MEDLINE | Health and Drug Information

MEDLINE | Health and Drug Information

Medical examination and medical diagnostics

Examination is an important factor, perhaps the main stage of the work of the therapist because it pretty much decide the success or failure of the treatment works: Working doctor may do good new findings are true and complete to the symptoms can be an accurate diagnosis and adequate, then the prognosis is that the new regulations, treatment and prevention for correctness.

This is a work:

Science: In addition to medical knowledge that all physicians are required to have full, there must be a listing of the man is a dialectical unity in which each department are organically related to each other, so not only single examination department that patients should always check the entire body.

Technique: Must regularized examination and examination techniques to detect it properly symptoms (eg, to hear the sound unusual in heart, lung, spleen or liver touching peek out from costal margin, or when type tendon reflexes ...)

None of the show, it was a work:

Politics: How meticulously thorough medical examination by a physician in addition to helping physicians detect disease properly reinforces the confidence of stable patients thought their pessimistic fears, giupho confidence in treatment in the cure this: essential elements for the treatment to be good.

Today, despite the progress and development of preclinical methods, the role of the clinical examination is important because it gives the direction from which the diagnostic designated as preclinical tests required, avoid making widespread or vice versa does not do the necessary tests. So medical examination should be carried out like?

How to conduct medical examinations

place of examination

It should be:

Clean, fresh air but avoid drafts.

Warm, especially in winter.

There is enough light.

Discreet, especially those where women used to examine patients.

means

In addition to the furniture necessary for the physician and patient visits to the sick bed is examined, where care needs to be equipped with a minimum of means:

Medical stethoscope.

Sphygmomanometer.

Tools for pressing the tongue: to visit the sick throat.

Reflex hammer and needle to neurological examination.

How fingers or gloves (doigtier) Rubber: for rectal or vaginal examination when necessary. If you have an extra flashlight to check the pupillary reflexes needed the better.

physician

It should be noted to dress: clothes dirty, angry black collar, long fingernails dirty, unkempt hair will reduce the confidence of the patient to the physician lot.

Attitudes need to intimate, warm to the patient at risk of exposure, easy revealed the secret of his problems. Avoid the attitude of patients misunderstand the physician "grace" for them.

When asked patients to use straightforward language, avoid using the word medicine that the disease is difficult to know (royal sure, hematuria ...) and especially patience to exploit the subjective symptoms of the disease, if necessary do not hesitate to ask questions or to change the way the questions to capture all of the patients.

When the doctor should have gentle style, meticulous, avoid rough, avoid sick day or more without the need for the most seriously ill. The physician, physician especially men, need to pay attention to the nature of the woman shy to ask and how to avoid the most indecent manner doctor too revealing, self-injure the patient's women, so they do not say what needed to diagnose and treat.

Upon receipt of the required objective symptoms and caution: there should be no prejudice before, especially for older patients, physicians are more likely to have thought the old disease recurrence. Need to appreciate the symptoms, especially the subjective symptoms of the disease: the identification, analysis, evaluation of symptoms that must be based on a scientific basis.

Be careful while talking with patients about their condition; in general, to think before talking to did not say what issues can make them fear, panic or pessimism with their patients; to explain to uplifting, thought for their stability assured treatment in the healing message.

For the families of patients, we can tell the truth in a certain range, that is, depending on the problem, depending on the person's relationship to the patient.

patients

Should be examined in a comfortable position. If health conditions permit, the patient should check the way to go.

Should reveal the need to check. Best of all, the sick men wearing only underwear when a medical examination if place to ensure adequate warmth. The sick woman should reveal part: chest, abdomen, and limbs ... In winter, Notes prompts the patient removed because scarf scarves can hide some very important issues in the neck: tumors borders, the jugular vein float, the cost-neck scar ...

Content doctor

After asking technical part history (see above), the doctor usually conducted in three parts:

Full body examination.

Check each department.

Check more waste.

Body Check

It should be observed:

Gait, standing by the patient:

After first contact with the patient, we can immediately notice a few ways and located, walking, standing by the patient immediately suggests to us a direction of certain diseases or syndromes:

How is "trigger", facing the dark side in patients with meningeal disease.

How high is the top or half-recumbent (Fowler position) of the patients dyspnea.

Getting stiff, body like a log of people with Parkinson's disease.

How di "grass" a convulsive hand to the chest of the patient paralyzed from the waist, can cramp.

How to walk hugging the right upper quadrant of the liver abscess patients.

The spirit of the disease:

Noting see patients in the state:

Awake: The disease can be patient self-reports, statements and answers are obvious questions of the physician.

Delirium: the patients are not identified and does not answer the question correctly, not only that the patient was in a state of panic, mumble, even when running or destroying wild. It is the mental condition of the patient:

Sort entered hepatic coma.

Any fever for what reasons, but the most common in our country is fierce bout of malaria.

Mental Illness.

Coma: the disease is not identified nor answer my question.

But here the patients do not panic, do not mumble but left more or less lost contact with the external environment, even in the case of coma:

The patient does not know the pain when pinched.

Do not swallow the water poured into their mouths.

Loss of corneal reflex.

Coma is a very serious incident, the consequences of infectious diseases and poisoning of many parts, should be examined carefully and ask discovered why.

General shape:

Need to identify the disease:

- Slim or fat, skinny means: The gaunt, sunken cheeks, the facial bones protruding, especially cheekbones. Ribs, scapula highlighted. Flat belly, belly skin commandments rang. Total weight less than the average weight of 20% (with an average weight of feces than 100 meters of height; eg, a 1m62 high, the average weight of 62 kg).

- Slim common in these cases:

Undernutrition by: Eating a lack of quality or quantity. Eating enough but the department does not use digest and absorb, esophageal, pyloric stenosis, chronic bowel disease, chronic pancreatitis ...). Eating relative but not enough to meet the needs of the body increases due to overwork or disease. Chronic diseases: tuberculosis, liver cirrhosis, cancer ... Some endocrine diseases: diabetes, Basedow.

- Obesity means:

Face swollen, bulging cheeks, chin droop. Stock usually not seen retracted. Limbs rounded and grooved. Abdominal skin with thick layers of fat and sagging to make the abdomen. Total weight is higher than the average weight of 15%.

- Fat normally are:

Nutritional Causes: The most common, especially when eating more and less active. Endocrine causes: Women of all age kinh.Nam world after losing testicles. Cushing's disease caused by pituitary or adrenal glands due to intensity.

Causes Mental: a sometimes occur due to strong mental trauma.

- High or low. Need to pay attention to two cases of disease:

The medium to medium high oversized alone or in combination added to the first phenomenon and expenses: this is huge disease (gigantisme), a disease of the pituitary gland.

The medium low and too small: as well as a case of pituitary disease, patients calculation (infantilisme).

The balance between these parts: often there is a certain balance between the parts of the body, head and limbs. In some pathological cases, we find that balance disappear:

To early disease (hydrocephalie): the first is to not match the entire body.

Acromegaly (acromegalie): head and especially the hands and feet are oversized, not commensurate with the expenditure and body rest.

Teo an amputation, a chi chi or both symmetric: common in neurological diseases such as amyotrophic the fiber column (sclerose laterale). Flute marrow disease (syringommylelie) and is the most common sequelae of poliomyelitis children (PAA). But when the patient's body:

Both parties chest unbalanced by a party effusion or pneumothorax as stretch or vice versa due to pleurisy thick and sticky traction as falling.

The color of skin and mucosa:

Some medical conditions shown on the color of the skin and mucous membranes such as:

- Skin and mucosal cyanosis: demonstrates the lack of oxygen normally found in:

Some congenital heart disease, chronic pulmonary heart disease and heart failure cases.

The lung disease causing breathing difficulty levels: bronchopneumonia in children, pneumothorax severe asthma.

The airway disease causing suffocation bar: bar almost paralyzed by diphtheria.

In these diseases, cyanosis cases appear in the environment, in the human eye diseases, acute cyanosis new to the place, even when the whole body.

In contrast, in some other disease, cyanosis confined to one area, for example in:

Inflammation of the arteries: cyanosis in the toes, fingers, sometimes the feet, hands or even an amputation so that the dominant artery.

Capillary vascular disorders: cyanosis all extremities especially the fingers.

- Skin and mucous membranes pale. Status pale sometimes evident on the countenances of the disease, but the secret to looking at the lining of the eyes, mucous membrane of mouth, tongue or hands feet. It is shown clinical acute or chronic anemia due to many reasons.

- Yellow skin and mucous membranes: the skin of patients with various forms of gold:

Golden straw: in cancer.

Yellow belly: in severe anemia.

Bright yellow more or less: by drinking plenty quinacrin or santonon. Sometimes there is the yellow pigment in the palms of the hands and feet.

In this situation, the current situation can only yellow skin or the palms, soles of the feet. By contrast in jaundice. Gold status can present both in the lining eyes, mouth, tongue: these are symptoms of a very valuable suggestions diagnosis, because yellow is an almost nonspecific symptoms of hepatobiliary system.

- Skin and mucosal gray (m LANO ermie): this is not a normal case of tanned outdoor workers, but also a case of having the disease pathology:

Addison's disease (Addison's disease).

Accumulation of melanin (Melannose de Richl).

- A pale skin, if that area has more cool feeling stinging pain when we must think carefully and find the cause of style.

Mucocutaneous condition:

Need findings:

- The skin lesions: detection purposes other skin diseases identified the need to pay attention to the scarring sequelae of certain diseases in the history of the disease and surgery, because the lesions are resolving It is the cause of the current turmoil as:

Scars do think music colon atopic workers.

Scars "moved climb" (shingles) on the chest, may be the cause of pain intercostal nerves now.

Scars caused by bullets in the chest towards the cause was thought to cough up blood now.

- The bleeding note: often a manifestation of blood diseases and expression in many forms:

Arrays ecchymosis (ecchymose).

Ban bleeding (purpura).

Dot bleeding (petechre).

- The exhaustion of water. Represented by:

Dry skin, warning rang even have patches of psoriasis.

The existence of the leopard skin wrinkles ssau.

Often seen in the following cases:

Severe diarrhea or diarrhea level takes a long time.

Severe nausea.

Fever, infection lasts.

- Status fluid: represented by: compliance with concave publications (soft line) or without pressing concave (hard line), to detect the face (especially the eyelids), in the leg ankle (look for signs of publications concave side of the tibia and ankle).

Often seen in the following cases:

Level or chronic glomerulonephritis, nephrotic patients grease.

heart Failure

Cirrhosis.

Undernutrition.

Be wet beriberi.

Artery or vein inflammation of lymph nodes.

System Status and hair coat:

There may be pathological phenomenon as follows:

- Too many men in fur or hair growth in places where no ordinary woman (beard): one case of adrenal disease intensity (Cushing).

- No hair growth or hair loss, hair loss. Expression of:

A condition can be debilitating disease caused by an infection or poisoning.

A spot disease of the skin and scalp.

An endocrine disorders: ovarian disorders, thyroid insufficiency.

Check each department

Often the doctor immediately should stay patient department, the question carefully braided initially associated with the review body will help us think about organ disease.

Then check the other parts, the first is the part related to physiological or anatomical parts with thin, then visit the rest of the parts and should go sequentially from top to bottom (top , neck, chest, abdomen, limbs ...) in order not to miss.

Back to search contents of each department, we do not speak carefully here, because there are separate articles in the latter case, we only emphasize the issues that need attention in every department including:

At the top:

In addition to comments skin, mucosa and skull, hair mentioned above, check:

12 cranial nerves (the program will tell nerve), especially if the person has a mental illness experience.

Teeth, tongue, throat: the program will tell digestion.

In stock:

Attention to:

Thyroid.

The scar in the neck or neck scar colon music.

Jugular vein: OC veins stand to be a manifestation of the right heart failure.

In the chest:

It should be observed:

Morphology and the operation of the chest to the rhythm of breathing.

The ribs and intercostal spaces.

Check the heart and lungs.

Do not forget the two breast and axillary lymph nodes.

In the stomach:

Morphology and activity of the abdominal wall under the breath.

Check belly general (discussed in the first chapter of) and the abdominal viscera.

Attention to the rectal and vaginal is a simple gesture made mandatory for all patients with pathological findings in the abdomen, especially in the lower abdomen.

In men, do not forget to check the penis, scrotum sex, spermatic cord, and the hernia hole.

In the limbs and spine:

Attention to:

Malformation or disfigurement of the limbs and spine by:

The spine is curved, hunchback or pure: a harsh pain in the spine, especially at the base of the spine to the wood, to make us think of a vertebral tuberculosis.

Sequelae of fractures and an old disease of bone.

The joints: one or more swollen joints, to make us think of arthritis as:

Rheumatic fever.

Chronic arthritis.

Lao joints.

Purulent inflammation of the joints.

The fingers and nails: nail "watch glass" means nail cupped round like a watch glass, is a manifest need attention. The phenomenon that at first alone, later combined with additional fingers to friends as drumstick to a symptom called Hippocrates finger instance:

Some congenital heart disease (disease Fallot).

Heart disease - chronic lung.

Chronic infections in organ, common in subacute endocarditis Oxle and chronic lung abscess or bronchiectasis, chronic infections.

Some cases of lung tumors: Pierre Marie syndrome.

Cholestatic cirrhosis Primary: Hannot disease.

After careful examination of the body and parts combined with thoughtful questions disease, we must never ending clinical examination by checking the weather and some waste can translate.

Check the weather Waste

This is only a preliminary review of clinical, should be supplemented by the results of preclinical testing of these substances. However, the preliminary remarks are great because it gives us right at the bedside of the factors necessary for diagnosis.

Urine:

Yellow slots: define for us a jaundice.

Red: We identified patients for blood in the urine.

Coating: could be a urinary tract infection.

Analysis:

Red blood slimy nose: dysentery syndrome.

Black as coffee grounds: suggest a gastrointestinal bleed.

sputum:

There rays and blood clots in the blood or hemoptysis.

Pus in the lung abscess.

Purulent sputum chocolate in lung abscess caused by amoeba.

Vomit:

You need to consider the composition and color vomit.

In the spirit as for the more waste, we can get some volume in the probe tips, depending on the clinical picture.

There pleural effusion or pericardial: Amniocentesis right pleural or pericardial.

Ascites, to tapping ascites.

Meningeal syndrome: to tapping cerebrospinal water.

Like the more waste, what this translates immediately with preliminary remarks on the bed, was able to make the correct diagnosis:

Amniocentesis pleural pus, making diagnosis even a purulent pleurisy; if pus-colored chocolate makes me think of the cause by amoeba.

Amniocentesis cerebrospinal see turbid water, make a diagnosis as soon as meningitis. By examined above, there are cases:

It can be diagnosed immediately, but not in sufficient detail.

But they have not even been able to have diagnosed that only a certain direction. Therefore need to use additional methods of subclinical.

The method of subclinical

The progress of science in all fields has contributed to the development of sub-clinical methods to help medical diagnosis more certain. The phuoong it more convenient, more accurate and sophisticated. The probe can subclinical against 4 types of purposes:

To identify morphological

Often, it is the method:

Radiology; projectors and shoot, shoot often or dye.

Soi organs.

Radioisotopes.

To identify lesions

This is the viscera biopsy (biopsy or better blind biopsy under the control of the eye) to remove a sample held the test.

Micro: find the lesion pathology, diagnosis is often worth the surest.

Biochemical model was applied in countries with scientific progress.

To find pathogens

Pathology tests mentioned above as well as a method to find the causative agent (biopsy of an enlarged lymph nodes for pathogens as cancer or tuberculosis, depending on the pathological anatomy with tumor cells or international giant cells of tuberculosis).

There's also another method to directly or indirectly:

Bacteria, viruses.

Parasite.

Mushrooms ...

In the humoral and more waste.

To probe the function

A large part of this approach is that the biochemical tests. Also the method used machinery (due to underlying metabolic exploration of thyroid function to probe ECG heart function ...) and more recently using the radioisotope method.

The necessity of subclinical

So far, no one has dared to deny the necessity of the method for practical clinical approach of this method of diagnosis helps to find:

It's accurate.

It's full.

And especially very early, when the disease is diagnosed while still in the preclinical period. But it is inevitable downside.

Disadvantages of subclinical

The validity of the method of subclinical depends on many factors:

Qualities of machinery or chemicals used in it.

How to obtain and ensure specimens from disease prevention to the test site.

Nheim accountability and professional competence of testing. So the method for preclinical us:

We need not rely on the clinical examination is indicated to the right to avoid making unnecessary spill has wasted chemicals, machinery and labor power of the test, just wasting disease is the blood thnah and blood of patients with fatigue when patients do not need.

Based on clinical need to identify these results, ie to compare the results of preclinical and clinical situations: if not appropriate then check again, both clinical and subclinical if necessary then repeat the test for subclinical.

In this way we obtain the correct documentation of clinical and subclinical, the factors necessary for us to go to the section diagnosis.

diagnose

The document clinical and subclinical above should be incorporated into the syndrome: a person may have one or more symptoms. Based on the syndrome that we will make the definitive diagnosis, differential diagnosis, diagnose the cause and assess prognosis.

In the diagnosis, need to respect some rules:

Must be based on the symptoms of the disease, clearly, clearly no one can deny, clinical and subclinical.

Consider first of all to those patients most often and must be based on the specific symptoms diagnostic value of this disease.

So try to find a diagnosis may include all of the symptoms and the patient's symptoms. If it can not be considered as new patients with 2 or 3 patients at the same time.

conclude

Diagnosis is a difficult task. Want to properly diagnose patients to get an attitude and preventive treatment appropriate, the physician should have:

Medical Knowledge fully comprehensive.

Thorough examination style, meticulous.

Scientific reasoning methods and dialectics.

The spirit of loving parents to their patients.

This is the fourth major requirement that each student must train yourself in the process in clinical practice.

Functional symptoms of respiratory apparatus

The functional symptoms are the symptoms felt by the patient to suffer from respiratory disease in their patients recalled. In respiratory disease, the main symptoms: chest pain, coughing, shortness of breath, coughing sputum and blood. These symptoms have important implications for diagnosis.

chest pain

mechanisms

No branch pulmonary sensory nerve pain. Chest pain is usually caused by damage to the chest wall (muscles, bones, joints), pleura, pericardium, esophagus and tracheobronchial tree. When the lung tissue damage that occurs due to pleural chest pain in response to this damage.

characteristics

The important point to understand when patients ask:

How onset:

Sudden intense: intense pain without prior notice nature and degree of pain immediately at the maximum.

Persistent pain gradually increased.

Location of pain:

Location pain may suggest organ damage and the nature of the injury.

Pain in the front of the sternum following: Inflammation of the tracheobronchial or mediastinal syndrome.

Pain on the front side: Pneumonia or pleura. Pain in the breast less common in acute pneumonia.

Upper quadrant pain common in pleural disease.

The change of chest pain with breathing movements: The degree of pain when coughing change when changing positions often have little diagnostic value. The pain increases when you cough or breathe deeply.

Characteristics of chest pain according to the agency vulnerable

Chest pain due to lung diseases - the pleura:

Pain is often sudden onset, accompanied by clinical symptoms and x rays.

The pain of acute pneumonia: Sore breasts, increased pain when coughing, often accompanied by other symptoms such as chills, fever, lung examination coagulation syndrome. This pain is encountered in pulmonary embolism.

Tracheobronchitis pain: patients feel a burning pain behind the sternum, increased pain when coughing, may or may not meet sputum in bronchial inflammation caused by influenza gas or smoke inhalation irritation.

Pain due to pleural disease: pain in the side and bottom of the chest, pain intensity changes, increased coughing and deep breathing. Pain spreading to the shoulders and are often associated with dry cough, pain medication less effective and often occur when changing positions. In pleural effusion pain often associated with shortness of breath, chest side fell ill and had to move 3 down syndrome.

Chest pain due to pneumothorax: Sudden, intense "pain stabbing" pain in the side, shoulder, breast orang sometimes like angina. Pain is often accompanied by shortness of breath, coughing when changing positions and the triad of Gaillard. Stabbing pain when faced lung abscesses, abscesses under the diaphragm rupture into the pleura.

In pleurisy in low areas including the periphery of the diaphragm pleura is dominated by six intercostal nerves below, these are the nerves that govern the abdominal wall so as pleurisy in this section may be accompanied by pain in the abdomen. The central part of the diaphragm is controlled by nerve diaphragm (CIII and CIV) as inflammatory diseases in this section

workers may feel pain in the neck or shoulder tip.

Chest pain due to pulmonary tuberculosis is usually dull, nagging.

Chest pain in lung cancer. Pain is not clear, the location may change, but fixed time of day, less analgesic effect, often accompanied by cough, hemoptysis can ... At the peak of lung tumors spread from the chest pain the upper limb.

Pain in the mediastinal disease inflammatory or non-inflammatory:

Pain behind the breastbone can be accompanied by fever.

Chronic pain in mediastinal tumors:

Pain in the mediastinal compression syndrome before: Pain behind the sternum, false angina pain accompanying line jacket, purple and collateral circulation, increasing pressure on the veins of the coughing and straining.

Pain in the mediastinal syndrome pinched between pain type "braces" irregular and often accompanied by shortness of breath hissing, wheezing, cough, voice sometimes backfired cord paralysis due to left, step by compression or mental paralysis business diaphragm.

Pain in the mediastinal compression syndrome following: pain due to intercostal nerve compression. Pain spreading to the arm or by compression of the nerve roots in the arm plexus CVIII - DI.

  Chest pain due to disease: pathology addition of pleural pain in the chest may be caused by:

Bone lesions: Pain due to broken ribs usually persistent, increasing the respiratory movements, changing positions and cough.

Rib cartilage injury (Tietze's syndrome).

Muscle damage, myalgia, myositis.

Intercostal nerve damage: Pain that spreads along the thoracic ribs in half.

Chest pain in people who play sports (tennis).

Pain due to other causes:

Chest pain due to cardiovascular disease:

Pain due to coronary artery disease: Pain behind the breastbone, spreading to the neck and upper limbs.

Pain due to pericardial effusion: pain before the heart, increased exertion, taking a deep breath.

Pathologic esophageal pain: Pain after sternum, appeared to swallow and supine can be combined with difficulty swallowing.

The chest pain caused by disease of the breast: The pain spread to other parts of the chest.

Pain comes from the belly: The pathology of the liver, bile, stomach, pancreas.

Pain from retroperitoneal: nephropathy.

cough

define

Ho is reflective of the respiratory organs, causing cough receptors are stimulated. This is a positive reflection to exclude from airway secretions and foreign material.

mechanisms

Cough reflex arc include: The cause cough receptors in the pharynx, larynx, bronchi large mediastinal pleura and, in addition to other receptors in the liver, uterus, ear canal. Lung parenchyma and small airways at the receptor causes coughing. Medullary cough center, floor 4 intraventricular nerve afferent nerves consisting of strings X backfired, nerve diaphragm, intercostal nerves, abdominal muscles.

characteristics

Analysis of the characteristics of cough may help diagnosis.

Circumstances and time appear cough:

Spontaneous.

Appears on exertion, change posture, swallowing (cough when swallowing is characteristic symptom of esophageal probe - windpipe).

Ho morning waking up, day or night cough.

Paroxysmal or persistent cough, Chronic: Chronic cough is a cough that lasts more than 3 weeks

Rhythm: Ho ho to attack or aggression.

Timbre: cough may be higher or depression.

Him in his hoarse cough or laryngitis. like barking dogs.

Ho voice double: cough at high-downs. Meet the opposite recurrent nerve paralysis.

Cough or sputum: Coughing up phlegm mucus that is coughed prove the quality of bronchial secretions (children and women often do not spit out phlegm that swallowed the stomach).

Value of Symptoms

Dry cough occurs when changes in posture having pleural effusion.

Productive cough with fever, chest pain, dyspnea, pulmonary inflammation

Cough lasts: laryngeal disease, interstitial lung disease, chronic mastoiditis. pharyngitis beads, felt throat disorders, inflammation of the sinuses mountain.

A persistent cough with sputum in chronic bronchitis, bronchiectasis.

Paroxysmal cough: There may encounter due to the following reasons:

Pertussis: a bout ho, ho often limp night, causing vomiting, productive cough flow into wires.

Respiratory viral infections.

Foreign body airway: Tigers first fall in airway foreign bodies previously overlooked - common in children.

Lung cancer in adults: Cough lasts. in smokers symptoms are often ignored by the mistaken idea that cough from smoking.

Tuberculosis: According to national TB programs Vietnam, coughing more than 3 weeks needed medical care whether or not infected with tuberculosis.

Tracheobronchial spasm: Common in bronchial asthma, cough, shortness of breath attacks, but also when asthma attacks only manifested by cough, about dawn, common in children.

Ho led to disorder awareness: Often sudden onset, with one or more coughs caused a temporary sense of gloom or fainting (Cough Syncope), also known as stroke larynx (Ictus Larynge) met in respiratory failure very severe, dyskinesia tracheobronchial atypical.

Cough in heart disease: nocturnal cough accompanied by shortness of breath, asthma, heart in hypertension due to left heart failure, valve stenosis 2 leaves.

gob

define

Sputum is coughing and spitting out the discharge, the product is in airway pathology orang lid glottis.

characteristics

Features phlegm is coughed up from the tracheal tree is very important in the diagnosis and treatment of respiratory diseases. But it must first determine whether the patient actually productive cough or not. It should be noted the following cases are not sputum:

Spit out saliva: white and thinning.

Spit out the substance from the nose and throat, or the quality of esophageal reflux, stomach.

Need to determine the time and number of colors, flavors and ingredients not stink of sputum.

Characteristics of sputum under bronchopulmonary disease

Acute bronchitis: After the cough is productive cough mucus stage latex. yellow or green.

Chronic bronchitis: In the absence of multiple infections; greyish white mucus or phlegm.

Pneumonia:

Level lobe pneumonia in adult pneumococcal: cough sputum usually on day 3 of the illness, difficult to expectorate sputum stick, with less blood and sputum called "rust", along with typical coagulation syndrome. After illness variables in the 9th day of the disease, sputum becomes diluted, easy to cough up, down and out in the 15th.

Klebsiella pneumonia: Sputum color stone tiles.

Pneumonia caused by pseudomonas curling: green sputum stuck.

Sputum in bronchoalveolar inflammation: A green or yellow purulent sputum, mucus.

Viral pneumonia: Usually cough or sputum with white mucus. When multiple infections with purulent sputum mucus.

Lung abscess: sputum is basic symptoms of lung abscess help diagnose, monitor progress and direction pathogens. To monitor the number and nature of sputum daily.

The first phase cough or coughing up mucous sputum.

Phase ộc pus: Usually happens from day 5 to day 10.

Prodrome: Breathing the smell rotten, sometimes with blood concepts.

OC latex bulk: Patients with Severe chest pain feels like chest x, can be passed. Then ho ộc hundreds ml pus comes out through the mouth to the nose sometimes.

OC latex partial Patients cough up different amounts of pus, several times a day.

Sputum knob coin: When patients stop coughing coughing up thick gob, the coin (Crachat nummulaire).

Sputum odor suggesting abscess caused by anaerobic bacteria.

Chocolate colored sputum, or chicle: Abscess by amoeba.

Bronchiectasis:

More productive cough in the morning, when waking up. The total amount of mucus in the day from a few tens to hundreds of milliliters (probably more than 300 ml / 24 hours). Place in a glass cup with 3 layers:

On the mucous layer of foam.

The middle layer is mucus (due to increased bronchial secretion)

The bottom layer of latex.

Asthma:

Sputum in the last bout dyspnea, sputum white sticky or cooked like tapioca, pearls can have phlegm (as described by Laennec).

Pulmonary edema: pink foam sputum, greater numbers.

Tuberculosis: Sputum "top three" white, smooth, sometimes mixed with mucus and blood.

Follicle available for: Sputum diluted, clear, with particles such as millet, color, available for the first tests.

Coughing up blood

define

Coughing up blood is the phenomenon of blood from the lower respiratory tract is escaping through the mouth. Coughing up blood is often a medical emergency.

mechanisms

Common mechanisms are:

Ulcers, broken blood vessels in labor: Rupture of an aneurysm Ramussen, bronchiectasis: breaking the circuit in paragraph stop-Von Hayek, lung cancer.

Due to increased vascular pressure: hemodynamic pulmonary edema, increased permeability of blood vessels in the pulmonary edema lesions.

Damage to the alveolar capillary membrane: Good Pasture Syndrome.

Coagulopathy, bleeding, especially when accompanied by lung disease.

characteristics

Circumstances occur: After exertion, emotion, women in menstrual period or no special circumstances.

Prodrome: A burning feeling behind the breastbone, itchy throat, or mouth fishy tired fainted away.

Coughing up bright red blood, foam, can only pure blood or sputum.

Tail blood summary: the sign had stopped bleeding, common in tuberculosis, blood spitting out little by little, dark red and black again.

Classification level hemoptysis

Currently, the classification of the severity of hemoptysis inconsistent. In fact, there are usually two likelihood that the patient is coughing, coughing up blood in the new few hours or hemoptysis in 24 h.

So to help manage and prognostic classification as follows:

  Mild: Cough each small beach bloody sputum, coughing up blood of <50 ml. pulse and blood pressure normal.

Moderate: Whole blood was coughing up from 50 to 200 ml. rapid pulse, blood pressure was normal, no respiratory distress.

The severity: coughing up blood volume> 200 ml / time or 600 ml / 48 hours, more lung damage, respiratory failure, cardiac arrest.

Ho blood lightning: Appears sudden, large amounts of blood, lungs flooded ngap2 gayngat breathing and death.

Differential Diagnosis: There is a difference hemoptysis with bleeding from the nose, throat, mouth and vomited blood.

Vomiting up blood Coughing up blood

Cough, chest pain epigastric pain

Itchy throat and cough Nausea and vomiting

Bright red blood and sputum, blood and foam food

alkaline pH acid pH

Separate normal (black swallowing blood) black stool

Differential diagnosis between coughing and vomiting blood will be difficult, as patients with hemoptysis accompanied by vomiting bloody vomit, blood swallow down by the stomach. When it needs a thorough examination and lung X-ray, mining engineering history of stomach; if necessary, bronchoscopy or gastroscopy to detect lung injury.

The main causes of hemoptysis

Tuberculosis: The most common cause, all TB can cause coughing up blood from the few to the many. In that tuberculosis has progressed bean pulp necrosis majority. Then came bronchial tuberculosis. very rare in primary employment and labor Statistics. Coughing up blood and sputum residue can usually beans and tail concept blood.

Lung Cancer: A common cause, mainly in primary lung cancer, lung cancer is less common in secondary. Sputum and blood rays, with moderate coughing blood, usually in the morning coughing red purple (plum).

Bronchiectasis: In dry bronchiectasis may be expressed only by coughing up blood, bright red blood, recurrent, easily confused with tuberculosis.

Cardiovascular disease and other diseases: pulmonary infarction, 2 leaves stenosis, congenital heart disease, illness or disease Good Pasture Collagen system. Can meet all levels of hemoptysis. Noting: Blood and pink foam found in pulmonary edema.

Pneumonia: Pneumonia caused by bacteria, lung abscess.

Lobe pneumococcal pneumonia: rust colored sputum.

Klebsiella pneumonia necrosis bloody sputum tile adhesive

The rare cause:

Bronchopulmonary Aspergillus.

U pulmonary blood vessels.

Also see hemoptysis due to injury, and lung injury due to intervention procedures such as bronchoscopy, transthoracic lung biopsy ...

Shortness of breath

define

Difficulty breathing is difficult feelings and problems in the patient's breathing. Trouble breathing alter the performance characteristics of the patient to breathe normally as breathing frequency, duration of the inhalation and exhalation, the coordination and participation of the respiratory muscles. So to describe adequately dyspnea should be combined with patient examinations.

characteristics

Facial appearance:

Acute paroxysmal dyspnea.

Chronic persistent dyspnea.

Circumstances occur:

When you leave or after exertion, infection, trauma.

Appear suddenly or slowly.

Difficulty breathing rhythm types:

Frequency:

Shortness of breath quickly:> 20 times / minute.

Shortness of breath slow: <12 times / minute.

By the breath:

Shortness of breath is inhaled.

Shortness of breath is exhaled.

By location:

Difficulty breathing when lying down.

Shortness of breath when moving from lying to standing position.

Shortness of breath related to environmental factors:

Changing weather, occupational exposure.

Dyspnea accompanied by functional symptoms and other entities:

Cyanosis (a sign of respiratory distress or chronic), cough, chest pain, sputum, or respiratory muscle contraction not the women.

The degree of dyspnea:

Classification of the American Heart Association NYHA (New York Heart. Associatide).

Level I: No limit physical activity.

Level II: Breathlessness on exertion much.

Level III: mild dyspnea on exertion and limited physical activity.

Level IV: Dyspnea stay.

Some special types of dyspnea

Shortness of breath due to heart disease: Appears on exertion or chronic, with symptoms of heart failure.

Shortness of breath due to central nervous system damage and peripheral: Difficulty breathing Biot type: irregular breathing at quickly, sometimes slowly, while shallow, deep time, no see kz cycle of meningitis.

Shortness of breath due to metabolic disorders:

KUSSMAUL Dyspnea: Shortness of breath with 4-stroke cycle: Inhale - stop - breathe out - stop by metabolic acidosis in diabetes.

Dyspnea type Cheyne - Stokes: Yes cycle, amplitude increase - decrease - stop having pulmonary renal syndrome, obesity, some cerebrovascular disease, severe heart failure ...

Cause shortness of breath

Upper airway: Difficulty in breathing accompanied by withdrawal recessed hole on memory and language Stridor, the hiss sounds harsh and prolonged, on the inhale, spasm, edema loaded hoacday sound, object, laryngitis management, cancer, or thyroid to tracheal compression ..

Airway below:

Emphysema in chronic obstructive pulmonary disease, shortness of breath on exertion, gifts, chronic.

Asthma: In a typical asthma attack, attack paroxysmal dyspnea, shortness of breath out slowly, hissing, spontaneously or after bronchodilator use, or relapse when weather changes.

Lung parenchyma:

Pulmonary fibrosis: Progress slowly smoldering, at first appeared after the exertion of chronic appear both stay.

Pneumonia: Shortness of shortness.

Waste Management - Waste inflammation: rapid shallow breathing is difficult, often accompanied by symptoms of respiratory distress, cyanosis, tachycardia, especially in children, the elderly.

Pleural Disease:

Pleural effusion: Shortness of shortness, increases the movement and coughing.

Pneumothorax: sudden shortness of breath, rapid shallow, sometimes accompanied by cyanosis.

U mediastinal tracheal compression: Difficulty breathing when lying down, wheezing.