cough up blood
Introduction
Introduction Hemoptysis is a condition in which the bleeding of the respiratory organs below the throat is discharged through the mouth. Common causes include tuberculosis, bronchial lung cancer, bronchiectasis, lung abscess, pneumonia, chronic bronchitis, paragonimiasis, mitral stenosis, certain blood diseases (such as thrombocytopenic purpura, leukemia, hemophilia). Therapeutic measures include treatment of primary disease and symptomatic treatment. Those with blood or small amount of hemoptysis can use cough, sedative and hemostatic drugs. Those with moderate or large hemoptysis should stay in bed strictly, apply strong hemostatic drugs (such as pituitary vasopressin), and if necessary, fiber beam Bronchoscopy to stop bleeding and emergency surgery to stop bleeding.
Cause
Cause
Due to lung injury, blood is caused from the lungs, coughing through the airway, or pure red blood, or blood stasis, or bloodshot in the sputum. Also known as blood stasis, hemoptysis. External evils attack the lungs, phlegm obstruction of the lungs, liver fire guilty of the lungs, lung and kidney yin deficiency, qi deficiency and other diseases cause lung collateral damage, lung gas upside, bloody airway. Generally, the course of exogenous hemoptysis is short, and the onset is urgent. At the beginning, there is fever and aversion to cold. The internal injury and hemoptysis are slow and the course is long. There are signs of viscera, yin and yang qi and blood deficiency or partial prosperity. Treatment of real fire hemoptysis, should clear heat and diarrhea, cooling blood to stop bleeding, choose diarrhea white scattered phlegm, clear dry rescue lung soup, Qianjin stalk soup addition and subtraction; virtual fire hemoptysis, yin yin Qingre, Ninglu hemostasis, choose Lily Gujin Tang, Yuehua Pills add and subtract; wind cold attack lung hemoptysis, should be wind and cold, Ningluo hemostasis, choose gold boiled grass to add and subtract; qi deficiency does not take hemoptysis, Yiyiqi blood to stop bleeding, choose Zhengyang The soup is added and subtracted.
Examine
an examination
Related inspection
Chest CT chest CT examination
First, medical history
Ask for bleeding for the first time or multiple times. If it is multiple times, it is different from the past. Young adults with cough, hemoptysis with low fever should consider tuberculosis. People over the middle age, especially male smokers, should pay attention to the possibility of lung cancer; must ask and observe the hemoptysis, color, with or without sputum, ask about the history of tuberculosis when asking for personal history, years of smoking history, menstrual history , occupational dust exposure history, raw crabs, history and so on.
Hemoptysis with chest pain is more common in pulmonary infarction, pneumococcal pneumonia; hemoptysis with cough is more common in bronchial lung cancer, ktk of mycoplasma pneumonia is seen in lung abscess; a large number of hemoptysis is more common in cavitary tuberculosis, bronchiectasis, rupture of aneurysm. Domestic literature reports that no jaundice-type leptospirosis also causes large hemoptysis that causes disease.
Second, physical examination
Patients with hemoptysis should be carefully examined repeatedly. Some chronic heart and lung diseases can be accompanied by clubbing (toe). Progressive tuberculosis and lung cancer patients often have significant weight loss. Some blood diseases have systemic hemorrhagic tendency.
Third, laboratory inspection
examination can help to find tuberculosis, fungi, bacteria, cancer cells, parasitic 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.
Fourth, equipment inspection
1, X-ray examination of patients with hemoptysis should be X-ray examination, chest fluoroscopy, chest radiograph, body slice, if necessary, can do bronchography to assist diagnosis.
2, CT examination helps to find small bleeding lesions.
3, bronchoscopy unexplained hemoptysis or bronchial obstruction atelectasis should consider bronchoscopy, such as tumors, tuberculosis, foreign bodies, etc., while taking direct biopsy pathological examination or foreign body removal, bleeding and sputum aspiration Wait.
4, radioactive radionuclide gallium examination to help the differential diagnosis of lung cancer and other lung masses.
Diagnosis
Differential diagnosis
1. Different from vomiting blood, hemoptysis and vomiting blood are all spoken, but the two are completely different. The hemoptysis is blood from the lungs, and the cyanosis occurs through the airway. The blood color is mostly red, often mixed with sputum. Before hemoptysis, there are many symptoms such as cough, chest tightness, and itchy throat. After a large amount of hemoptysis, the sputum belt can be seen. Blood for a few days, the stool is generally not black; vomiting blood is from the stomach, vomiting, blood color purple, often with food residue, vomiting blood before stomach ache or stomach pain, nausea and other symptoms, no vomiting blood There is blood in the sputum, but the stool is mostly black.
2. Different from pulmonary sputum The hemoptysis of patients with pulmonary sputum is mostly caused by the change of wind temperature, often with pus and blood phase, and smells bad. In the early stage, it can also be seen that the wind and heat hit the syndrome of the lungs. When it evolved into the stage of spit and pus, it was accompanied by heat, irritability, chest pain, red tongue, yellow greasy moss, and slippery pulse. This can be distinguished from the hemoptysis syndrome.
3. Differentiation from oral hemorrhage in the nasopharynx, gums and other parts of the mouth, often pure blood or blood with saliva, less blood, and the corresponding symptoms of oral and nasopharynx lesions can be found, can be The difference between cough and blood.
