Transcript Hemoptysis

GuoYing
The respiratory department of the
first affiliated hospital of liaoning
medical college
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Common symptoms
• Cough
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•
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Expectoration
Hemoptysis
Chest pain
Dyspnea
Cyanosis
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Cough
A cough is a sudden, forceful, noisy
expulsion of air from the lungs.
It is a protective reflex ，but excessive
coughing is harmful to human’s body.
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Mechanism of cough
larynx, trachea, bronchi, pleura
Stimuli from and external acoustic meatus
afferent nerve fiber
vagus nerve
coughing centre （in oblongata）
efferent nerve fiber
laryngeal nerve diaphragmatic nerve spinal nerves
deep breath
glottal closure
sudden glottal opening
intrathoracic pressure increase
outward blast of air
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Cough : manifestations
• Characteristics
– Unproductive /Dry cough (non-sputum: non-infectious)
– Productive cough (sputum: infectious, edema)
• Attack
– Time (single/paroxysmal /nocturnal)
– Season (chronic)
– motivation
• Tone
– Hoarseness
– High pitch/brassy cough
– Weak
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Cough : Clinical Occurrence
• Respiratory diseases___ the most common causes
– Airway agents
• Bronchitis, bronchiectasis, asthma,
endobronchial tuberculosis, tumor, pharyngitis，
tracheoesophageal fistula，foreign bodys
– Lung agents
• Infection, edema, fibrosis, tumor
– Pleural agents
• Pleurisy, pneumothorax, mesothelioma of pleura
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•Cardiovascular diseases
–Cardiogenesis edema/ congestive heart failure,
–pulmonary embolism and infarction
_vasculitis : Wegener, Churg-Straus syndrome ,
Goodpasture syndrome.
_aortic aneurysm, pulmonary hemorrhage.
•Central nervous system agents
–Initiative cough, encephalitis, meningitis
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Chronic unexplained coughs are most commonly
related to one or a combination of :
chronic post-nasal drip;
gastroesophageal reflux;
cough-variant asthma;
drugs (angiotensin converting enzyme inhibitors)
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Cough: accompany signs
• Fever (infection)
• Chest pain (infection, tumor, pleurisy,
pneumothorax, pulmo embolism)
• Hemoptysis (bronchiectasis, tuberculosis,
tumor)
• Bulk pus sputum (bronchiectasis, lung abscess)
• Wheezing (asthma, foreign body)
• Clubbing fingers (bronchiectasis, lung cancer,
chronic lung abscess)
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Common symptoms
• Cough
• Expectoration
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•
•
•
Chest pain
Hemoptysis
Dyspnea
Cyanosis
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Expectoration
The attributes of sputum
Bloody Sputum (Hemoptysis,next class )
Bloody gelatinous sputum
Rusty Sputum
Purulent Sputum
Stringy Mucoid Sputum
Frothy Sputum
Broncholiths
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Bloody gelatinous sputum
（Currant-jelly sputum ）
Copious quantities of tenacious ,bloody
sputum are almost pathognomonic for
pneumonia caused by klebsiella pneumoniae or
streptococcus pneumoniae
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Rusty Sputum ( Prune-juice Sputum)
Purulent sputum containing changed blood pigment is typical of
pneumococcal pneumonia but it is frequently preceded by small
amounts of frank blood.
Stringy Mucoid Sputum
Increased mucous production and formation of mucous plugs occur
in asthma; during resolution of an acute attack, retained mucous is
mobilized.
Frothy Sputum ( Pulmonary Edema)
Fluid from the pulmonary capillaries enters the alveoli and is
expectorated. A thin secretion containing air bubbles, frequently
colored with hemoglobin , is typical of pulmonary edema. Both acute
lung injury and left ventricular failure produce this sign.
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Purulent Sputum
Inflammatory cells, predominately polymorphonuclear leukocytes,
enter the airways and alveoli in response to lower airway infection.
Colour:yellow (general bacterial), green (aeruginosus Bacillus), or Grey
or black (dust inhalation).
Amounts:Small amounts ：acute bronchitis, pneumonia during
resolution, small tuberculous cavities or lung abscess. Copious purulent
sputum suggests lung abscess, bronchiectasis, or bronchopleural fistula
communicating with an empyema. Many lung abscesses do not yield
much sputum because their bronchial communications are inadequate for
complete drainage
Odor :Fetid sputum suggests anaerobic infection and/or lung abscess.
Bronchiectasis:200 to 500 ml/d. On standing, bronchiectatic sputum
typically separates into three layers,with mucus on top separated by clear
fluid from pus on the bottom. (or upper: frothy, middle: serofluid or
serofluid pus,lower: necrosis substance)
bronchopleural fistula :Copious sputum from a patient with signs of
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pleural effusion suggests
Broncholiths
Occasionally, calcified particles are found in the
sputum either by the patient or the physician. These
are usually broncholiths, derived from calcified
lymph nodes eroding the bronchi or from calcareous
granulomas in silicosis, tuberculosis, or
histoplasmosis. Their discovery may explain the
source of pulmonary hemorrhage
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Common symptoms
• Cough
• Expectoration
• Hemoptysis
• Chest pain
• Dyspnea
• Cyanosis
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Hemoptysis
• Definition: Spitting or coughing of blood is
hemoptysis.
• The blooding region: anywhere from the nose to
the lungs .
• The amount varies from blood-strained sputum to several
hundreds ml pure blood
– Mild: 100ml/d
– Moderate: 100-500ml/d
– Severe: >500ml/d, or 100-500/time
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Hemoptysis
• Differential diagnosis
– Bleeding from upper respiratory tract
Expectorated blood usually comes from the upper
respiratory tract while blood in the bronchial tree
induces coughing. However, the patient may not be able
to distinguish which of the two is occurring, so both
upper and lower respiratory tract disorders must be
considered.
– Hematemesis
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Distinguished hemoptysis from
hematemesis
Hemoptysis
Hematemesis
Causes
Pulmo or cardiac
digestive system
Previous symptoms
Cough, chest tightness
Nausea, vomiting
Spit up
Cough up
Vomited
Color
Bright red
Dark red
Mixture
Sputum, frothy
Gastric contents
pH
alkalinity
acidity
Tarry stools
Negative/ positive
positive
Post-bleeding
Sputum with blood
No sputum
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Hemoptysis: causes
• Bronchial disorders
– Bronchiectasis
– Bronchogenic
carcinoma
– endobronchial TB
– Chronic bronchitis
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Hemoptysis: causes
• Pulmo Disorders
– Pulmo TB
– Pneumonia
– Lung abscess
– Pulmo embolism
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Hemoptysis: causes
• Cardiovascular disorders
– Acute left heart failure
– Mitral stenosis
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Hemoptysis: causes
• Others
– Hematologic disease, leptospirosis （钩端螺
旋体病），epidemic hemorrhagic fever，
endometriosis （子宫内膜异位症）
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Bloody Sputum
• Blood in the sputum usually impresses patients enough to
bring them to the physician. The first problem is to identify
the anatomic site of hemorrhage.
• Blood-Streaked Sputum is usually caused by inflammation
in the nose, nasopharynx, gums, larynx, or bronchi.
Sometimes it occurs only after severe paroxysms of
coughing and may be attributed to trauma.
• Pink Sputum usually results from blood mixing with
secretions in the alveoli or smaller bronchioles; it most
frequently occurs in pneumonia or pulmonary edema.
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• Massive bleeding occurs with erosion of a
bronchial artery by cavitary pulmonary
tuberculosis, aspergilloma, lung abscess,
bronchiectasis, pulmonary infarction, pulmonary
embolism, bronchogenic carcinoma or a
broncholith.
• Goodpasture syndrome Alveolar Hemorrhage,
does not produce bloody sputum in all cases.
• mitral stenosis. Not infrequently,frank bleeding
from the lungs occurs in
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Hemoptysis: accompany symptoms
• Fever
– Infection or carcinoma
• Chest pain
– Infection， Pulmo Embolism，Carcinoma
• Pus sputum
– Bronchiectasis，Lung abscess
• Clubbing fingers
– Bronchiectasis，Lung abscess，Carcinoma
• Hemorrhagic spots
– Hematologic disease, leptospirosis, epidemic
hemorrhagic fever
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Clubbing fingers
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Clinical occurrence
1.Upper Respiratory Tract
bleeding from :
nasopharynx,
oropharynx,
gums,
laryngitis,
laryngeal carcinoma,
hereditary hemorrhagic telangiectasia.
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2.Bronchial Tree
bronchiectasis,
bronchial carcinoma,
acute and chronic bronchitis,
trauma from coughing,
broncholiths,
foreign body aspiration,
erosion by aortic aneurysms.
bronchiectasis
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broncholiths
carcinoma
foreign body
3 Lungs
infections ( pneumonia, especially caused by Klebsiella,
lung abscess, tuberculosis,fungal infections, amebiasis,
hydatid cyst) , pulmonary embolism with infarction,
trauma, pulmonary hemorrhage ( vasculitis especially
Wegener, Goodpasture syndrome ) , idiopathic
pulmonary hemo-siderosis, lipoid pneumonia.
4 Cardiovascular diseases
Mitral stenosis, congestive heart failure, arteriovenous
fistula, anomalous pulmonary artery, hypertension.
5 Hematologic diseases
thrombocytopenia, leukemia, hemophilia
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lobar pneumonia
Lung abscess
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Pulmo TB