pulmonary disease
Introduction
Introduction to lung disease Lung disease The lungs of the disease itself or the systemic disease. The respiratory system consists of the respiratory tract (nose, pharynx, larynx, trachea, and bronchial tubes) and alveoli. The lung is the main organ of the respiratory system, and the lung disease is a respiratory disease. In order to complete metabolism, the human body needs to continuously take in oxygen from the air and emit carbon dioxide (gas exchange), which is called breathing. Gas exchange between the lungs and the external environment and ventilation of the lungs - the exchange of gas between the alveoli and the blood is called external breathing (also called lung respiration). The gas exchange between the blood and the tissue cells or tissue fluid after the gas has been transported through the blood to the tissue is called Internal breathing (also known as tissue breathing). Therefore, the lungs are closely related to the cardiovascular system. In addition to the respiratory function, the lungs have non-respiratory defense, immune and endocrine metabolic functions. The causes of lung diseases are different, and can be caused by infections caused by viruses, bacteria, etc., air pollution, smoking, inhalation of dust or harmful gases. The occurrence of some diseases is related to immune and genetic factors. Primary lung cancer is most common in primary lung cancer. The cause of some diseases is unknown. Common symptoms are: cough, sputum, hemoptysis, dyspnea, chest pain, infection or immune-related diseases may be associated with fever, the lightness, weight and nature of these symptoms vary depending on the disease and the degree of disease . basic knowledge Proportion of disease: according to different lung diseases, the proportion of illness is different Susceptible people: no special people Mode of infection: some lung diseases can be transmitted through the respiratory tract Complications: respiratory failure pneumonia lung abscess tuberculosis
Cause
Cause of lung disease
Pulmonary disease refers to a type of disease syndrome that causes lung dysfunction and pathological changes under the influence of external or internal injuries. Pneumonia is inflammation of the lung parenchyma caused by various pathogens (such as bacteria, viruses, fungi, parasites, etc.). Others such as radiation, chemistry, and allergic factors can also cause pneumonia to occur in all seasons, and occur in winter and spring. .
First, the external cause of lung disease
1. Respiratory tract infection: For those who have already suffered from lung disease, respiratory infection is an important factor leading to acute exacerbation of the disease, which can aggravate the progress of the disease. However, it is unclear whether the infection can directly cause the onset of lung disease.
2. Inhalation: Inhalation of soot, irritating gases, certain particulate matter, cotton dust and other organic dusts can also promote the onset of lung disease. Animal tests have also shown that mineral dust, sulfur dioxide, coal dust, etc. can cause lesions similar to human lung disease in animal models.
3. Social and economic status: There is a negative correlation between socioeconomic status and the incidence of lung disease, that is, people with lower socioeconomic status have a higher incidence of lung disease, which may be related to indoor and outdoor air pollution, room congestion, poor nutrition, and Other factors related to the lower socioeconomic status.
4. Smoking: Smoking is currently recognized as the most important risk factor for lung disease. The results of many epidemiological studies abroad showed that the incidence of pulmonary dysfunction was significantly higher in smokers than in non-smokers, and the number of people with respiratory symptoms increased significantly.
5. Air pollution: Long-term living in areas where outdoor air is contaminated may be an important factor in the pathogenesis of lung disease. For patients already suffering from lung disease, severe urban air pollution can exacerbate the condition.
Second, the cause of lung disease
1. Genetic factors: Epidemiological studies suggest that lung disease susceptibility is related to genes, but lung disease is certainly not a single-gene disease, and its susceptibility involves multiple genes. At present, the only certainty is the lack of a single anti-trypsin deficiency. Others such as glutathione S transferase gene, matrix metalloproteinase tissue inhibitor-2 gene, heme oxygenase-l gene, tumor necrosis factor-a gene, interleukin (IL)-13 gene, IL-10 gene, etc. May also have a certain relationship with the onset of COPD.
2, airway hyperresponsiveness: domestic and foreign epidemiological studies have shown that the incidence of lung disease is also significantly increased in patients with increased airway responsiveness, the two are closely related. Lung development, poor growth In the pregnancy, neonatal, infancy or childhood, individuals with lung development or poor growth due to various reasons are prone to lung disease after adulthood.
3. A large number of epidemiological studies have confirmed that smoking is the leading risk factor for lung cancer. Experts pointed out that 70% to 80% of lung cancer is associated with smoking (including passive smoking), and other related factors are: radioactive exposure factors, environmental or occupational exposure factors, genetic or familial factors.
Prevention
Lung disease prevention
1 Stay optimistic and happy. Long-term mental stress, anxiety, irritability, pessimism and other emotions will make the balance of the cerebral cortex excitatory and inhibition process imbalance, so you need to maintain a happy mood.
2 life temperance pay attention to rest, work and rest, life orderly, maintaining an optimistic, positive, and upward attitude towards life has a great help in preventing diseases. Do the regularity of tea and rice, live daily, not overworked, open-minded, and develop good habits.
3 Reasonable diet can eat more high-fiber and fresh vegetables and fruits, balanced nutrition, including essential nutrients such as protein, sugar, fat, vitamins, trace elements and dietary fiber, with a variety of foods, diversified food varieties, full The complementary role of nutrients in food is also helpful in preventing this disease.
Complication
Pulmonary complications Complications, respiratory failure, pneumonia, lung abscess, tuberculosis
1, respiratory failure
The concept is a serious disorder of the lungs and ventilation function caused by various reasons, so that it is unable to maintain sufficient gas exchange at rest, resulting in hypoxic hypercapnia, which causes a series of physiological functions and corresponding clinical manifestations syndrome. At sea level, breathing air at resting conditions, and excluding intracardiac anatomical shunt and primary new blood output decreased, arterial blood pressure below 60mmhg partner with or accompanied by carbon dioxide higher than 50mmHg, for respiratory failure.
Pneumonia
Pneumonia is the lung parenchyma and interstitial. Pneumonia can also be caused by other factors such as radiation, chemistry, immunity, allergies and drugs caused by various pathogens.
3, lung abscess
Lung abscess is a pulmonary suppurative infection caused by a variety of pathogenic bacteria. In the early stage, the infection of lung tissue is an infectious inflammation of lung tissue in the early stage, followed by necrosis, liquefaction, formation of abscess, clinical features of hyperthermia, cough, and sputum sputum.
4, tuberculosis
Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis causing lung tissue exudation, dry-like necrosis and other value-added reactions.
Symptom
Symptoms of lung disease Common symptoms Cough, cough, chest pain, fever, cough, slightly... Cough with wheezing, irritability, loss of appetite, hemoptysis, hemoptysis, chest pain, dyspnea
Chronic pneumonia
Chronic pneumonia is characterized by periodic recurrence and deterioration. It is a wavy type. Due to the age of the lesion, age and individual, the symptoms are various. During the quiescent period, the body temperature is normal, no obvious signs, almost no cough, but running. It is easy to pant when going upstairs, often accompanied by pulmonary insufficiency during the deterioration, cyanosis and difficulty in breathing, and due to decreased vital capacity and respiratory reserve and shortened breath holding time, the external respiratory dysfunction caused by hyperventilation, the improvement is slow after the deterioration , often cough, and even facial edema, cyanosis, thoracic deformation and clubbing, toe, due to emphysema, pulmonary insufficiency caused by increased pulmonary circulation resistance, increased pulmonary artery pressure, increased right heart burden, can be within six months to two years Pulmonary heart disease occurs, there may be liver dysfunction, white blood cells increase, and erythrocyte sedimentation rate increases moderately.
Elderly pneumonia
1, more no fever, chest pain, rust and rust and other typical symptoms, only 35% of symptoms.
2, the first symptom is highlighted by non-respiratory symptoms: elderly pneumonia patients can first manifest as abdominal pain, diarrhea, nausea, vomiting and loss of appetite and other gastrointestinal symptoms, or palpitations, shortness of breath and other cardiovascular symptoms, or apathy, lethargy, sputum, Neuropsychiatric symptoms such as incitement and disturbance of consciousness are often manifested in one or more of the typical five-year signs of senile disease (urinary incontinence, mental paralysis, unwanted activity, falls, loss of ability to live, etc.).
3, the lack of typical signs: rarely appear typical pneumonia, increased vocal fibrillation, bronchial breath sounds and other signs of the lungs, can appear pulse speed, breathing fast, breath sounds weakened, the bottom of the lungs can smell wet rales, but easy to coexist Chronic bronchitis, heart failure, etc. are confused.
4. The results of laboratory tests are not typical:
1 The basic diseases are many, and it is prone to multiple organ dysfunction.
2 complications are more and more serious: elderly pneumonia is prone to water and electrolytes and acid-base balance disorders, respiratory failure, hypoproteinemia, arrhythmia and shock and other serious complications, high mortality.
Bronchopneumonia
Rapid onset or slow onset, sudden onset of fever, refusal or vomiting, lethargy or irritability, wheezing and other symptoms, before the onset may have mild upper respiratory tract infection for several days, early body temperature is mostly 38 ~ 39 ° C, can also Up to 40 ° C, mostly gallop or regular fever.
Most of the weak babies are slow onset, fever is not high, cough and lung signs are not obvious, common refusal to eat, breast milk, vomiting or difficulty breathing.
pneumonia
Clinical manifestation
Most of the onset is rapid, often caused by cold rain, fatigue, viral infections, etc., about 1/3 of the upper respiratory tract infection before the disease. The course of disease is 7 to 10 days.
1, chills and high fever
Typical cases start with a sudden chill, followed by high fever, body temperature can be as high as 39 ° C ~ 40 ° C, showing a heat retention pattern, often accompanied by headache, body muscle soreness, reduced food intake. The heat type after antibiotic use can be atypical, and the elderly and the weak can only have low fever or no fever.
2, cough and cough
The initial stage is irritating dry cough, and then cough up white mucus or bloody sputum. After 1~2 days, it can cough up bloody sputum or rust sputum, or it can be purulent sputum. And thin.
3, chest pain
Most of them have severe lateral chest pain, often acupuncture-like, exacerbated by coughing or deep breathing, and can be radiated to the shoulder or abdomen. Such as lower lobe pneumonia can stimulate severe abdominal pain caused by the pleura, easy to be misdiagnosed as acute abdomen.
4, difficulty breathing
Difficulty and shallow breathing due to insufficient lung ventilation, chest pain and toxemia. When the condition is severe, the gas exchange is affected, and the arterial oxygen saturation is lowered to cause purpura.
5, other symptoms
A few have gastrointestinal symptoms such as nausea, vomiting, bloating or diarrhea. Seriously infected people may have confusion, irritability, lethargy, coma and so on.
Lung cancer
Most of the lung cancer patients are male, the ratio of male to female is about 4-8:1, and the majority of patients are over 40 years old.
The clinical manifestations of lung cancer are closely related to the location, size, oppression of the cancer, invasion of adjacent organs, and the presence or absence of metastasis. Early lung cancer, especially peripheral lung cancer, often does not produce any symptoms, mostly found during chest x-ray examination. After a cancer grows in a large bronchus, it often produces a irritating cough. Most of them have a paroxysmal dry cough or only a small amount of white foam. It is easy to mistake the cold. When the cancer continues to grow and affect the bronchial drainage, secondary pulmonary infection, there may be purulent sputum, the amount of sputum is also increased. Another common symptom is blood stasis, usually a small amount of hemoptysis in the sputum with blood spots, bloodshot or intermittent, and a large amount of hemoptysis is rare. Some lung cancer patients may have chest suffocation, wheezing, shortness of breath, fever and mild chest pain in the clinic due to the large bronchial obstruction caused by the tumor.
When advanced lung cancer oppresses a nearby organ or invades a distant metastasis, the following symptoms can occur:
1. Oppression or invasion of the phrenic nerve causes paralysis of the ipsilateral diaphragm.
2, oppression or violation of the recurrent laryngeal nerve, causing vocal cord paralysis, hoarse voice.
3, oppression of the superior vena cava, the bow g face, neck, upper limbs and upper chest vein engorgement, tissue edema, upper limb venous pressure increased.
4, invading the pleura, can cause pleural effusion, often bloody. A large amount of fluid can cause shortness of breath. In addition, cancer invading the pleura and chest wall can cause persistent severe chest pain.
5, cancer invades the mediastinum, oppression of the esophagus, can cause difficulty swallowing.
6, the top of the upper lobe, can invade and oppress the organ tissue located in the upper thoracic cavity. Such as the first rib, subclavian arteriovenous, brachial plexus, cervical sympathetic nerve, etc., resulting in severe chest pain, upper extremity venous engorgement, edema, arm pain and upper limb dyskinesia, ipsilateral upper eye face drooping, pupil diminution, eyeball retraction Cervical sympathetic syndrome such as no sweat on the face. After the lung cancer has been transferred to the bloodstream, different symptoms are caused by invading the organ.
In addition, there are a small number of lung cancer cases, due to the secretion of endocrine substances in cancer, clinically presented non-metastatic systemic symptoms, such as osteoarthritis syndrome (caries, bone and joint pain, periosteal hyperplasia, etc.), Cushing's syndrome , myasthenia gravis, male mammary gland enlargement, multiple muscle neuralgia and so on. These symptoms may disappear after removal of a lung cancer.
tuberculosis
1, pay attention to the inquiry
1 with or without fever, night sweats, loss of appetite, weight loss, cough, cough, blood stasis or hemoptysis, chest pain, difficulty breathing and other symptoms. Female patients have menstrual disorders or amenorrhea.
2 ask about the length of the disease, onset time, X-ray lesions, sputum examination, diagnosis, treatment medication and program, treatment, efficacy, drug side effects.
2, physical examination
Note whether the superficial lymph nodes are swollen or not, and there is no BCG scar on the left upper arm. Whether there is abnormality in the chest, other systems have signs of tuberculosis complications.
3, tuberculosis classification tuberculosis is divided into five large: primary tuberculosis (type 1); blood line disseminated tuberculosis (type II); invasive tuberculosis (type III); chronic fibrovascular tuberculosis (type IV); tuberculosis Pleuritis (V type). The activity and outcome of tuberculosis: divided into three phases, namely, the progress period, the improvement period, and the stabilization period.
Lung abscess
1, acute inhalation lung abscess sudden onset, patients with chills, fever, body temperature can be as high as 39 ~ 40 ° C, with cough, cough mucus or mucus purulent, inflammation and local pleura can cause chest pain, the lesion range is large, There is an impatience, in addition, there is still lack of energy, fatigue, poor appetite, about 7 to 10 days later, the cough is intensified, the abscess ruptures in the bronchi, cough up a lot of pus sputum, up to 300 ~ 500ml per day, due to anaerobic Infected with bacteria, it has odor. After standing, it is divided into 3 layers. From top to bottom, it is foam, mucus and pus. After pus discharge, the systemic symptoms are improved and the body temperature is lowered. If effective antibiotics can be applied in time, the lesions can be Within a few weeks, the body temperature tends to be normal, the amount of sputum is reduced, and the general condition returns to normal. Sometimes there is blood or moderate hemoptysis in the sputum. If the treatment is not timely, the medication is not suitable, the medicine is not adequate, the body resistance is low, and the lesion is low. It can be gradually turned into chronic, and some break into the chest to form a pus or chest bronchial pleural fistula. At this time, the symptoms are light and heavy, mainly cough, cough and sputum, many have hemoptysis, blood from sputum to large hemoptysis, intermittent fever And chest pain, etc.
2, chronic lung abscess patients have chronic cough, cough and sputum, repeated hemoptysis, secondary infection and irregular fever, etc., often anemia, weight loss chronic consumption sickness.
3, blood-borne lung abscess more than the original lesion caused by chills, high fever and other symptoms of systemic sepsis, after a few days to two weeks before the emergence of lung symptoms, such as cough, cough, etc., usually sputum Not much, very little hemoptysis.
Pulmonary embolism
The clinical manifestations of pulmonary embolism can range from asymptomatic to sudden death. Common symptoms are dyspnea and chest pain, with an incidence of more than 80%. Pleural pain is caused by inflammation of the adjacent pleural cellulose, and sudden onset often indicates pulmonary infarction. The pleural involvement can be radiated to the shoulder or abdomen. If there is pain in the back of the chest, it is similar to a myocardial infarction. Chronic pulmonary infarction may have hemoptysis. Other symptoms are anxiety, which may be caused by pain or hypoxemia. Syncope is often a sign of pulmonary infarction.
Examine
Pulmonary examination
Routine laboratory tests are non-specific, and the total number of white blood cells in bronchoalveolar lavage fluid may increase, but the cell classification is similar to that of a normal smoker or a smoker with IPF.
1, chest X-ray film: 2 / 3 or more patients with X-ray film showed lung network reticular shadow or reticular nodules infiltration, but the lung volume is often normal, a few patients with normal chest X-ray.
2, chest CT: high-resolution chest CT (HRCT) showed diffuse or patchy ground glass-like changes, mainly seen in the lower lung; also showed atelectasis, intralobular or interlobular interstitial thickening, emphysema And peripheral pulmonary bullae.
3, lung function: often restrictive or mixed ventilatory dysfunction and a slight decrease in the amount of diffusion, occasionally normal lung function, increased lung volume suggests gas traps in the blocked bronchioles, resting or active There is mild hypoxemia.
Diagnosis
Diagnosis and diagnosis of lung disease
diagnosis:
According to laboratory tests and chest CT, ultrasound and other examinations, it is easy to diagnose lung diseases.
