检体诊断学：3 Hemoptysis

1、Hemoptysis New words Hemoptysis咯血 Hematemesis呕血 Respiratory tract呼吸道 Bronchitis支气管炎 Bronchiectasis支气管扩张 Tuberculosis结核 Purulent sputum脓痰 Bronchoscopy支气管镜 Angiograph血管造影 Definition Hemoptysis: Coughing up blood from lower respiratory tract. Definition o From where? o Lower respiratory tract: trachea,

2、 bronchi and lungs. o Hematemesis: Blood originates from gastrointestinal. o Blood come from mouth, nose, throat, and pharynx Definition Hemoptysis is a symptom of many underlying disorders. There are many diseases that can cause hemoptysis. Hemoptysis can range from blood-streaking sputum to massiv

3、e hemoptysis, even life- threatening hemoptysis. Etiology There are many underlying disorders that can cause hemoptysis. Worldwide: tuberculosis is the most common cause. In industrialized countries: bronchitis, bronchiectasis, and bronchogenic carcinoma are most common causes. Etiology Hemoptysis H

4、eart diseases Lung diseases Airway disorders Etiology The main etiologies of hemoptysis lAirways diseases: bronchial carcinoma; bronchiectasis bronchitis; airway trauma. lPulmonary parenchymal diseases: tuberculosis; pneumonia; lung abscess; pulmonary infract Etiology lCardiovascular disease: pulmon

5、ary embolism; elevated pulmonary capillary pressure by mitral stenosis, left ventricular failure, congenital heart disease, and sever pulmonary hypertension. lMiscellaneous: hematologic diseases, Wegeners granulomatosis, Goodpastures syndrome. Clinic feature The quantity of blood loss. Characteristi

6、cs of hemoptysis in different underlying diseases. Accompanied symptoms. Clinical feature 1. The quantity of blood loss lMild hemoptysis: 100ml per 24hr. lModerate hemoptysis: 100ml to 500ml per 24hr. lMassive hemoptysis: 500ml per 24hr. 200ml one time Clinical feature Massive hemoptysis: Medical em

7、ergency Lead to asphyxia （窒息窒息） Life-threatening coagulate in the airway Clinic feature 2. Characteristics of hemoptysis in different diseases lBright red: TB, bronchiectasis lDark red: heart diseases (mitral stenosis) lRust-colored sputum: pneumococcal pneumonia lFoamy and pink-colored sputum: left

8、 heart failure lBlood streaking sputum: lung cancer Clinic feature 3. accompanied symptoms lChest pain: pneumonia, lung cancer lFever: infectious diseases lPurulent sputum: bronchiectasis, lung abscess lBleeding: hematologic diseases lJaundice: leptospirosis(钩端螺旋体病) Diagnosis Make sure is hemoptysis

9、 Assess the severity of hemoptysis Determine the cause and location Diagnostic procedure Diagnosis 1. Differential diagnosis of hemoptysis lExcluding: Blood come from the upper airway including mouth, nose, and pharynx. lHematemesis: Blood from the gastrointestinal. Diagnosis Hemoptysis Hematemesis

10、History Lung disease Gastric or hepatic disease Respiratory symptoms Digestive symptoms laboratory examination Bright red Dark red or brown Mixed with mucous Mixed with food Alkaline pH Acidic pH Diagnosis 2. Assess the severity lMild hemoptysis lModerate hemoptysis lMassive hemoptysis Diagnosis 3.

11、Determine the cause and the location of bleeding. lHistory lSputum examination lRadiograph lCT lBronchoscopy langiography Cases lBronchiectasis l Middle age man l Massive hemoptysis l Repeating cough Chronic purulent sputum l Dilation of bronchi Abnormal thickened bronchi walls . Cases l Young man l Moderate hemoptysis l Low-grade fever Chronic cough Weight loss l Radiography: Cavities l Tuberculosis Cases Sputum: acid-fast bacilli l Tuberculosis Cases l Old age man l Smoking l Bl