Cyanosis

Introduction Hair bun is a manifestation of a decrease in the amount of reduced hemoglobin in the blood that causes the skin and mucous membranes to change in a cyan, also known as purpura. This change often occurs in areas where the skin is thinner, pigmented and capillaries are abundant, such as the lips, fingers (toes), nail beds, and the like.

Cause

Red blood cells contain hemoglobin to make the blood appear red. When the oxygenated hemoglobin is rich, it is bright red, and when oxygen is released to reduce hemoglobin, it appears dark red. The color of the skin and mucous membranes varies primarily with the color of the bloodstream and is also affected by local blood flow. The production of cyanosis depends on the absolute content of reduced hemoglobin or abnormal hemoglobin in the blood. When the reduced hemoglobin content in the capillaries of the surrounding circulation exceeds 5g/100mL, the skin mucosa can present purpura, and the color of methemoglobin and hemoglobin is deeper than that of reduced hemoglobin, when its content in the blood exceeds 30g/L and 5g/L respectively. When you have a noticeable hair loss. Clinically, according to the etiology, the purpura is divided into the following three types: 1 central purpura. 2 peripheral purpura. 3 mixed purpura. According to the different mechanisms of occurrence, it can be divided into: increased hemoglobin in the blood and increased hemoglobin derivatives in the blood.

Commonly the following three types of diseases can cause purpura symptoms.

1. Respiratory diseases: The respiratory system is where hemoglobin binds to oxygen to form oxyhemoglobin. Any bronchial, pulmonary or pleural disease that affects hemoglobin and air contact can reduce oxyhemoglobin in systemic arterial blood, increase hemoglobin, and cause purpura. Common include mechanical obstruction of the upper respiratory tract (such as sputum obstruction, laryngeal edema, tracheal foreign body), severe lung disease (such as tuberculosis, pneumonia, pneumoconiosis, emphysema, pulmonary edema, etc.), pleural disease (such as massive pleural effusion) , pneumothorax, etc.). The oxygen content in the air is not enough. If it is at high altitude, even if the respiratory system is healthy, it will cause purpura because hemoglobin cannot be fully oxygenated.

2. Circulatory diseases:

(1) purpura-type congenital cardiovascular disease: some congenital heart disease has abnormal pathways in the heart or between large blood vessels, so that the right heart unoxygenated blood flows directly to the left heart and aorta without passing through the lungs. Therefore, the arterial blood is mixed with many reduced hemoglobin, resulting in purpura, common with tetralogy of Fallot, pulmonary hypertension right to left shunt syndrome and pulmonary arteriovenous fistula.

(2) Heart failure and shock: decreased heart function, decreased blood output from the heart, slow blood circulation, blood stasis in the veins, especially congestion in the lungs can block the oxygenation of hemoglobin, and the oxygen consumption increases as the blood passes through the surrounding tissues. Therefore, the blood reduces the amount of hemoglobin and produces purpura.

(3) Poor local blood circulation: blood stays in the local area for a long time, oxygen is consumed in large quantities, and local purpura may appear. If exposed to cold environment, the blood vessels contract cold, local blood circulation is not smooth, lips, ears, nose tips Purpura can appear at the fingers and toes. In paroxysmal arterial stenosis, the extremities of the extremities contract, causing purpura on the fingers and toes.

3. Other:

(1) Polycythemia vera: As the number of red blood cells increases significantly, part of the hemoglobin loses the chance of oxygenation, resulting in more reduction of hemoglobin and purpura.

(2) Poisoning: poisoning of aniline, nitrobenzene and nitrite, causing degenerative hemoglobinopathy, causing purpura. Due to the consumption of metamorphic vegetables containing a large amount of nitrite and causing toxic methemoglobinemia, purpura may occur, which is called "intestinal cyanosis".

an examination

1. Physical examination:

Pay attention to the location of the sable and the purple sputum, whether there is difficulty in breathing, clubbing (toe), heart and lung signs, liver and splenomegaly. Severe purpura is mainly seen in cyanotic congenital cardiovascular disease, methemoglobinemia, and hemoglobinemia. Acute purpura with a state of exhaustion or disturbance of consciousness, often due to acute poisoning, shock, acute lung infection or acute cardiac insufficiency of certain drugs or chemicals. Repeated episodes of purpura are often caused by local blood circulation disorders.

2. Laboratory inspection:

Blood methemoglobin and sulphi hemoglobin can be detected by spectroscopic analysis. Connective tissue disease, cryoglobulinemia also depends on laboratory tests for diagnosis.

3. Device inspection:

Purpuric congenital cardiovascular disease often requires ultrasound, right heart catheterization and selective cardiovascular angiography to make a diagnosis.

Differential diagnosis

(1) Central hair loss: The characteristics of this type of hairpin are systemic, except for the limbs and face, but also the skin of the trunk and mucous membranes, but the skin of the affected area is warm. The causes of cyanosis are caused by heart and lung diseases, respiratory failure, ventilation and ventilation dysfunction, and insufficient pulmonary oxygenation leading to a decrease in Sa02. Generally can be divided into:

1 pulmonary hair loss: that is due to respiratory insufficiency, pulmonary oxygenation is insufficient. Common in various serious respiratory diseases, such as laryngeal, tracheal, bronchial obstruction, pneumonia, obstructive emphysema, diffuse pulmonary interstitial fibrosis, pulmonary congestion, pulmonary edema, acute respiratory distress syndrome, pulmonary embolism, Primary pulmonary hypertension and so on.

2 cardia mixed cyanosis: due to abnormal channel shunt, some of the venous blood does not pass the pulmonary circulation for oxygenation and the human circulation arteries, such as the flow rate exceeds 1/3 of the cardiac output, can occur. Common in cyanotic congenital heart disease, such as Fallot quadruple syndrome, Eisenmenger syndrome.

(2) Peripheral cyanosis: This type of cyanosis is often caused by peripheral circulation blood flow disorders. Its characteristics are manifested in the fact that cyanosis often occurs at the end and sagging of the limb. The skin in these areas is cold, but if you give a massage or warming, the skin will warm up and the bun will fade. This feature can also be used as a point of identification for central cyanosis. This type of hair can be divided into:

1 bloody peripheral hair cyanosis: common in diseases causing systemic congestion, slow blood flow around, such as right heart failure, exudative pericarditis, pericardial tamponade, constrictive pericarditis, thrombophlebitis, superior vena cava obstruction Signs, varicose veins of the lower extremities, etc.

2 ischemic peripheral hair loss: common in diseases that cause a decrease in cardiac output and local blood flow disorders, such as severe shock, exposure to cold and thromboangiitis obliterans, Raynaud's disease, limb hair cyanosis Symptoms, cryoglobulinemia, etc.

(3) Mixed hair blemishes: central hair strands coexist with peripheral hair strands. Can be seen in heart failure and so on.

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