Abnormal breath

Introduction Breathing in the breath, the breath exhaled by people has no special smell. Abnormal breath often comes from food, smokers, drinking, etc. If you breathe out a stench or have a special breath, it is of great significance when it is found in the oral cavity, respiratory tract, digestive tract and some visceral diseases. Another type of abnormal breath is abnormal frequency of breathing and rhythm.

Cause

1. Oral diseases: periodontal disease, gum infection and oral hygiene, glossitis, oral inflammation (infection after extraction, sputum stomatitis, gingival gingival), oral cancer, laryngeal cancer, etc.

2, nasopharyngeal diseases: stinky nose (chronic rhinitis), nasopharyngeal carcinoma, maxillary sinus cancer, acute tonsillitis, angina and so on.

3, bronchial diseases: suppurative bronchitis, bronchiectasis with anaerobic infection, bronchopleural fistula (hepatomegaly, empyema, etc.) caused by various reasons.

4, lung disease: lung abscess and lung infection with anaerobic bacteria, pulmonary ring sputum, tuberculosis cavity, lung cyst with infection, lung cancer.

5, pleural lesions: suppurative pleurisy with bronchopleural fistula, liver abscess ulceration to the pleural bronchial pleural effusion.

6, digestive tract diseases: esophageal diverticulum, esophageal cancer, esophageal stricture, cardia cancer with ulcers, gastritis, indigestion, constipation, esophageal fissure, gastric cancer, gastrointestinal infection, pyloric obstruction, intestinal obstruction, gastro-intestinal fistula, peritonitis, Appendicitis, advanced chronic liver disease, etc.

7, other: diabetic ketoacidosis, hunger, indigestion and malabsorption, salicylic acid poisoning, uremia, poisoning, alcoholism, oral medication, high fever, respiratory or upper gastrointestinal bleeding, occupational chemical poisoning.

mechanism

After eating certain foods or drugs (such as garlic, wine, etc.), the breath will contain its odor, and the mouth can directly emit its special breath. When the foreign body is corrupted, such as food residue remaining in the tooth gap, there is odor, throat, nose, pharyngeal foreign body retention time is too long or cause local inflammation, causing secretions (, , saliva, etc.) to decompose and rot gas. Some bacteria in the respiratory tract (various anaerobic bacteria) break down proteins and starches and produce odorous gases. When the tissue is destroyed or necrotic, it can produce a foul smell of rotten eggs. When blood ketones, urea and other ingredients increase (such as diabetic ketosis, uremia acidosis), there may be ketone, urine breath when exhaled.

an examination

Related inspection

Chest CT examination sputum routine examination

Clinical manifestation

Abnormal breath comes from the mouth and nose, and can often be directly detected. The abnormal breath from the gastrointestinal tract often has clinical signs of indigestion. Abnormal breath from the bronchial tubes, lungs, often accompanied by cough, a lot of skunk, chills, fever, ipsilateral chest pain, shortness of breath, sweating, general malaise, lack of appetite, etc., physical examination of the side of the lung turbidity, lung consolidation Signs, chronic patients often have clubbing (toe), diabetic acidosis patients exhaled acetone breath like a stupid apple flavor. Slightly sweet, often have symptoms of polyphagia, polydipsia, polyuria and weight loss; uremia patients exhale with urinary breath and kidney disease manifestations of edema, anemia, hypertension and urine changes and renal function changes. In the advanced stage of cirrhosis, there are signs of portal hypertension, and there is a specific liver odor when liver function declines.

Laboratory inspection

In the lung purulent inflammation, the total number of blood cells increased (20~30). X10/L neutrophils were above 0.90, and the nucleus was obviously left shifting, often with poisoning particles. It is purulent. yellow-green. Bacterial examination of cockroaches can reveal bacteria. Hepatic cirrhosis decompensated liver function damage, aminotransferase (ALT) was significantly increased. IgG, IGA, and LGM can all be increased. When uremia, blood red eggs fall, platelet floor decreases, proteinuria, tubular urine, renal dysfunction, ammonia urinary ammonia and plasma creatinine increase, uric acid increases. In diabetic acidosis, the ketone body is strongly positive, the blood glucose level is increased, the blood ketone body is elevated, the carbon dioxide binding force is decreased, and the residual residual value of the alkali is increased.

Device inspection

X-ray examination of lung abscess showed large thick and fuzzy infiltrating shadows, unclear edges, or lumpy dense shadows distributed in one or several lung segments, with a round translucent area and a liquid level in the abscess, surrounded by dense inflammatory infiltration. Fiberoptic bronchoscopy can directly check whether there is any foreign body obstruction, drainage of the bronchus, and can do brush and biopsy, obtain relevant bacteriological and cytological evidence, and also aspirate sputum to help abscess drainage, play a certain therapeutic role. Liver cirrhosis B-type sounding showed liver size, shape change and splenomegaly. Portal vein, portal vein diameter was widened at portal hypertension, and liquid dark area was found in ascites. X-ray examination of the esophagus and swallowing, X-ray of the esophageal vein curve showed that the worm-like or sacral filling defect, the longitudinal mucosal wrinkle arm widened, and the varicose veins of the fundus showed a chrysanthemum-like filling defect. Gastroscopic examination, radionuclide, liver biopsy, abdominal hernia examination, etc. can be found in the corresponding lesions.

Differential diagnosis

Identification of diseases with abnormal breath

First, respiratory diseases

1, chronic hypertrophy and chronic atrophic rhinitis when the breath has a bad smell, chronic hypertrophic rhinitis, endometrial hypertrophy, hyperplasia, nasal obstruction, paralysis, chronic atrophic rhinitis, nasal tissue atrophy, nasal enlargement, smelly nose, more common in Young women. Sinusitis has fever, nasal congestion, headache, pus, odor, nasal examination, sinus puncture and X-ray film help to confirm the diagnosis.

2, foreign body: throat, nose, nasopharynx, bronchial foreign body obstruction (such as peanuts, beans, fruit cores, melon seeds, etc.) after the corruption, smell, direct glance, laryngoscope, nose, bronchoscope and X-ray The photo can be diagnosed.

3, suppurative bronchitis: cough, fever, a lot of skunk or bloody exhalation and odor, X-ray examination showed increased lung texture, or bronchial pneumonia shadow.

4, bronchiectasis and anaerobic infection: sputum and stinky, repeated hemoptysis, long-term cough; the lower part of the affected side can smell wet voice, clubbing (toe). X-ray chest radiographs can be seen in the shape of curls, bronchial iodine oil imaging agent filled with bronchial red sac cystic, columnar or cystic shadow, is the most important basis for the diagnosis of bronchial dilation.

5, lung abscess: anaerobic infection, sputum has a foul smell, a sharp onset, chills, high fever, cough, a history of foreign body inhalation, repeated hemoptysis, anemia, weight loss, physical examination of the side of the voice and lung physical signs, Clubbing (toe). X-ray chest radiograph presents a dense, dark shadow with abscess and fluid level. The abscess is round and the inner wall is smooth. The fiberoptic bronchoscope can directly observe whether there is foreign body obstruction, bronchial bronchus, leukocytosis, and neutrophils. The cells are increased, and the pathogenic bacteria can be found in the culture of sputum culture including anaerobic bacteria.

6, lung gangrene: is the result of lung suppuration, bronchiectasis or pulmonary infarction development, patients with fever, weight loss, weakness, anemia, general poor, due to lung tissue necrosis, breath and sputum have odor such as rotten eggs, purulent sputum Green or brown.

7, tuberculosis cavity secondary infection: sputum smell, patients with tuberculosis symptoms such as low fever in the afternoon, night sweats, burnout, wilting, weight loss, loss of appetite, hemoptysis, etc., signs are often negative, tuberculosis can be heard Luo Yin. X-ray examination of infiltrative lesions is soft cloud-like or small-like, with blurred edges or inflammation around the cavity, a liquid level inside, and tuberculosis in other lung fields. Tuberculosis is found in tuberculosis, and pathogenic bacteria are found in common cockroaches. Serological tests for strong anti-tuberculosis antibodies. ESR increased. The OT test was positive. Fiberoptic bronchoscopy was performed for sputum bacteriology and pathological examination to confirm the diagnosis.

8, pulmonary cyst secondary infection: patients with fever, cough, cough and sputum or repeated hemoptysis, chest pain. X-ray showed a single-capsule combined infection with a circular shadow, with a liquid level, sometimes different from lung pus, but the surrounding inflammatory infiltration is not good lung abscess, when the inflammation is absorbed, the true nature of the cyst can be revealed. Polycystic lesions appear as a ring, with honeycomb shadows or fluid levels, and bronchography can show the location and morphology of the capsule.

9, suppurative pleurisy (purulent chest): accompanied by bronchopleural fistula, coughing history, sputum has pus or mixed blood, X-ray can be seen pleural effusion or enveloped effusion, visible bronchial pleural effusion Plane or see a purulent chest and pus examination can confirm the diagnosis.

Second, digestive diseases

1, esophageal stricture, tumor, diverticulum: can make food stay, after the corruption with a smell of breath. Clinical, manifested as progressive pharyngeal difficulty, swallowing pain, food reflux, severe chronic dehydration, malnutrition, weight loss or cachexia. Double contrast angiography of the esophagus X-ray was performed after swallowing. It is beneficial to observe the morphology of the esophageal mucosa. Esophagoscopy can directly observe stenosis, tumor, diverticulum or a brush or biopsy for pathological examination, which can be diagnosed.

2, expensive cancer: with the formation of ulcers often have a foul smell. Clinical manifestations of progressive dysphagia, nausea, vomiting, malnutrition, weight loss, cachexia, X-ray barium meal examination and gastroscopy combined with mucosal biopsy are currently the most reliable diagnostic tools.

3, gastritis: indigestion, constipation can be discharged from the heat of the digestive tract. Chronic gastritis and prolonged, clinical manifestations of upper abdominal fullness discomfort, especially after a meal, irregular upper palate pain, heating, pantothenic acid, vomiting, etc., gastroscopy and gastric mucosal biopsy can confirm the diagnosis.

4, cirrhosis coma: the patient is a special mildew odor, hepatic encephalopathy is seen in portal cirrhosis, the virus is often negative, the upper tuberculosis of the lung can hear the fine wet rales. X-ray examination of infiltrative lesions is soft cloud-like or small-like, with blurred edges or inflammation around the cavity, a liquid level inside, tuberculosis in other lung fields, and tuberculosis in tuberculosis. Serological examination of strong anti-tuberculosis, erythrocyte sedimentation rate. The OT test was positive. Fiberoptic bronchoscopy was performed for sputum bacteriology and pathological examination to confirm the diagnosis.

5, pulmonary cyst secondary infection: patients with fever, cough, cough and sputum or repeated hemoptysis, chest pain. X-ray showed a single cystic infection with annular shadow bone fluid level, sometimes difficult to distinguish from lung swelling, but the surrounding fire infiltration is not good lung abscess, when the inflammation is absorbed, it can show the true nature of the cyst, polycystic The lesion appears as a ring, with a honeycomb shadow or a fluid level, and bronchography can show the location and morphology of the cyst.

6, suppurative pleurisy (purulent chest): accompanied by bronchopleural fistula, coughing history, sputum has pus or mixed blood, X-ray can be seen pleural effusion or enveloped effusion, bronchopleural sputum visible liquid level Or see a pus and chest, chest puncture examination can confirm the diagnosis.

Third, urinary system diseases

In uremia, the amount of urea in the blood increases, and the breath is ammonia or urine. Uremic diseases are various chronic kidney diseases such as glomerulonephritis, chronic pyelonephritis, tubulointerstitial nephropathy, polycystic kidney disease, etc.; renal diseases secondary to systemic diseases such as systemic lupus erythematosus (SLE) nephropathy, diabetic nephropathy Hypertensive renal arteriosclerosis, nodular polyarteritis nephropathy, multiple spinal cord nephropathy, etc.; urinary tract obstructive nephropathy such as urinary calculi, prostatic hypertrophy, neurogenic bladder and urethral stricture. Clinical manifestations are complex and gastrointestinal symptoms are the earliest and most common symptoms: loss of appetite, upper oral odor and gastrointestinal bleeding, etc. Others such as anemia, bleeding, tendency, hypertension, heart failure, pericardial effusion, arteriosclerosis, Uremic lung, itchy skin, osteoporosis, infection, acidosis, etc., increased BUN in the blood, decreased carbon dioxide binding, and severe damage to kidney function are helpful for diagnosis.

Fourth, diabetic ketoacidosis

It is the main disease that produces acetone. It is early to show thirst, polydipsia, polyuria, polyphagia, fatigue, accompanied by loss of appetite, nausea, vomiting, often accompanied by headache, lethargy, irritability, rapid breathing, exhalation Rotten apple flavor (acetone), severe water loss, decreased urine output, decreased blood pressure, late or reversal of various nerve reflexes, sleepiness and even coma, laboratory tests: strong urine sugar, urine ketone body, blood sugar, blood ketone body The difficulty is raised, the carbon dioxide binding force is lowered, the pH is <7.35, and the residual residual value of the alkali is increased.

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