the famous French clinician A. Mondor: “If there is obstruction, you should first of all examine the hernial orifice and look for a strangulated hernia.” That is why, if a patient complains of sudden abdominal pain (especially if they are accompanied by symptoms of intestinal obstruction), it is always necessary to exclude a strangulated hernia. That is why, when examining any patient with suspected acute abdomen, the anatomical areas of possible hernia should be examined.

If there are any doubts regarding the diagnosis, they must be resolved in favor of a strangulated hernia. Surgeons with extensive experience in the treatment of hernias formulate this guideline as follows: “In doubtful cases, it is much more correct to lean towards the diagnosis of strangulation and urgently operate on the patient. It is less dangerous for a patient to recognize an impairment where there is none than to mistake the impairment for some other disease.”

Examples of diagnosis formulation

Strangulated left-sided inguinoscrotal hernia.
Strangulated giant umbilical hernia, acute strangulated intestinal obstruction, fecal phlegmon of the hernial sac, abdominal surgical sepsis.

A.A. Matyushenko, V.V. Andriyashkin, A.I. Kiriyenko

Cough– a jerky, sharp release of air from the respiratory tract. A cough appears when nerve receptors are irritated against the background of changes in different parts of the respiratory system, as well as when the cough center in the brain is excited and the external auditory canal is irritated.

Under the influence of infection, the mucous membrane becomes inflamed, which leads to an increase in the amount of sputum in them and a slowdown in its evacuation.

In preschool children, cough and obstructive syndrome are caused by swelling of the mucous membrane and accumulation of viscous sputum. And in children over 5-6 years old, spasm (narrowing of the lumen due to contraction of the muscle fibers of the bronchial wall) of the bronchi is more pronounced. This should be taken into account when choosing treatment.

Rare episodes of coughing can occur in a healthy child, for example during sleep when mucus accumulates in the larynx.

Types of cough

• Coughing– short repeated episodes of cough as a result of accumulation of mucous discharge in the larynx. Occurs with pharyngitis, mild bronchitis, as a habit after suffering from bronchitis;
• Wet cough characterized by the discharge of sputum, which, accumulating in the respiratory tract, irritates the unequal receptors of the walls of the bronchi, trachea, larynx and pharynx. Occurs on the 4-8th day from the onset of acute bronchitis, with pneumonia;
• Dry unproductive- without mucus discharge, unpleasant, intrusive, irritating. Appears with laryngitis, at the onset of bronchitis, aspiration (inhalation) of a foreign body, on the 2nd day from the onset of pneumonia. Healthy children may experience this when moving to a warm room from the cold.
• Laryngeal appears in diseases of the larynx (laryngitis, diphtheria). This is a hoarse, “barking” cough, with diphtheria it becomes almost silent;
• Bitonal- with a hoarse low sound at the beginning and a whistling high sound at the end. Appears when the lumen of large bronchi narrows (foreign body, bronchitis);
• Paroxysmal- in the classic version, it occurs with whooping cough, when several coughing shocks are followed by a deep breath with a whistle (reprise). During an attack, the face turns red or blue, tears flow from the eyes, and there may be vomiting at the end. Attacks occur more often at night;
• Whooping cough appears in the presence of thick viscous sputum. It is similar to the paroxysmal cough of whooping cough, but does not have recurrences. Occurs in cystic fibrosis;
• Spastic— appears in a child with obstructive diseases (bronchial asthma, obstructive bronchitis). This is an obsessive non-productive cough with a whistling sound. Intensifies with deep breathing.
• Psychogenic dry cough appears in emotional children when they want to attract the attention of adults, in various stressful situations (while waiting for a doctor’s appointment at the clinic), with excessive restless attention of the mother to the symptoms of a cold. This cough goes away when the child is left alone and adults do not concentrate attention on it.

Diseases associated with cough

Disease	Character of the cough	Associated symptoms
Bronchitis	Dry at first, later becomes wet	Fever, loss of appetite, headache.
Obstructive bronchitis	Spastic	An increase in body temperature, rapid breathing, noisier exhalation, when breathing, the nostrils flare, the intercostal spaces are drawn in. The child is irritable and restless.
Pneumonia	Dry	Increased body temperature and chills, weakness, loss of appetite.
Bronchial asthma	Spastic dry, often at night	During an attack: the child is excited, the intercostal spaces are drawn in when breathing.
Pharyngitis	Unproductive dry, may worsen with crying, laughing, changes in air temperature	Sore and red throat, pain when swallowing, possibly increased body temperature.
Laryngitis	Laryngeal, dry	Possible increase in body temperature, hoarse voice.
Tracheitis	Dry, unproductive, may be whooping cough	Possible fever, symptoms of intoxication (headache, weakness).
Whooping cough	Unproductive dry turns into paroxysmal	Fever, runny nose, after several coughing shocks there is a deep noisy breath (reprise), there may be vomiting during an attack. Coughing attacks can continue for a month or more.
Cystic fibrosis	Whooping cough	Diarrhea, foul-smelling stool, delayed physical development, low body weight.
Rhinitis	Unproductive dry	Nasal congestion, watery nasal discharge, nasal sound, possible snoring.
Gastroesophageal reflux disease (in young children)	Morning	Excessive regurgitation, frequent vomiting, hiccups, abdominal pain.
Foreign body in the respiratory tract	Bitonal, paroxysmal	Appears against the background of general well-being, characterized by shortness of breath and hoarseness.

The table lists the most common causes of cough in children, but many other diseases may also cause a child to cough.

For example, with ascariasis, during the migration of larvae throughout the body and their passage through the lungs, there may be a dry cough.

ARVI (acute respiratory viral infections) occur with symptoms of pharyngitis, laryngitis, tracheitis and even bronchitis.

Inhalation of smoke and aerosols of other irritants may cause a child to cough severely.

In chronic adenoiditis (inflammation of the adenoids), the cough appears during sleep, is accompanied by snoring, and the child sleeps with his mouth open. This manifestation also occurs with sinusitis.

Treatment

To cure a cough, you need to determine its nature, and the choice of medications depends on this. So, a dry cough must be converted into a wet one with good sputum discharge; in case of a painful paroxysmal cough, the frequency of cough impulses must be reduced, etc.

Types of medications for treatment:

• Antitussives– drugs that reduce the intensity of cough by inhibiting the cough center in the brain (central acting drugs) or by inhibiting the cough reflex as a result of reducing the sensitivity of receptors in the respiratory tract (peripheral acting drugs).
  These drugs are prescribed only for excruciating, painful dry cough, which exhausts the child, disrupts his sleep and worsens his general condition. As a result, there is no complete removal of mucus from the respiratory tract; it irritates the receptors even more, and the cough only intensifies.
  Characteristic of the initial stage of bronchitis, laryngitis, tracheitis.
  Such drugs include Sinekod, Tusuprex, Sedotussin. Taking these drugs if you have airway obstruction syndrome is contraindicated!
• Enveloping agents used for coughs caused by irritation of the upper respiratory tract (rhinitis, pharyngitis). For this purpose, herbal preparations, teas, syrups, and various lozenges are used.
• Expectorants stimulate the removal of viscous sputum by diluting it due to an increase in volume. Herbal extracts (elecampane, thyme, marshmallow, plantain, anise), potassium and sodium iodides have these properties. But these drugs can cause allergies in a child, and therefore their use in children, especially young children, is limited.
• Mucolytic drugs lead to the dilution of sputum, but almost do not increase its volume. They are taken for diseases accompanied by a wet cough with thick, difficult to separate, viscous sputum.
• Preparations based on ambroxol not only dilute sputum, but also enhance its excretion. These include Ambroxol, Ambrobene, Halixol, Flavamed, Lazolvan and others. A similar effect is typical for carbocysteine ​​preparations: Mucopront, Fluditec.
  Acetylcysteine ​​preparations (ACC, Mukobene) strongly dilute sputum, but do not remove it, so their use in children is not recommended.
• Combination drugs along with inhibition of the cough reflex, the viscosity of sputum is also reduced. These include Tussin Plus, Glycodin, Stoptussin.
  And Bronholitin also has a bronchodilator effect.
• Drugs with indirect action help stop coughing by affecting additional causes of its development. First of all, these are bronchodilators, drugs that expand the lumen of the bronchi. Indicated for obstruction to relieve bronchospasm. Among these drugs are Salbutamol, Berodual, Clenbuterol, Atrovent.
• Antihistamines(allergy medications) can help in some cases reduce cough by reducing swelling of the mucous membrane. These are various drugs: Fenkarol, Fenistil, Zyrtec, Parlazin, Erius.

The use of mucolytic drugs simultaneously with antitussives is contraindicated due to the possibility of “swamping” of the respiratory system (the cough reflex is inhibited, liquid sputum is not removed.)

To treat cough, you can use not only medications in the form of tablets, syrups, powders, but also in the form inhalations. It is best to use compressor-type inhalers (nebulizers) for these purposes.

To moisturize the mucous membrane of the respiratory tract and facilitate the removal of sputum, you can alkaline inhalations(mineral water Borjomi, Essentuki).

Solutions are used to thin sputum. ambroxol inhalation.

To facilitate coughing up sputum, it is necessary to postural drainage. The child lies on his stomach, the upper body should be slightly lower. The adult folds his palm in the shape of a boat and begins to tap the child’s back with the palm side. This method is used for bronchitis and pneumonia.

As you have already seen, the list of drugs for treatment is very large. Therefore, a doctor will help you decide how to treat a cough and, after an examination, will prescribe the correct treatment for your child.

Use of traditional medicine

Various medicinal herbs and infusions can be used to assist with basic treatment. But it should be remembered that this type of treatment is not recommended for children under 5-7 years of age, since herbs are a fairly strong allergen.

Expectorant and antitussive preparations:

№	Compound	Directions for use
1	Common coltsfoot, leaves – 20 g. Althaea officinalis, roots – 20 g. Oregano, grass – 10 g	Take half a glass 2 hours before meals.
2	Common coltsfoot, leaves – 20 g. Large plantain, leaves – 20 g. Licorice naked, roots – 20g. Violet tricolor, grass – 20g.	Leave in a water bath for 15 minutes, strain. Take ¼ cup warm 5 times a day before meals.
3	Elecampane, rhizome and roots, 20g	Pour a glass of water, boil over low heat for 30 minutes, take 4 tablespoons per day.
4	Thyme, grass – 20g	Leave in a water bath for 15 minutes, cool, strain. Take 1-2 teaspoons.

Features of the disease and its treatment in infants

In infants, the equivalent of a cough may be sneezing.

By taking phlegm thinners, we want to make it easier to remove. But for babies, things are a little different. Children of this age cannot yet fully cough. And it turns out that sputum accumulates more and more in the respiratory tract, contributing to the worsening of the disease. For this reason, very often in children, bronchitis can turn into pneumonia.

To avoid this, you need help the child clear his throat. To do this, you need to press with a flat, blunt object (the tip of a spoon, a spatula) on the root of the tongue. Do not be alarmed if your baby may vomit at the same time; this will also remove excess phlegm from the digestive tract, because the child swallows some of it (children also do not know how to spit). This procedure needs to be done quite often, always before each feeding.

Of the medications for children in this group not recommended use acetylcysteine ​​preparations (ACC). When taking medications in the form of syrups, you need to pay attention to the fact that the dyes and sugar used in their production can cause allergies.

General concept of cough

Causes and mechanism of cough

Cough and sputum are the main symptoms accompanying most diseases of the respiratory system.

Under normal conditions, dust particles, bacteria, and mucus in small quantities, entering the respiratory tract, are removed from them due to the active activity of the ciliated epithelium of the mucous membrane of the trachea and bronchi. If a foreign body enters the respiratory tract or accumulates mucus, pus or blood in them due to respiratory diseases, they are eliminated by coughing, which is a reflex-protective act. As a reflex act, cough can be caused by irritation of the endings of the vagus and glossopharyngeal nerves located in the mucous membrane of the respiratory tract - the pharynx, larynx, trachea and large bronchi. In the smallest bronchi and alveoli there are no such endings, so the cough reflex does not arise. Most often and most easily, a cough is caused by irritation of the so-called cough zones of the posterior pharyngeal wall, glottis, trachea, and pleura.

However, reflex irritations can also come from other places - the nasal cavity and even internal organs. A cough can also be of central origin, i.e. in such cases, the irritation comes from the cerebral cortex and is a nervous tic. The mechanism of the cough impulse comes down to a deep inhalation followed by a sudden and intense exhalation, and the cough impulse begins with the glottis closed, and then there is a kind of air “shot” through the narrowed glottis.

In inflammatory processes of the respiratory tract, the nerve endings are irritated by swelling of the mucous membrane or accumulated pathological secretions (sputum). Swelling and accumulation of secretions may be of allergic origin or the result of circulatory stagnation. In childhood, mechanical irritants can often be foreign bodies in the respiratory tract, and in other cases, compression of the trachea or vagus nerve by enlarged lymph nodes and tumors in the mediastinum.

Clinical characteristics of cough

When assessing a cough, you need to pay attention to its rhythm, timbre and character, the time of its appearance and body position.

Based on the rhythm, three forms of cough can be distinguished:

1) cough in the form of separate cough impulses, the so-called coughing, is observed with laryngitis, tracheobronchitis, often in smokers, in the initial forms of tuberculosis, sometimes in nervous people;

2) cough in the form of a series of cough impulses following each other, repeated at certain intervals, pulmonary-bronchial cough;

3) paroxysmal cough is observed when a foreign body enters the respiratory tract, with whooping cough, with bronchial asthma, with pulmonary cavities (cavity formations), with damage to the bronchial lymph nodes.

Based on the timbre of cough, several forms can also be distinguished:

1) a short and cautious cough, usually accompanied by a painful grimace, is observed with dry pleurisy and at the beginning of lobar pneumonia;

By its nature, cough is divided into:

1) dry (cough without sputum);

2) wet (cough with sputum).

Dry cough is often observed with dry bronchitis, irritation of the larynx, pleura, miliary tuberculosis, and damage to the intrathoracic lymph nodes; wet - for bronchitis and pneumonia. Young children usually swallow sputum, and only some diseases result in the production of sputum. In this case, it is necessary to pay attention to the nature of the sputum: is it mucous, mucopurulent, purulent, with a possible admixture of blood. It would be good if parents clarified the information regarding the color and smell of sputum.

Sputum is always a pathological phenomenon, since normally no discharge is observed from the respiratory tract.

According to the nature of sputum, it is divided into:

1) mucous membrane;

2) serous;

3) purulent;

4) mucopurulent;

5) bloody.

Mucous - viscous sputum, whitish or colorless. Characteristic of bronchitis, pneumonia, bronchial asthma.

Serous sputum is liquid, easily foams, and is characteristic of pulmonary edema.

Purulent sputum - greenish or brown, creamy consistency, occurs when an abscess of one origin or another breaks into the bronchus (with a lung abscess, pleural empyema, echinococcus, etc.).

Mucopurulent sputum occurs in most inflammatory processes in the bronchi and lungs.

Serous-purulent - with bronchiectasis, lung cavities and especially gangrene of the lungs (it is distinguished by a disgusting putrefactive odor).

Based on the time of cough onset, the following types can be noted:

1) morning cough - with chronic inflammation of the upper respiratory tract (nose, nasopharynx, paranasal cavities, pharynx, larynx, trachea), especially in alcoholics and smokers. This cough is called “cough when washing,” but it can appear earlier - at 5–7 a.m. with the accumulation of sputum overnight and with difficulty coughing it up;

2) evening cough - with bronchitis, pneumonia;

3) night cough - due to a nighttime increase in the tone of the vagus nerve and an increase in its excitability - with enlargement of the intrathoracic lymph nodes, with pulmonary tuberculosis, etc.

From the point of view of the conditions under which cough occurs, or the phenomena that accompany it, one must keep in mind the following forms:

1) a cough that occurs in connection with a change in body position is observed in the presence of cavities in the lungs (bronchiectasis, tuberculosis cavities, abscess, gangrene of the lungs), if from them, at a certain position, the contents are released into the bronchi. Paying attention to the exact position in which the cough appears, you can sometimes establish the location of the cavity;

2) cough ending in vomiting, observed with whooping cough in children (vomiting at the end of a cough attack), with some forms of pulmonary tuberculosis, with chronic pharyngitis (due to irritation of the sensitive mucous membrane of the pharynx with viscous sputum);

3) cough that occurs in connection with food intake, especially if particles of just eaten food appear in the sputum, observed when the esophagus communicates with the trachea or bronchus (esophageal fistula connecting to the respiratory tract);

4) cough, accompanied by the release of large amounts of sputum (sputum production “full of mouth”), is typical for emptying cavities, especially bronchiectasis, as well as for a breakthrough of a lung abscess or pleural empyema into the bronchus. Cough, as mentioned above, is one of the most common cardiorespiratory symptoms. It is caused not only by inflammatory reactions, but also by exposure to chemical, mechanical and thermal factors. Cough is observed with mediastinal syndrome, aortic aneurysm, mesaortitis, mitral stenosis, hysteria. The causes of paroxysmal cough with sputum production are acute bronchitis, pneumonia, bronchial asthma, as well as chronic nonspecific pneumonia, chronic bronchitis, breakthrough of purulent contents from the cavity of a lung abscess, cavity or bronchiectasis, bronchial cancer, tuberculosis, pulmonary infarction, incipient pulmonary edema. Paroxysmal cough occurs with tracheitis, bronchitis, pneumonia, compression of the trachea and bronchi. Paroxysmal cough can lead to a number of complications - rupture of the emphysematous bulla and others; it is accompanied by cardiac arrhythmias, hemoptysis, etc. Sometimes paroxysmal cough is so intense that it is accompanied by headache and even short-term loss of consciousness (which is caused by increased intrathoracic pressure and decreased blood flow to the heart).

Clinical characteristics of cough in various diseases

Cough of varying intensity, usually dry at first, then wet. It may not begin from the first day of the disease. In the pharynx there are catarrhal phenomena.

Acute bronchitis

Acute bronchitis can be caused by both viral (flu, measles, etc.) and bacterial infections (including whooping cough). 2–3 days after the onset of the disease, as a rule, the largest amount of sputum appears. The lungs are dry, then scattered moist rales. If the patient continues to have a paroxysmal cough for several days with increased heart rate and breathing, with the release of mucopurulent sputum, incipient bronchopneumonia should be excluded. In such cases, a chest x-ray is required.

Lobar pneumonia

In the first days there is a dry, painful cough, and from the 2nd–3rd day of the disease, rusty-colored sputum appears, characterized by a sudden increase in temperature and chills, pain in the chest when breathing, increased breathing and pulse. In the lungs - crepitating wheezing in the initial stage and in the resolution stage, hard breathing and a change in percussion sound.

Influenza pneumonia

Influenza pneumonia usually occurs on the 4th–7th day of illness (but in young children it may occur earlier). Characterized by a repeated rise in temperature and severe intoxication, severe chest pain, weakness. In the lungs there is a change in percussion sound, dry and moist fine bubbling rales.

When analyzing blood, it is possible to increase the leukocyte count and shift the formula to the left; options with a decrease in the number of leukocytes are described.

Pulmonary tuberculosis

The nature of the cough can be different, from a small morning cough with a small amount of sputum to a painful paroxysmal cough.

Paroxysmal cough is a common manifestation of exudative tuberculous pleurisy, which subsides as fluid accumulates.

Dry pleurisy

At the onset of the disease there may be a paroxysmal cough, but a stabbing pain in the chest predominates, aggravated by coughing and deep breathing. The patient tries to restrain his cough. A lag in breathing of the affected half of the chest is characteristic.

Pulmonary edema

With the development of pulmonary edema, a cough may occur against a background of shortness of breath.

The discharge of sputum brings relief to a patient with pulmonary pathology, which is not observed in patients with congestive heart failure.

Bronchial asthma

Cough occurs after contact with an allergen, as well as during an attack of suffocation. The cough is controlled by bronchodilators.

At the end of the attack - the release of light glassy sputum.

Acute laryngotracheitis

The disease laryngotracheitis is characterized by a hoarse, even barking cough, in which patients complain of a feeling of constant irritation in the larynx. The voice becomes hoarse and rough.

The disease can develop independently or following inflammation of the nasopharynx, the mucous membrane of which appears reddened upon examination.

Cough in newborns and infants

In newborns, cough is a fairly rare occurrence. In addition, in children of this age the cough reflex is rather weak, and in premature babies it is not developed at all.

In infancy, coughing is more common due to an increase in inflammatory diseases of the respiratory tract and lungs, as well as the number of respiratory infections, in which coughing is an almost regular symptom.

The appearance of a cough during feeding indicates aspiration (entry into the respiratory tract) of food. This can happen not only during force feeding, but due to the ingestion of various objects (grains, coins, buttons, pins, toys, etc.).

Clinical manifestations are observed at various times after a foreign body enters the trachea and bronchi, which depends on its size, configuration and level of blockage. Characterized by a sudden paroxysmal cough, difficulty breathing, and chest pain. When a foreign body moves to the distal parts, coughing attacks become less frequent and stop. This condition is extremely dangerous for the patient; immediate hospitalization to the otolaryngology department is indicated.

Acute laryngitis in children aged 1 to 3 years

In young children aged 1 to 3 years, the inflammatory process spreads mainly to the false vocal cords. At the same time, especially in neurotic children, spasm also occurs. A picture of laryngeal stenosis (false croup) develops.

In these cases, a hoarse cough is accompanied by severe shortness of breath with prolonged inhalation. Usually the child wakes up suddenly with a hoarse cough and shortness of breath. The child is very scared, excited, the skin is pale with blue around the mouth and eyes, and fingertips.

In the morning the condition usually improves, but the hoarse cough remains, and often the picture repeats the next night.

Very often, the phenomena of false croup can be repeated 2-3 or more times in the same child. This disease must be distinguished from true croup, which occurs with diphtheria.

Cough treatment

Treatment of cough with traditional methods

The most widely used means for improving airway drainage are:

1) marshmallow root (syrup, infusion), children from 6 months to 1 year - 1 des. l. - 1 tbsp. l. up to 4–5 times a day;

2) mucaltin, children from 3 months to 1 year - 3–4 times a day;

3) thermopsis herb (infusion) - from 6 months to 1 year - 1 des. l. - 1 tbsp. l. 3 times a day;

4) breast elixir - 3-4 times a day, as many drops as the child is old;

5) pertussin - 0.5 tsp. - 1 dec. l. 3 times a day;

6) terpin hydrate is prescribed at the rate of 25 mg per year of life 3 times a day;

7) bromhexine - from 1 to 8 mg 3 times a day;

8) ACC (for viscous sputum) - from 50 to 200 g 3 times a day;

9) stoptussin (especially for dry, painful cough) - children over 5 years old (10 to 20 drops).

However, it should be remembered that the ultimate goal is not to suppress the cough impulse, which is a protective reaction of the body, but to eliminate the cause of the cough. Your doctor will help you make the right choice.

Independent use of potent drugs is fraught with unpredictable consequences.

False croup

For any croup, hospitalization in a hospital is indicated, in severe cases - in the intensive care unit.

In mild cases (with the development of stenosis), the child can be helped before the doctor arrives.

Use:

1) general hot baths, foot baths with mustard;

2) warm drink - always plenty of it (milk with Borjomi, 2% soda solution);

3) mustard plasters;

4) taking sedatives (herbs or tincture of valerian, motherwort);

5) inhalation of warm steam, influx of fresh air;

6) prescription of antihistamines (tavegil, suprastin, pipolfen, etc.).

In the hospital, hormonal drugs, infusion therapy, and drugs to improve bronchial drainage (thermopsis dry extract, bromhexine-8, alkaline inhalations) are used.

For a painful dry cough, antitussives are prescribed - codeine, dionine (they cannot be used for purulent processes in the lungs). For symptoms of bronchospasm, aminophylline, intravenous ephedrine, and salbutamol are indicated.

For suppurative lung diseases, anti-inflammatory drugs (aspirin, etc.) and antibiotics are indicated.

Aspiration cough in newborns and infants

Among the urgent measures before the ambulance team arrives, the following techniques can be applied:

1) immediately vigorously pat with your palm between the victim’s shoulder blades;

2) Heimmech maneuver: the victim is covered from behind with his hands so that the right hand, clenched into a fist, is at the level between the navel and the xiphoid process of the sternum, and the left hand is on top of it. In this position, make four sharp pushes inward and upward, causing an artificial cough;

3) try (carefully) to remove the foreign body with your fingers or tweezers.

Rehabilitation measures

For the rehabilitation of patients with lung diseases, physiotherapy, reflexology, as well as exposure to an artificial microclimate (hypoxic, helium-oxygen mixtures, aeroionization, heliotherapy) are used.

Treatment of cough with unconventional methods

Homeopathic therapy

Homeopathy is a method of treatment with specially prepared harmless homeopathic medicines. In modern conditions, as opposed to the so-called official allopathic medicine, homeopathy can offer effective treatment methods with an individual approach to the patient. Homeopathy treats the patient, not the disease. In fact, every disease manifests itself in such a variety of symptoms that there is no one medicine that can be prescribed for it.

Treatment of patients with the use of homeopathic medicines can only be carried out by a highly qualified doctor with appropriate training. However, homeopathic medicines can often be started before visiting a doctor. This applies to cases where the disease itself is not life-threatening, and the indications for taking medications are quite clear.

Thus, the disease can be stopped at the initial stage and complications can be avoided. At the same time, homeopathic medicines do not have any harmful side effects.

As for coughing, it is not a disease, but a symptom that occurs in many diseases.

The following homeopathic medicines are most often used:

1) aconite 6 - acute dry short cough with chills, dry and hot skin, worsening towards midnight. The cough gets worse at night and when lying on your back (take 7 granules or 6 drops every 2 hours);

2) bryopil 3x, 3 - dry cough with chest pain, every movement increases stabbing pain, difficult expectoration;

3) belladonna 3, 6 - dry spasmodic cough with shaking of the whole body. Sudden onset of a general infectious disease. With convulsive noisy inhalation during a coughing attack in children. The face becomes red when coughing;

4) ipecac (based on the herb mouse) 6, 12 - convulsive cough with shortness of breath, a feeling of suffocation and wheezing, clogging of the bronchi with viscous mucus that cannot be coughed up;

5) hepar sulfur 6, 12 - for dry or wet cough associated with diseases of the bronchi and skin;

6) phosphorus 3, 6 - dry cough with a feeling of rawness in the throat and chest, aggravated by talking;

7) in addition, iodotum capsules 3, 6 help well; gotsiamus 3x, 3; Dulcamara 3x, 6, 12; rumex 3x, 3; stannum 6, 12, etc.

Phytotherapy

Medicinal plants have their advantages and disadvantages compared to other medicinal products.

The positive aspects are their wide distribution, accessibility and high medicinal effectiveness, especially when used fresh; multilateral effect on the human body.

A feature of treatment with medicinal plants is their rather long period of use; only then is their positive therapeutic effect revealed. The effectiveness of exposure is influenced by the conditions of growth, collection, processing, storage and preparation of drugs.

There are many herbs that can be used for coughs. The safest and most widespread are: apricot, calamus, marshmallow, watch, cherry, elecampane, sweet clover, oregano, figs, viburnum, cranberries, nettles, flax, larch, raspberries, malta, coltsfoot, lungwort, almonds, juniper, carrots, mint, dandelion, black nightshade, plantain, wheat, wheatgrass, radish, odorless chamomile, black currant, licorice, pine, thermopsis, caraway seeds, dill, tricolor violet, horseradish, thyme, string, garlic, saffron, rose hips, orchis, barley.

Here are recipes for preparations for the treatment of respiratory diseases (parts of raw materials are taken):

1) coltsfoot leaves - 4, plantain leaves - 3, licorice roots - 3, marshmallow roots - 2, licorice roots - 2, fennel seeds - 1; wild strawberry leaves - 2, thyme herb - 1, sage leaves - 1. Apply as follows: 1 tbsp. l. mixture per glass of boiling water. Leave for several hours, then strain. Take 2 tbsp. l. after 2–3 hours. Facilitates expectoration;

2) coltsfoot leaves - 1, marshmallow root - 1, licorice root - 1, mullein flowers - 1, plantain leaves - 1. 1 tbsp. l. mixture in a glass of boiling water, cook over low heat for 10 minutes. Take 0.25 cups warm 3-4 times a day;

3) mullein flowers - 2, marshmallow roots - 8, licorice root - 3, violet root - 1, anise seeds - 1, coltsfoot leaves - 4. 1 tbsp. l. Brew in 2 cups of boiling water, leave for 20 minutes, strain. Take 0.25 cups every 3-4 hours;

4) elecampane (roots) - 1, anise (fruit) - 1, pine buds - 1, sage (leaves) - 1, peppermint (herb) - 1, calendula (flowers) - 1, mother-and- stepmother (leaf) - 1, St. John's wort (herb) - 1, large plantain (leaves) - 1, eucalyptus twig (leaves) - 1. 1–2 tbsp. l. the mixture is poured with 200 ml of boiling water and placed in a water bath for 15 minutes. Leave for 45 minutes, strain and add boiled water to 200 ml. Take 1/4–1/3 cup of infusion 3 times a day after meals for chronic pneumonia, bronchiectasis.

Raw materials used to prepare the mixture for laryngitis, tracheitis: eucalyptus (leaf), sage, chamomile (flowers), peppermint (herb), elecampane (roots), common thymogen (herb), Scots pine (buds).

Cough remedies from traditional medicines

In his recipes, the hereditary healer P. M. Kurenkov, author of the “Russian Folk Medicine Book,” offers several effective cough remedies.

Black radish in the amount of 6–8 pcs. cut into very thin slices. Sprinkle each slice generously with sugar. Drink the resulting juice 1 tbsp. l. every hour. Healers claim that the described remedy cures the most severe cough in a relatively short time.

Brazilian method: rub 2 ripe bananas through a sieve and add 1 cup of water, heat and drink this mixture.

If you have a prolonged dry cough, rub your chest with a dry cloth, then rub the internal lard (worse - melted butter) dry, adding a little pine oil to it.

Cut into small pieces and boil 10 onions and 1 head of garlic in unpasteurized milk until the onions and garlic are soft. Add a little budra juice (another name is dog mint). Add honey. Dose - 1 tbsp. l. every hour throughout the day.

Take rye, barley, chicory, add 120 g of peeled bitter almonds and drink like regular coffee. Can be drunk with hot baked milk.

In the spring, it is useful to drink birch sap or maple tree sap with milk for coughs.

Mix 2 tbsp. l. fresh country butter, 2 fresh egg yolks, 1 tsp. millet.

Boil 1 tbsp in a glass of milk. l. finely chopped Icelandic moss. Boil, cover with a saucer, strain. Drink the medicine as hot as possible, only at night before bed. Don't walk after that.

Icelandic moss infusion, 1 tsp. per glass, drink like tea, adding a little honey. This is a remedy for repeated colds, bronchitis, and pneumonia. The effect is after 1–3 months until complete recovery.

O. A. Morozova’s home doctor offers the following proven cough remedies.

Take 1 dess. several times a day. l. this mixture: 2 tsp. butter, 2 raw yolks, 1 des. l. flour or starch, 2 des. l. honey Mix everything well.

For people who often have colds and coughs, it is useful to drink birch sap with milk and a small amount of flour or starch in the spring, and also use strawberry or strawberry infusion instead of tea.

And now a few recipes that have been repeatedly tested for severe coughs.

Take 500 g of peeled chopped onion (can be grated), 50 g of honey, 400 g of sugar. Boil this entire mixture in 1 liter of water for 3 hours over low heat. The liquid must be cooled, poured into bottles and sealed tightly. Take 1 tbsp for severe cough. l. 4–5 times a day.

An ancient recipe for pulmonary diseases. 1 pound (approximately 454 g) butter, honey, sugar, 0.25 pound cocoa, 8 yolks, 3 cups cream.

Pour the yolks, cream and cocoa into 1 vessel. Heat the butter and a pound of lard together. Mix. Then boil everything until you get a liquid dough (like for pancakes). Cool. Drink 3 times a day, 1 tbsp. l.

Apitherapy

There is probably no person in our country who has never heard of the miraculous balm - mummy. It is found in rocks and caves that are difficult for humans to reach in the form of deposits, icicles, and accumulations in crevices.

Mumiyo contains about 28 chemical elements, 30 macro- and microelements, as well as 10 different metal oxides, 6 amino acids, a number of vitamins B, C, A, essential oils, bee venom, and resin-like substances. The mechanism of action on the body is quite complex and multifaceted: as an anti-inflammatory, antiseptic, tonic, the drug restores the structure of nerve trunks and the brain.

The authenticity test is as follows: 0.1 g of purified mumiyo is completely dissolved without residue in 5 ml of water and filtered. The mumiyo solution does not change when dilute alkalis are added; it becomes lighter and forms a brown precipitate when dilute acids are added. There are practically no contraindications for using mumiyo in moderate doses.

The required amount of mumiyo for one-time use is 0.2–0.5 g, depending on the person’s weight: up to 70 kg - 0.2 g, up to 80 kg - 0.25–0.3, up to 90 kg - 0.3– 0.4, more than 90 kg - 0.4–0.5 g; children from 3 months to 1 year - 0.01–0.02 g, up to 9 years - 0.05 g, from 9 to 14 years - 0.1 g per day.

When using mumiyo, you need a complete diet rich in vitamins and proteins. The prepared mummy should be washed down with milk, juice, and honey. If 5 g of mumiyo is dissolved in 20 tbsp. l. water, then in 1 tbsp. l. - 0.25 g mummy, 1 dess. l. - 0.2 g mumiyo, 1 tsp. - 0.1 g mummy.

Store the solution in the refrigerator for no more than 10 days.

For inflammatory and allergic diseases, runny nose, catarrh of the upper respiratory tract, sneezing, cough - take 0.2–0.5 g of mumiyo mixed with honey and milk in the morning and evening. Course - 10–25 g mummy. For 25–28 days with a 5-day break. Bronchial asthma - take mumiyo 0.2–0.5 g 2 times a day (in the morning on an empty stomach and in the evening before bed). The course of treatment is 25–28 days. Depending on the severity of the disease, 1–3 courses are required with a break of 5 days between courses.

Massage

In the complex treatment of cough with bronchitis and pneumonia, massage is indicated. There are many contraindications to massage, so you should first consult a specialist. Almost all procedures can be done at home.

Back muscle massage begins with planar stroking of the trapezius muscles, as well as the lower and middle back. In the lower part, stroking is done from the bottom up to the axillary lymph nodes (do not massage the armpit area). In the upper part - from the back of the head to the supraclavicular lymph nodes. This muscle group is located throughout the middle part of the back, and its outer edge lies on a line running from the middle of the armpit to the tailbone. Along the entire outer edge of the muscles (the “armpit - tailbone” line) you need to carry out using the supporting part of the palm or its edge, kneading - longitudinal and transverse. When kneading longitudinally, the massaging hand moves in a horizontal direction, and when kneading transversely, along the edge of the muscles. Shifting using the entire palm must also be carried out in two directions. This is followed by forceps-shaped longitudinal and transverse kneading of the upper outer edges of the trapezius muscles. The edge of the muscle is grabbed with the fingers and kneaded, first with simultaneous advancement along it, and then with a transverse bending of the edge of the muscle between the fingers. Moving directly to the trapezius muscle, rub its surface with your fingertips. Also massage the latissimus dorsi muscle. Then rub both muscles with your palm.

After this, do vibration stroking and continuous vibration of the back muscle, with the help of which oscillatory movements of varying speeds and amplitudes are created in the tissues. While doing this, the massage therapist’s hand presses on the tissue without leaving the skin of the massaged area. The duration of a series of continuous vibrations is on average 5–15 s, then there is a pause for 3–5 s, during which stroking is carried out. A series of oscillatory movements are carried out with a gradually increasing speed. At the beginning of the massage, the vibration frequency is 100–200 vibrations per minute, in the middle - 200–300, then gradually decreases. The same technique, performed with constant movement on the skin, is called vibration stroking.

Each massage technique is repeated 3–5 times. Duration - 7–15 minutes. The course of treatment is 7–10 procedures. At the end of the course there is a break of several days.

Chest massage for bronchitis and pneumonia should be performed in a drainage position, i.e., the head is below the chest. To do this, you can simply place a pillow.

In addition, the procedure of rubbing the soles of the soles is very useful for all those suffering from diseases of the respiratory system. The foot is rubbed with palms, fingertips, the edge of the palm, fingers folded into a fist, until well warmed.

It takes 1–1.5 minutes to massage each foot.

Breathing exercises

Special breathing exercises occupy an important place in the recovery of people suffering from respiratory diseases. They provide complete drainage of the bronchi, cleanse the mucous membrane of the respiratory tract, and strengthen the respiratory muscles.

When performing breathing exercises, you need to breathe through your mouth so as not to carry the pathological contents of the nasopharynx into the bronchi.

Starting position (i.p.) - standing, feet shoulder-width apart, arms to the sides at shoulder level, laid back. The hands are turned forward with the palms. On the count of 1, cross your arms with lightning speed and clap your shoulder blades with your palms, then on the count of 2, return to i. p., sticking out his stomach with an inhalation. It is necessary to ensure that the hands are moved far back each time, only then the blow to the important reflexogenic zone will be of the required force.

I. p. standing on his toes, bending over. Feet shoulder width apart. Cross your fingers as if holding an ax over your head. On the count of 1 (sharp, powerful exhalation), lower yourself onto your feet and at the same time quickly lean forward, “lowering the ax.” On the count of 2, return to the starting position, inflating your stomach with a diaphragmatic inhalation.

I. p. standing on his toes, bending over. Feet shoulder-width apart, arms up to the sides. On the count of 1, lower yourself onto your feet. Lean forward, rounding your back, and cross your arms across your sides in front of your chest, hitting your shoulder blades painfully with your hands (exhale). On the count of 2-3, spread your arms to the sides and then hit your shoulder blades again. Then, on the count of 4, sticking your stomach out, return to the starting position.

A useful exercise for children would be to train the respiratory muscles, such as creating resistance while exhaling (inflating balloons).