hemoptysis
Introduction
Introduction to hemoptysis Hemoptysis refers to a symptom of bleeding from the trachea, bronchi, and lung parenchyma, which is caused by coughing from the mouth. It is the lower respiratory tract or pulmonary vascular rupture in the throat, and the blood is clogged out of the mouth with cough. Hemoptysis can be divided into blood, a small amount of hemoptysis (daily hemoptysis less than 100 ml), moderate hemoptysis (daily hemoptysis 100 ~ 500 ml) and large hemoptysis (daily hemoptysis up to 500 ml). In the sputum with blood or small blood clots, mostly due to mucosal or lesion capillary permeability increased, blood oozing, large hemoptysis, may be due to rupture of small aneurysms in the respiratory tract or bronchial varices due to pulmonary venous hypertension. basic knowledge The proportion of illness: 0.003% Susceptible people: no specific population Mode of infection: non-infectious Complications: shock
Cause
Hemoptysis
Although hemoptysis patients have applied various examination methods, 5% to 15% of patients have unclear hemoptysis, which is called occult hemoptysis. Some occult hemoptysis may be due to trachea, bronchial non-specific ulcer, varicose veins, early adenoma, bronchus Caused by small stones and mild bronchiectasis.
Bronchial disease (20%):
Common bronchodilatation (tuberculosis or non-tuberculosis), chronic bronchitis, endobronchial tuberculosis, bronchial carcinoma (primary lung cancer), etc., less common benign bronchoma, endobronchial stones, bronchial non-specific ulcers Wait.
Lung disease (25%):
Commonly there are tuberculosis, pneumonia, lung abscess, etc., less common are pulmonary blood stasis, pulmonary infarction, malignant tumor metastasis, pulmonary cyst, pulmonary fungal disease, paragonimiasis, etc., tuberculosis is one of the most common causes of hemoptysis.
Cardiovascular disease (20%):
More common hemoptysis caused by mitral stenosis, hemoptysis can also occur in some congenital heart diseases such as atrial septal defect, patent ductus arteriosus and other pulmonary hypertension.
Other (10%):
Blood diseases (such as thrombocytopenic purpura, leukemia, hemophilia, etc.); acute infectious diseases (such as pulmonary hemorrhagic leptospirosis, epidemic hemorrhagic fever, etc.); connective tissue diseases (such as nodular polyarteritis); Endometriosis and the like.
Prevention
Hemoptysis prevention
Prevention of hemoptysis seven elements
Patients with respiratory diseases should pay attention to protection during the autumn and winter.
1. Prevent colds from getting out of the clothes according to weather changes to prevent colds.
2. Pay attention to diet, diet is the first choice of foods rich in vitamins.
3. The Manage Air room is often ventilated to maintain a suitable temperature (typically 18 to 25 ° C) and humidity (typically 40% to 70%).
4. Exercise to exercise moderate physical exercise and respiratory function.
5. Prepare a small medicine kit at home, especially for cough medicines, such as the treatment of dry cough-based tongweiweilin (kekeqing) tablets and syrup, antitussive-based syrup, antitussive-based palmamine mixture, etc., family essential hemostatic drugs such as Yunnan Baiyao, sedative drugs such as stability, etc., pay attention to timely replacement of expired drugs in small medicine boxes.
6. Smoking cessation, patients with alcohol-restricted diseases, must quit smoking; limit alcohol to reduce the cause of hemoptysis.
7. Emotional fluency Chinese medicine believes that emotional changes and diseases have a certain relationship, such as "happy sadness", "sorrowful lungs", like Lin Hongyu who suffers from tuberculosis in "Dream of Red Mansions", he is worried too much, tears of flowers, sadness and sorrow Finally, he died of hemoptysis. Therefore, to prevent hemoptysis, we must pay attention to self-cultivation.
Complication
Hemoptysis complications Complications
Asphyxia and shock are major complications of hemoptysis and the leading cause of death. The performance of suffocation: hemoptysis occurs when hemoptysis occurs, chest tightness and shortness of breath, nervousness, dark complexion, squeaky voice in the throat, or sudden sequelae of jet hemoptysis is a harbinger of suffocation. Eyes, two hands clasped, convulsions, sweating, closed jaws or sudden loss of consciousness, suggesting that suffocation occurred, if not rescued in time, due to heartbeat, breathing stopped and died.
Symptom
Hemoptysis symptoms Common symptoms Hemoptysis hemoptysis with fever hemoptysis with cough and hemoptysis with chest pain, breath sounds weakened hemoptysis with jaundice lymph node enlargement hemoptysis with skin and mucous membrane hemorrhagic sputum
There are different definitions of the hemoptysis. Large hemoptysis usually means that the hemoptysis exceeds 600-800ml within 24h or the hemoptysis is more than 300ml; the small amount of hemoptysis refers to less than 100ml per hemoptysis; the medium amount of hemoptysis refers to each hemoptysis. 100 to 300 ml.
Emergency diagnosis is important for understanding major bleeding and preventing the diagnosis and treatment of asphyxia.
First, medical history
The amount of hemoptysis, traits, occurrence and duration, and sputum traits are of great value in the differential diagnosis of hemoptysis. Purulent sputum with hemoptysis is more common in bronchitis, bronchiectasis or lung abscess. Pulmonary edema is more common in pink foam. Long-term bed rest, fracture, trauma and heart disease, oral contraceptives, hemoptysis with chest pain, syncope should consider pulmonary embolism, males over 40 years old should be alert to the possibility of lung cancer, female patients in the menstrual cycle or after abortion of hydatid hemoptysis, Need to be alert to endometriosis or choriocarcinoma lung metastasis, for young women, repeated chronic hemoptysis, without other symptoms, need to consider the exclusion of bronchial adenoma.
Second, physical signs
The lungs should be examined in detail. When the chest X-ray examination has not been performed, the bleeding method can be used as early as possible. For example, when the hemoptysis starts, the respiratory sound of one side of the lungs is weakened or (and) the voice is present, and the contralateral lung is present. The field breath sound is good, often suggesting that bleeding is on this side, physical examination can also support some specific diagnosis, such as mitral diastolic murmur is conducive to the diagnosis of rheumatic heart disease; wheezing in the limited lung and bronchial area Sound, often suggesting bronchial lesions, such as lung cancer or foreign bodies; vascular murmur in the lung field supports arteriovenous malformations; clubbing is more common in lung cancer, bronchiectasis and lung abscess; supraclavicular and anterior scalene lymph nodes, Support for metastatic cancer.
Third, accompanying symptoms
(A) hemoptysis with fever: can be seen in tuberculosis, pneumonia, pulmonary hemorrhagic leptospirosis, epidemic hemorrhagic fever, bronchial lung cancer.
(B) hemoptysis with chest pain: can be seen in lobar pneumonia, pulmonary infarction, tuberculosis, bronchial lung cancer.
(3) sputum and blood stasis: can be seen in lung abscess, hollow tuberculosis, bronchiectasis, etc., bronchiectasis also has repeated hemoptysis without cough, this type is called dry bronchodilation.
(D) hemoptysis with cough: can be seen in bronchial lung cancer, mycoplasma pneumonia.
(5) hemoptysis accompanied by bleeding of skin and mucous membranes: attention should be paid to epidemic hemorrhagic fever and blood diseases.
(6) hemoptysis with jaundice: attention should be paid to pulmonary infarction, leptospirosis.
Examine
Hemoptysis check
Physical examination
Patients with hemoptysis should be carefully examined repeatedly. Some chronic heart and lung diseases can be associated with clubbing (toe), and patients with progressive tuberculosis and lung cancer often have significant weight loss. Some blood diseases have a generalized hemorrhagic tendency.
2. Laboratory examination
examination helps to find tubercle bacilli, fungi, bacteria, cancer cell parasite eggs, heart failure cells, etc., bleeding time, clotting time, prothrombin time, platelet count and other tests help to diagnose bleeding disorders, red blood cell count and Protoerythrin assays help to infer the extent of bleeding, and eosinophilia suggests the possibility of parasitic diseases.
3. Device inspection
(1) X-ray examination: patients with hemoptysis should be X-ray examination, chest fluoroscopy, chest radiograph, and bronchography to assist diagnosis if necessary.
(2) CT examination: help to find small bleeding lesions.
(3) bronchoscopy: patients with unexplained hemoptysis or bronchial obstruction of atelectasis should consider bronchoscopy, such as tumors, tuberculosis foreign bodies, etc., and take biopsy pathological examination.
(4) radioactive radionuclide gallium examination: help differential diagnosis of lung cancer and other lung masses.
Diagnosis
Hemoptysis diagnosis
diagnosis
Diagnosis can be based on the cause, clinical manifestations and laboratory tests.
Differential diagnosis
Hemoptysis: Respiratory bleeding is discharged with cough. The color of the blood is bright red, and the blood contains gas mixed with sputum. There are very few black stools.
Hematemesis: hemorrhage of the upper gastrointestinal tract. The color of the blood is dark red or brown. If it is intragastric bleeding, the food may be mixed with food residue. There may be tar-like stools.
