Fever with cough, expectoration, chest pain

Introduction Fever with cough, expectoration, and chest pain is one of the symptoms of respiratory diseases. Respiratory diseases refer to acute and chronic inflammation of the respiratory tract such as colds, bronchitis, bronchitis, pneumonia, etc., which are common multiple diseases and are harmful. Respiratory diseases are caused by a variety of viral infections.

Cause

First, the relationship between the structural function of the respiratory system and disease

The respiratory system is most frequently exposed to the external environment in various systems of the human body, and the contact area is large. At rest, adults have 12,000 L of gas per day entering the respiratory tract, and 300-750 million alveoli (total area of about 100 m2) exchange gas with the capillaries of the pulmonary circulation, extract oxygen from the external environment, and discharge carbon dioxide to the environment. in vitro. During the breathing process, organic or inorganic dust in the external environment, including various microorganisms, heterologous protein allergens, dust particles and harmful gases, can be inhaled into the respiratory tract and cause various diseases. Among them, pulmonary infection is the least common, primary infection is most common in viral infection, first in the upper respiratory tract, followed by bacterial infection; exogenous asthma and exogenous allergic alveolitis; inhalation productivity The pneumoconiosis caused by dust is most common in silicosis, coal sputum lung and asbestos lung; inhalation of irritating gases such as sulfur dioxide, chlorine and ammonia with high water solubility may cause acute and chronic respiratory inflammation and pneumonia, while inhaling low-water-soluble nitrogen and oxygen. Compounds, phosgene, dimethyl sulfate and other gases damage acute pulmonary edema in alveolar and pulmonary capillaries.

There are two groups of blood vessels in the lungs. The arteries and veins of the pulmonary circulation are functional blood vessels for gas exchange; the bronchial arteries and veins of the systemic circulation are nutrient vessels such as airways and visceral pleura. The lungs are connected to the blood and lymphatic circulation of various organs of the body, so the skin and soft tissue sputum, the thrombosis of embolic phlebitis, and the tumor thrombus can reach the lungs, causing secondary lung abscess, pulmonary infarction, and metastasis, respectively. Sexual lung cancer. Lung cancer in the digestive system, lung lesions can also spread to the whole body, such as lung cancer, tuberculosis spread to bones, brain, liver and other organs; also can occur in the lung itself.

The blood vessels of the pulmonary circulation are as fine as the trachea-bronchus, the cross-sectional area of the small arteries is large, the area of the pulmonary capillary bed is larger, and it is easy to expand. Therefore, the lung is a low-pressure (pulmonary circulation blood pressure is only 1/10 of the systemic blood pressure), low-resistance, high-capacity organs. When mitral stenosis, left heart failure, cirrhosis, nephrotic syndrome, and malnutrition hypoproteinemia, pulmonary interstitial edema, or leakage of the chest cavity occurs.

Some immune, autoimmune or metabolic systemic diseases, such as sarcoidosis, systemic lupus erythematosus, rheumatoid arthritis, dermatomyositis, scleroderma, etc., can affect the lungs. The lungs also have non-respiratory functions, such as endocrine syndromes produced by the production and release of ectopic sex hormones in lung cancer.

Second, the social population is aging

With the rapid advancement of science and medical technology, the rate of life extension of human beings has also accelerated rapidly. According to records, the average life expectancy of two thousand years ago is only 20 years old, increased to 30 years in the 18th century, and reached 40 years old by the end of the 19th century. According to the United Nations Population Division, by 2025, the number of people over the age of 60 will increase to 1.121 billion, accounting for 13.7% of the world's population, including 12% in developing countries and 23% in developed countries. At the end of 1993, the number of elderly people over the age of 60 in Shanghai exceeded 2.1 million, accounting for 16% of the total population. So far, the number of elderly people will reach 4 million in 2025, accounting for more than 28%. Respiratory diseases such as chronic obstructive pulmonary disease and lung cancer increase with age, and their prevalence increases. Because of the low immunity of the elderly and the possibility of causing aspiration pneumonia, even if various new antibiotics are introduced, lung infection Still the leading cause of infection in the elderly, often a direct cause of death.

Third, the harm of air pollution and smoking

Etiology studies have confirmed that increased respiratory disease is closely related to air pollution and smoking. It has been proved that when the smoke or sulfur dioxide in the air exceeds 1000ug/m3, the acute attack of chronic bronchitis is significantly increased; other dusts such as carbon dioxide, coal dust and cotton dust can stimulate the bronchial mucosa, reduce lung clearance and natural defense functions, and be microbial invasion. Create conditions. The incidence of lung cancer in industrialized countries is higher than that in industrially backward countries, indicating that it is related to the pollution of carcinogens in industrial waste gas. Smoking is a major source of pollution in small environments, smoking is associated with chronic bronchitis and lung cancer. In 1994, the World Health Organization proposed that smoking is the biggest plague in the world, and it has been shown that in the past half century, smoking in the developing countries has swallowed 60 million people, of which 2/3 are 45 years old to 65 years old. They died 20 years earlier than non-smokers. If the current smoking situation continues, by 2025, the world will reach 10 million people each year due to smoking, which is three times the current mortality rate, of which China accounts for 2 million. At present, the total consumption of tobacco in China is the highest in the world, and the smoking of young people has increased significantly. In the next 20 years, the number of deaths due to smoking will increase sharply.

Fourth, advances in medical science and applied technology have improved diagnostic levels

In recent years, advances in research in various fields such as physiology, biochemistry, immunity, pharmacology, nuclear medicine, laser, ultrasound, and electronic technology have provided conditions for the diagnosis of respiratory diseases. Cell and molecular biology techniques have been used to provide new and comprehensive understanding of the etiology, pathogenesis and pathophysiology of some respiratory diseases, so that the disease can be diagnosed more accurately and earlier.

5. Respiratory diseases have not received enough attention for a long time.

Because the respiratory organs have a large physiological function of reserve capacity, usually only 1 / 20 lung breathing function can maintain normal life, so the pathological changes of the lungs are often not reflected in the clinic; cough, cough, hemoptysis, respiratory diseases, Chest pain, shortness of breath and other symptoms lack specificity, often mistaken for colds and bronchitis by people and clinicians, and delayed diagnosis of severe pneumonia, tuberculosis or lung cancer; or due to repeated respiratory infections, to develop emphysema, lung Heart disease, respiratory failure is taken seriously, but it is too late, its pathological and physiological functions have been difficult to reverse.

an examination

Related inspection

Regression thermocoil (BR) Hepatitis A antibody Hepatitis A antibody Hepatitis A antigen lymphocyte ratio (LY%)

As with other systemic diseases, careful detailed medical history and physical examination are the basis for the diagnosis of respiratory diseases. X-ray chest examinations have a special role in lung lesions. Because respiratory diseases are often a manifestation of systemic diseases, comprehensive comprehensive analysis should be performed in combination with routine tests and other special examination results, in order to make a diagnosis of etiology, anatomy, pathology and function.

First, medical history

Learn about occupational and personal history of toxic substances in the lungs. Such as whether to contact a variety of inorganic, organic dust, moldy hay, air conditioning machine; when asked about the history of smoking, there should be a quantitative record of the number of annual packages, with or without raw crabs may be infected with paragonimiasis. Have you ever used certain drugs that cause lung disease, such as bleomycin, amiodarone may cause pulmonary fibrosis, -adrenergic blockers can cause bronchospasm, aminosteroid antibiotics can cause respiratory muscles Reduced muscle strength, etc. There are also some hereditary diseases, such as bronchial asthma, alveolar microlithiasis, etc. may have a family history.

Second, the symptoms

Cough, cough, hemoptysis, shortness of breath, wheezing, chest pain and other symptoms of the respiratory system.

Third, physical signs

Due to the nature and extent of the lesion, the signs of chest disease may be completely normal or abnormal. Tracheobronchial lesions are mainly dry and wet? The inflammation of the lungs has changes in the nature, tone and intensity of the breath sounds, such as large inflammatory changes, and signs of pleural effusion, pneumothorax, or atelectasis. Can be accompanied by displacement of the trachea.

Chest disorders may be associated with extrapulmonary manifestations, common clubbing (toe) with bronchial-lung and pleural purulent lesions; pulmonary osteoarthrosis, clubbing, and differences due to certain bronchial lung cancer Paracancerous syndrome such as endocrine syndrome.

Differential diagnosis

(1) fever with bleeding

Common in severe infections and blood diseases. The former such as severe measles, epidemic hemorrhagic fever, dengue fever, viral hepatitis, typhus, sepsis, infective endocarditis, leptospirosis. The latter are acute leukemia, acute aplastic anemia, malignant histiocytosis.

(2) fever with lymphadenopathy, accompanied by tenderness

May be caused by a local infection. Such as systemic lymphadenopathy, suggesting that there may be lymph node tuberculosis, leukemia, lymphoma, metastatic cancer.

(3) fever with joint swelling and pain

Can be seen in sepsis, scarlet fever, brucellosis, tuberculosis, rheumatic fever, connective tissue disease, gout and so on.

(4) fever accompanied by rash

Common in rash infections. Such as measles, scarlet fever, etc.

(5 fever accompanied by abdominal pain, diarrhea, nausea, vomiting

Common in digestive disorders.

(6) fever accompanied by frequent urination, urgency, dysuria, and back pain are common in urinary tract infections. As mentioned above, there are many causes of fever, both physiological and pathological. Patients should not mistakenly believe that fever is caused by infection and abuse of antibiotics and antipyretics.

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