cough
Introduction
Introduction Cough is one of the most common symptoms of respiratory diseases. It is a protective reflex action that removes secretions or foreign bodies from the respiratory tract. It produces an expiratory shock through coughing, which can excrete foreign bodies or secretions in the respiratory tract. However, severe long-term cough can cause respiratory tract bleeding. Correctly distinguish between general cough and cough variant asthma to prevent misdiagnosis. Treatment of cough should distinguish the type of cough, Western medicine, Chinese medicine can be, but the diet is the best. Preventing coughs is a key to preventing colds, so you should pay attention to your exercise.
Cause
Cause
There are many diseases that cause cough symptoms. According to different causes, they are mainly divided into the following categories:
(1) Infectious factors
1, upper respiratory tract disease, cold, adenovirus infection, rhinitis or paranasal sinusitis, tonsillitis, acute and chronic pharyngitis, acute and chronic laryngitis, acute epiglottis, throat tuberculosis.
2, tracheal, bronchial disorders acute and chronic bronchitis, endobronchial tuberculosis, bronchiectasis and so on.
3, lung, pleural disease pneumonia (bacterial, viral, mycoplasma), pulmonary fungal disease, lung abscess, pulmonary cysts with infection, tuberculosis, pleurisy.
4. Infectious diseases, parasitic diseases, pertussis, diphtheria, measles, influenza, paragonimiasis, pulmonary hydatidosis, hookworm disease, etc.
(2) Physical factors
Any physical condition such as obstruction, compression, or pulling of the respiratory tract that causes the wall to be stimulated or the lumen to be distorted and narrowed can cause coughing.
1, airway obstruction: tracheal or bronchial foreign body, bronchoconstriction (common in tuberculosis), bronchial tumor, atelectasis, pulmonary edema, emphysema, alveolar proteinosis, alveolar microlithiasis, alveolar cancer.
2, respiratory tract compression: hilar or bronchial lymphadenopathy, mediastinal tumor, mediastinal lymphadenopathy, retrosternal goiter, esophageal diverticulum, esophageal tumor, lung tumor, diffuse interstitial pulmonary fibrosis, pulmonary cyst, Sarcoidosis, pneumoconiosis, pneumothorax, pleural effusion, pericardial effusion, pleural tumor, etc.
(3) Chemical factors
All toxic and harmful irritating gases in the respiratory tract stimulate the respiratory tract to cause coughing. Commonly used are smoking, drinking tobacco, stimulating industrial gases such as ammonia, chlorine, dioxide, ozone, phosgene, nitrogen oxides, etc., also seen in the volatilization of nitric acid, sulfuric acid, hydrochloric acid, formaldehyde and so on.
(4) Allergic factors
Allergic rhinitis, bronchial asthma, cotton pneumoconiosis, tropical eosinophilia, lufu syndrome, hay fever, angioedema, etc.
(5) Other factors
Infraorbital abscess, hernia, esophageal fistula, Wegener granulomatosis, leukemia, Hodgkin's disease, uremia and connective tissue disease and other lung infiltration.
Examine
an examination
Related inspection
Mycoplasma pneumoniae complement-binding test Mycobacterium tuberculosis gene detection (PCR) Bolton granules Onderram ear urinary chromium (Cr)
First, medical history
The nature of the symptoms and cough is helpful in suggesting a diagnostic clue.
1, cough with high fever: cough with high fever call patients, consider more acute infectious diseases, acute exudative pleurisy or empyema.
2, cough with chest pain: cough with invented chest pain should consider pleural disease, or lung and other organ diseases, such as lung cancer, pneumonia and pulmonary infarction.
3, cough with cough: cough with cough and jaundice more consider bronchitis, pneumonia, etc. If cough a large number of purulent patients more consider lung abscess, bronchiectasis, secondary infection of lung cysts. If you have cough with cough and jam, you should consider lung amebiasis and paragonimiasis.
4, cough accompanied by hemoptysis: hemoptysis should consider bronchiectasis or cavitary tuberculosis, a small amount of hemoptysis or blood in the sputum to consider lung cancer, tuberculosis and so on.
Second, physical examination
First check the position of the trachea, chronic pleurisy or chronic empyema, chronic tuberculosis, atelectasis and other diseases of the trachea to the affected side, pneumothorax or a large number of pleural effusion when the trachea pushes to the healthy side, the superior vena cava syndrome prompts mediastinal swelling or Ditch tumor, supraclavicular lymph node enlargement should consider bronchial lung cancer, the occurrence of subcutaneous emphysema in the neck is often caused by tension pneumothorax or mediastinal emphysema; excessive side resuscitation on the lung side is more common in pneumothorax, excessive repercussions on both sides are more obstructive Emphysema, phlegm sounds in the upper part of the lung should pay attention to tuberculosis, turbidity in the lower part consider pleural effusion or lung consolidation, auscultation of bilateral dry vocalization considers chronic bronchitis, and any part of the lung hears limited greenhouse. It is suggested that there is a lung inflammation or a hole in the lungs, and there is a moderate wetness in the localized lung field. The tone may be considered to have the possibility of bronchial dilatation. Patients with emphysema signs should also consider the pulmonary origin when the whole party estimates the heartbeat. The presence of heart disease.
Third, laboratory inspection
Understanding the amount, color, smell and nature of cockroaches is diagnostic. In the sputum, bronchial tube type, lung stone, and sulfur granules were found to help pneumococcal pneumonia, tuberculosis, and pulmonary actinomycosis. Microscopic examination revealed Kusmanian spirochetes, and Xialan crystals were helpful for patients with bronchial asthma. The parasite eggs found in the sputum can be diagnosed with paragonimiasis. The head of the echinococcosis of the cysticercosis can be diagnosed with cysticercosis, and the amoebic trophozoite can be diagnosed for the diagnosis of pulmonary amebiasis. (Smear, culture, animal inoculation) is important for tuberculosis, pulmonary fungal disease, etc. It is found that cancer cells can identify the diagnosis of bronchogenic lung cancer; tuberculosis test has a certain significance for children with lymph node tuberculosis.
Fourth, equipment inspection
Because the lungs have a good natural contrast, ordinary X-ray films can detect most of the lung lesions, and sometimes the nature can be determined according to the location, extent and shape of the lesion, such as pneumonia, lung abscess, pulmonary cyst, tuberculosis, lung cancer. , pneumoconiosis, etc. For deep lesions, X-ray tomography was used. CT. MRI examination showed that the superiority of CT scan was that there was no image overlap in the cross-sectional image, and the lesions that could not be displayed by X-ray were found.
Bronchography can directly diagnose the location and shape of bronchiectasis, and can also be diagnosed with bronchial lung cancer. Patients with delirium should be diagnosed with barium meal examination. Bronchoscopy can diagnose endobronchial foreign bodies, endobronchial tuberculosis, and bronchial tumors; mediastinoscopy can help diagnose mediastinal tumors and detect mediastinal lymphadenopathy. Gallium scan is positive in lung inflammatory lesions and nodular ice, so it can not be used as a means to monitor lung cancer and pneumonia lesions and sarcoidosis.
Diagnosis
Differential diagnosis
The following diseases should be identified:
Persistent cough:
Persistent cough is a precursor to lung disease. This cough will take two to three months to heal once it starts, and any cough medicine seems to be powerless.
Spastic cough:
Sputum cough is characterized by severe cough, coughing and snoring, a cough can be dozens of sounds to dozens of sounds for a long time, coughing redness on the face and neck, breathing is affected, coughing is often required after a pause Inhalation, severe cough often causes glottic sputum, a chicken-like sound, persistent coughing often causes retching, coughing for a while and then quiet for a while, and then start coughing, can cause children with tongue ulcers, conjunctiva Bleeding, severe gastrointestinal fistula caused by increased abdominal pressure due to cough, inguinal hernia and rectal prolapse, spastic cough is common in pertussis, parapertussis and some adenovirus infections. If there is obvious cough, the peripheral blood counts of white blood cells and lymphocytes are significantly increased, according to these characteristics can make a clinical diagnosis of whooping cough. In addition, bacterial culture positive or serological immunology, positive PCR test can confirm pertussis.
Wet cough:
Cough is accompanied by sputum called wet cough. Can be seen in pneumonia, bronchitis, bronchiectasis, lung abscess, fibrovascular tuberculosis and so on. Early mild dry cough, then turned into a wet cough, snoring or coughing up yellow purulent, early symptoms of cold, such as fever, sneezing, salivation, pharyngeal discomfort.
Dry cough:
When you cough, there is no such thing as a dry cough. Can be seen in acute pharyngitis, bronchitis, early tuberculosis, pleurisy and so on.
Allergic cough:
Paroxysmal intermittent discontinuities occur, there is no persistent state, paroxysmal cough is a description of the form of seizures, there is no cause, so there is no meaning, most of the episode cough is allergic cough.
Allergic cough:
Allergic cough is caused by prolonged unhealed virus infection and bacterial infection, and allergic factors are involved.
