Purulent phlegm

Introduction Purulent sputum: As the cough increases, the sputum will gradually become thicker and become a purulent sputum. The appearance is mostly pale yellow lumps, which are caused by bronchitis, bronchial pneumonia or mixed infection of the lungs, tuberculosis, etc. Acute or chronic pharyngitis or suppurative tonsillitis. If the condition is further aggravated, there will be yellow purulent sputum, mostly yellow-green sticky lumps or opaque pus. At this time, lung abscess, chronic bronchitis, bronchiectasis, cavitary tuberculosis, severe infection, etc. Illness.

Cause

First, the body is weak, and the gas is insufficient. Because the spleen is not transported, the water can stay wet and condense into sputum.

Second, the spleen and stomach are weak, staying stagnation, damage the spleen and stomach; or eating raw food, melons and fruits, Zhongyang is injured; or drinking too much water due to fever, temper can not be transported, etc. can make the water wet and stay, gather for sputum. There is also a fat foraging, the stomach is turbid and steaming, and the heat can be turned into turbidity.

Third, the external sense of disrepair, or frail and often suffer from external sensation, the lungs are injured, can not be infused to Tianjin, the bladder is transferred under the water channel, so that the water stays, can also become sputum, stored in the lungs, lungs are unfavorable The swell of the airway will cause more cough.

Chinese medicine believes that the production of sputum is mainly related to the lungs and spleen. The main breathing of the lungs regulates the entry and exit of the qi (yuan). If the lungs are lost, there may be cough and lie and lying inequality. In the case of wind evil or cold evil invading the lungs, the body fluid in the lungs is condensed into sputum. The spleen is transported, that is, digesting and transporting nutrients to various organs. If the wet evil invades the human body, or if the thoughts are excessive, tired and unhealthy, it can damage the spleen and make it lose its transport function, causing the water to stop and condense into a phlegm.

an examination

Related inspection

Pus and wound infection specimens bacteriological examination white blood cell differential count lung function examination lung imaging position drainage

Physical examination:

Chronic pulmonary tuberculosis, atelectasis, trachea can be moved to the affected side, supra-sacral lymphadenopathy, Kyoto primary branch fistula cancer; lung tip percussion dullness should pay attention to tuberculosis, lower chest percussion dullness more consider lung inflammation or pleural effusion . Localized voices in any part of the lungs suggest lung inflammation or cavities; localized upper part of the lungs with fine wet voices suggesting tuberculosis; localized wetness in the localized lower extremities considers bronchiectasis bilaterally scattered in wheezing to indicate bronchial asthma cc The side scattered in the wet and dry voice prompts chronic bronchitis.

Laboratory inspection:

1. Microscopic examination:

First observe with the naked eye, select suspicious parts, such as purulent cheese-like or granular lumps, the positive rate of smear microscopy is high.

(1) Epithelial cells: Circular, columnar or squamous epithelial cells can be seen in the sputum. Generally, there is no special significance. In the chronic bronchitis, a large number of deformed and necrotic columnar epithelial cells and goblet cells can be seen.

(2) White blood cells: There are some special white blood cells in the sputum, which generally have no special significance, or indicate mild inflammation. When a large number of pus cells appear, it means respiratory septic inflammation.

(3) Eosinophils: A large number of eosinophils were found in sputum, and bronchitis was caused by bronchial asthma and parasitic diseases.

(4) red blood cells: suggesting respiratory bleeding, seen in tuberculosis. Bronchiectasis and the like.

(5) Pigment cells: macrophages phagocytose pigment particles are called pigment cells, phagocytosis of hemosiderin, found in idiopathic pulmonary hemosiderosis, heart function is not pulmonary congestion, phagocytosis The cells are found in various pneumoconiosis or inhalation of more smoke.

(6) Cancer cells: The diagnosis of cancer cells in lung cancer patients is diagnostic.

(7) Bacteria: Gram staining can identify cocci, bacilli, and acid-fast staining to find acid-fast bacilli.

(8) Parasites: Paragonimiasis eggs can be found in the sputum of patients with Pneumocystis sinensis. The head and small hook of the echinococcosis of the wrapped worm can be found in the sputum of the patient with the lung worm. Amoeba trophozoites can be found in the sputum of lung abscess.

(9) Actinomycetes: In the sputum of patients with actinomycetes, there may be sesame-sized yellow granules, which are sulphur particles. When the small sulphur particles are crushed, the central part can be seen in a line-like arrangement. The fungal hyphae, whose ends are swollen and stick-shaped.

(10) Sharp-edged crystal: It is a colorless and transparent octagonal crystal with sharp ends. It is different in size and is derived from eosinophils. It can be seen in the bronchial end and paragonimiasis.

2. Bacterial culture:

Identify pathogens and conduct drug susceptibility tests to guide clinical rational selection of antibiotics.

Device inspection:

1, X examination: is an important diagnostic tool for cardiopulmonary disease. Most of the inflammatory shadows in the lungs are inflammation of the lungs; if the symptoms such as chest pain, urgency, and shock are obvious, the shadows are fan-shaped, and when the basal part faces the pleura, the pulmonary infarction should be excluded. The infiltrating shadow of the upper part of the lung first considers invasive pulmonary tuberculosis. Pulmonary mass on the lungs and lung swelling, lung cancer, tuberculosis. Diffuse shadows in the lungs should consider miliary tuberculosis, alveolar cell carcinoma, hemosiderosis, silicosis, and lung metastases. For those suspected of having bronchiectasis, bronchial lipiodol angiography can be performed to determine the diagnosis and treatment plan.

2, CT: can distinguish the lung structure that can not be displayed in the ordinary X-ray, and the CT-guided percutaneous lung biopsy positioning is accurate and safe.

3, fiberoptic bronchoscopy: for patients with suspected lung cancer should do fiberoptic bronchoscopy to observe the lesions, lung infection in the fibrous bronchi with double cannula to absorb or brush the secretions of deep bronchus in the lungs, as a pathogen culture To avoid oral pollution, the positive rate is high, bronchoalveolar lavage can be feasible if necessary, to the cause of lung disease, a clear diagnosis.

Differential diagnosis

To be distinguished from rogue:

Rogue: A tuberculous suppurative disease that occurs between bones and joints. Because of its pus, it can flow around the lesion or form a abscess in the distant space. After the break, the pus is thin and thin. The cough is severe, the sputum will gradually become thicker, becoming a purulent sputum, and the appearance is mostly pale yellow.

Knowing the amount, color, smell, and traits of observing ticks often leads to diagnosis:

1, traits:

(1) Mucinous sputum: enamel is thick, colorless and transparent or slightly white, more common in the early stage of bronchitis, bronchial asthma, pneumococcal pneumonia.

(2) Mucous purulent sputum: sputum traits between mucus sputum and purulent sputum, there is a part of pus in addition to mucus, yellowish white, viscous; common in bronchitis, tuberculosis, inflammation in the lungs Wait. This is due to the formation of pus in the inflammatory process of the lung tissue, and a large amount of mucus secretions are mixed.

(3) purulent sputum: sputum purulent, yellow or green, thick and sticky, some with odor, common in suppurative bronchitis, bronchiectasis, lung abscess, empyema or liver, spine, mediastinal abscess Bronchospasm caused by wearing the lungs, squeaky purulent sputum, often suggest anaerobic infection.

2. Quantity:

The most common diseases are pulmonary edema, lung abscess, bronchiectasis, alveolar cell carcinoma, empyema or abdominal abscess. Checking the amount of sputum is generally based on 24h. The increase in sputum reflects the progress of bronchial and pulmonary inflammation; sputum can not be discharged smoothly, although the clinical manifestations of sputum reduction, in fact, the condition is still developing, the symptoms of poisoning will be aggravated.

3. Odor:

The general cockroach has no odor. When it is left for a long time, it will produce odor due to the decomposition of bacteria in the sputum. When anaerobic bacteria are infected, it has a bad odor. It is seen in the lungs, sputum, lung abscess, bronchiectasis, and late stage of bronchial lung cancer.

4, color:

Yellow or green sticky tips suggest a purulent infection in the respiratory tract. Green sputum is often caused by bile, degenerative hemoglobin or pyocyanin. It is found in jaundice, slow-absorbing pneumococcal pneumonia, Pseudomonas aeruginosa infection, and bloody sputum in lung cancer. Tuberculosis, bronchiectasis, rust stains, seen in pneumococcal pneumonia. Pink or bloody foam glimpses acute pulmonary edema. Reddish-brown or chocolate-colored sputum, seen in the amebic disease of the lung caused by the amoebic abscess that penetrates into the lungs.

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