诊断学咯血(英文)

HemoptysisNewwordsHemoptysis－－－咯血Hematemesis－－－呕血Respiratorytract－－－呼吸道Bronchitis－－－支气管炎Bronchiectasis－－－支气管扩张Tuberculosis－－－结核Purulentsputum－－－脓痰Bronchoscopy－－－支气管镜Angiograph－－－血管造影DefinitionHemoptysis:

Coughingupbloodfromlowerrespiratorytract.DefinitionFromwhere?Lowerrespiratorytract:trachea,bronchiandlungs.Hematemesis:Bloodoriginatesfromgastrointestinal.Bloodcomefrommouth,nose,throat,andpharynxDefinitionHemoptysisisasymptomofmanyunderlyingdisorders.Therearemanydiseasesthatcancausehemoptysis.Hemoptysiscanrangefromblood-streakingsputumtomassivehemoptysis,evenlife-threateninghemoptysis.EtiologyTherearemanyunderlyingdisordersthatcancausehemoptysis.Worldwide:tuberculosisisthemostcommoncause.Inindustrializedcountries:bronchitis,bronchiectasis,andbronchogeniccarcinomaaremostcommoncauses.EtiologyHemoptysisHeartdiseasesLungdiseasesAirwaydisordersEtiologyThemainetiologiesofhemoptysisAirwaysdiseases:bronchialcarcinoma;bronchiectasisbronchitis;airwaytrauma.Pulmonaryparenchymaldiseases:tuberculosis;pneumonia;lungabscess;pulmonaryinfractEtiologyCardiovasculardisease:pulmonaryembolism;elevatedpulmonarycapillarypressurebymitral

stenosis,leftventricularfailure,congenitalheartdisease,andseverpulmonaryhypertension.Miscellaneous:hematologicdiseases,Wegener’s

granulomatosis,Goodpasture’ssyndrome.ClinicfeatureThequantityofbloodloss.Characteristicsofhemoptysisindifferentunderlyingdiseases.Accompaniedsymptoms.Clinicalfeature1.ThequantityofbloodlossMildhemoptysis:≤100mlper24hr.Moderatehemoptysis:100mlto500mlper24hr.Massivehemoptysis:≥500mlper24hr.≥200mlonetimeClinicalfeatureMassivehemoptysis:MedicalemergencyLeadtoasphyxia（窒息）

Life-threatening

coagulateintheairway

Clinicfeature2.CharacteristicsofhemoptysisindifferentdiseasesBrightred:TB,bronchiectasisDarkred:heartdiseases(mitral

stenosis)Rust-coloredsputum:pneumococcalpneumoniaFoamyandpink-coloredsputum:leftheartfailureBloodstreakingsputum:lungcancerClinicfeature3.accompaniedsymptomsChestpain:pneumonia,lungcancerFever:infectiousdiseasesPurulentsputum:bronchiectasis,lungabscessBleeding:hematologicdiseasesJaundice:leptospirosis(钩端螺旋体病)DiagnosisMakesureishemoptysis

AssesstheseverityofhemoptysisDeterminethecauseandlocationDiagnosticprocedureDiagnosisDifferentialdiagnosisofhemoptysisExcluding:Bloodcomefromtheupperairwayincludingmouth,nose,andpharynx.Hematemesis:Bloodfromthegastrointestinal.

DiagnosisHemoptysis

HematemesisHistoryLungdiseaseGastricorhepaticdiseaseRespiratorysymptomsDigestivesymptomslaboratoryexaminationBrightredDarkredorbrownMixedwithmucousMixedwithfoodAlkalinepHAcidicpH

Diagnosis2.Assesstheseverity

MildhemoptysisModeratehemoptysisMassivehemoptysisDiagnosis3.Determinethecauseandthelocationofbleeding.

HistorySputumexaminationRadiographCTBronchoscopyangiography

keypointsofinquiryHemoptysisofhematemesisCharacteristicandquantityofhemoptysisRespiratorysymptomsthataccompanywithhemoptysis:cough,chestpain,purulentsputumandsoon.Generalsymptomsthataccompanywithhemoptysis:bleeding,jaundiceCasesBronchiectasisMiddleagemanMassivehemoptysis

RepeatingcoughChronicpurulentsputumDilationofbronchiAbnormalthickenedbronchiwalls.CasesYoungmanModeratehemoptysisLow-gradefeverChroniccoughWeightlossRadiography:Cavities

TuberculosisCasesSputum:acid-fastbacilliTuberculosi