expectoration
Introduction
Introduction is the secretion of trachea, bronchus or exudate in the alveoli, does not include mucus of the mouth, nose, throat. Cough is a pathological secretion in the respiratory tract that removes secretions from the respiratory tract by means of ciliary movement of bronchial epithelial cells, contraction of bronchial smooth muscle, and airflow impulses during coughing. Cough is common in pneumonia, chronic pharyngitis, chronic bronchitis, bronchiectasis, lung abscess and cavitary tuberculosis.
Cause
Cause
Cause:
1. Bronchial disorders:
Acute and chronic tracheobronchitis, bronchial asthma, endobronchial tuberculosis, bronchiectasis, primary bronchial carcinoma, liver abscess to the thoracic cavity to form bronchospasm.
2, lung disease:
Various causes of pneumonia (bacterial, viral, mycoplasma, fungal, etc.), tuberculosis, lung abscess, pulmonary infarction, pulmonary edema, diffuse pulmonary interstitial fibrosis, sarcoidosis, pneumoconiosis, etc.
3. Other:
Blood diseases such as leukemia, Hodgkin's disease, malignant histiocytosis, etc., and collagen diseases such as rheumatoid arthritis, progressive systemic sclerosis, systemic lupus erythematosus, nodular polyarteritis, wegener necrotizing granuloma Etc. can affect the lungs, as well as the pleura, diaphragm, mediastinal lesions (such as massive pleural effusion, mediastinal tumor, sputum, etc.) due to compression of the bronchus or cough caused by reflexes, there may be a small amount of mucus or serous sputum.
Examine
an examination
Related inspection
Sputum pathogen examination lung volume measurement airway resistance (R) maximum ventilation per minute (MVV) Mycoplasma pneumoniae complement fixation test
First, medical history
Knowing the amount, color, smell, and traits of observing ticks often leads to diagnosis:
(a) traits
1, mucinous sputum: enamel thick, colorless transparent or slightly white, more common in the early stages of bronchitis, bronchial asthma, pneumococcal pneumonia.
2, mucus purulent sputum: sputum traits between mucus sputum and purulent sputum, sputum in addition to mucus, a part of pus, with yellow-white, viscous; common in bronchitis, tuberculosis, lung inflammation, etc. . This is due to the formation of pus in the inflammatory process of the lung tissue, and a large amount of mucus secretions are mixed.
3, purulent sputum: sputum purulent, yellow or green, thick and sticky, some with odor, common in suppurative bronchitis, bronchiectasis, lung abscess, empyema or liver, spine, mediastinal abscess Bronchospasm caused by the lungs, squeaky purulent sputum, often suggest anaerobic infection.
4, serous sputum foamy sputum: sputum thin and more foam, common in pulmonary edema, is due to pulmonary sputum or pulmonary capillary vascular permeability, capillary fluid infiltration into the alveoli.
5, bloody sputum: sputum with blood, blood is not the same, the less is bloody sputum, many can be pink, tan. Common lung cancer, tuberculosis, pulmonary infarction, bronchiectasis, etc.
(2) Quantity
The most common diseases are pulmonary edema, lung abscess, bronchiectasis, alveolar cell carcinoma, empyema or abdominal abscess. Checking the amount of sputum is generally based on 24h. The increase in sputum reflects the progress of bronchial and pulmonary inflammation; sputum can not be discharged smoothly, although the clinical manifestations of sputum reduction, in fact, the condition is still developing, the symptoms of poisoning will be aggravated.
(three) smell
The general cockroach has no odor. When it is left for a long time, it will produce odor due to the decomposition of bacteria in the sputum. When anaerobic bacteria are infected, it has a bad odor. It is seen in the lungs, sputum, lung abscess, bronchiectasis, and late stage of bronchial lung cancer.
(four) color
Colorless transparent or gray-white mucus is seen in normal people, mild inflammation of the bronchial mucosa. Yellow or green sticky tips suggest a purulent infection in the respiratory tract. Green sputum is often caused by bile, degenerative hemoglobin or pyocyanin. It is found in jaundice, slow-absorbing pneumococcal pneumonia, Pseudomonas aeruginosa infection, and bloody sputum in lung cancer. Tuberculosis, bronchiectasis, rust stains, seen in pneumococcal pneumonia. Pink or bloody foam glimpses acute pulmonary edema. Reddish-brown or chocolate-colored sputum, seen in the amebic disease of the lung caused by the amoebic abscess that penetrates into the lungs. Jam-like mites are found in paragonimiasis, gray or black sputum, found in various pneumoconiosis, such as coal pneumoconiosis. Brown sputum, seen in the pulmonary infarction, the lungs contain iron and blood yellowing.
(5) accompanying symptoms
Patients with cough and high fever should consider pneumonia and lung abscess. Cough with chest pain should pay attention to lung lesions affecting the pleura such as pneumonia, lung cancer, lung infarction and so on. Coughers should consider the corresponding pneumoconiosis when they are exposed to harmful dust for a long time. Cough pink foam with dyspnea should pay attention to acute pulmonary edema, men over 40 years old, have a long history of smoking, hemoptysis should be alert to the possibility of lung cancer.
Second, physical examination
Chronic pulmonary tuberculosis, atelectasis, trachea can be moved to the affected side, supra-sacral lymphadenopathy, Kyoto primary branch fistula cancer; lung tip percussion dullness should pay attention to tuberculosis, lower chest percussion dullness more consider lung inflammation or pleural effusion . Localized sounds in any part of the lungs suggest lung inflammation or cavities; localized upper part of the lungs with fine wet sounds suggesting tuberculosis; localized lower extrinsic persistent moderate wet sounds considering bronchiectasis bilateral dispersal in wheezing bronchial asthma cc side scattered The wet tone suggests chronic bronchitis.
Third, laboratory inspection
(a) microscopy
First observe with the naked eye, select suspicious parts, such as purulent cheese-like or granular lumps, the positive rate of smear microscopy is high.
1. Epithelial cells: Circular, columnar or squamous epithelial cells can be seen in the sputum. Generally, there is no special significance. In the chronic bronchitis, a large number of deformed and necrotic columnar epithelial cells and goblet cells can be seen.
2, white blood cells: contains a number of white blood cells generally no special significance, or indicates mild inflammation, a large number of pus cells when the expression of respiratory system purulent inflammation.
3, eosinophils: a large number of eosinophils found in sputum, bronchitis in bronchial asthma, parasitic diseases.
4, red blood cells: suggesting respiratory bleeding, seen in tuberculosis. Bronchiectasis and the like.
5, pigment cells: macrophages phagocytose pigment particles called pigment cells, phagocytosis of hemosiderin, seen in idiopathic pulmonary hemosiderosis, heart function will not be pulmonary congestion, phagocytosis of carbon particles Cells, found in a variety of pneumoconiosis or inhalation of more smoke.
6, cancer cells: lung cancer patients found that cancer cells have diagnostic significance.
7, bacteria: Gram stain can identify cocci, bacilli, acid-fast staining can find acid-fast bacilli.
8. Parasites: The paragonimiasis eggs can be found in the sputum of patients with Pneumocystis sinensis. The heads and small hooks of the echinococcosis of the wrapped worms can be found in the sputum of the patients with broken lung worms. Amoeba trophozoites can be found in the sputum of the abscess.
9. Actinomycetes: In the sputum of patients with pulmonary actinomycetes, there may be yellow granules of sesame size, which are sulphur particles. When the small sulphur particles are crushed, the central part can be seen in a line-like arrangement. Fungal hyphae, whose ends are swollen and stick-shaped.
10, sharp-edged crystal, is a colorless transparent octagonal crystal with pointed ends, different sizes, from eosinophils, visible in the bronchial end and paragonimiasis.
(two) bacterial culture
Identify pathogens and conduct drug susceptibility tests to guide clinical rational selection of antibiotics.
Fourth, equipment inspection
1, X examination: is an important diagnostic tool for cardiopulmonary disease. Most of the inflammatory shadows in the lungs are inflammation of the lungs; if the symptoms such as chest pain, urgency, and shock are obvious, the shadows are fan-shaped, and when the basal part faces the pleura, the pulmonary infarction should be excluded. The infiltrating shadow of the upper part of the lung first considers invasive pulmonary tuberculosis. Pulmonary mass on the lungs and lung swelling, lung cancer, tuberculosis. Diffuse shadows in the lungs should consider miliary tuberculosis, alveolar cell carcinoma, hemosiderosis, silicosis, and lung metastases. For those suspected of having bronchiectasis, bronchial lipiodol angiography can be performed to determine the diagnosis and treatment plan.
2, CT: can distinguish the lung structure that can not be displayed in the ordinary X-ray, and the CT-guided percutaneous lung biopsy positioning is accurate and safe.
3, fiberoptic bronchoscopy: for patients with suspected lung cancer should do fiberoptic bronchoscopy to observe the lesions, lung infection in the fibrous bronchi with double cannula to absorb or brush the secretions of deep bronchus in the lungs, as a pathogen culture To avoid oral pollution, the positive rate is high, bronchoalveolar lavage can be feasible if necessary, to the cause of lung disease, a clear diagnosis.
Diagnosis
Differential diagnosis
It should be considered according to the patient's comprehensive situation, such as understanding the amount of sputum, color (red, yellow, white, etc.), traits (mucus sputum, purulent sputum, serous sputum, foam sputum, etc.).
(1) The patient's pharynx is dry, itchy and discomfort, and it stimulates coughing. Opening the mouth to the mirror, you can find that the mucosal surface of the posterior pharyngeal wall is rough. There are many small blood vessels that expand. In severe cases, there will be transparent small white bubbles. It should be suspected as chronic pharyngitis, especially simple. If the patient has a dry cough, but with a hoarse voice, it feels itchy throat, hot pain such as acupuncture, should be suspected of chronic laryngitis.
(2) If the patient is middle-aged or older, especially those with a long history of smoking, if they cough frequently, more or less mucus sputum will be aggravated after waking up in the morning, and every winter and spring, summer will be alleviated or relieved. Severe or longer-term new chest enlargement should be suspected as chronic bronchitis. If you have shortness of breath or difficulty breathing, you should suspect that you have progressed to the stage of chronic obstructive pulmonary disease (COPD). You should go to the hospital for detailed examination.
(3) If the cough recurs repeatedly, if the throat is like a saw when panting, the patient feels chest tightness and difficulty breathing. Every time it occurs in the late autumn, winter and early spring cold season or sudden changes in temperature, or exposure to certain allergens, it should be suspected. Bronchial Asthma.
(4) If the patient has low cough, cough with blood or hemoptysis, feel weak, the amount of food is reduced, the body is getting thinner, the body temperature is increased in the afternoon or at night, sweating increases during sleep, and there is flusteredness, accompanied by two hairs. Red should be suspected of tuberculosis.
(5) Middle-aged and elderly patients, who have hemoptysis and cough, must have chest radiographs, and first rule out the possibility of lung tumors.
Cough and cough are not only seen in the above diseases, but also appear as an independent symptom. Regardless of the cause of coughing or coughing, you should go to the hospital as soon as possible. So as not to delay the disease, and have adverse consequences.
