What is hemoptysis? What are the causes, clinical manifestations, examinations, and treatments for hemoptysis?

Hemoptysis refers to the process of bleeding from the respiratory organs below the throat (ie, trachea, bronchi, or lung tissue) and expelling from the mouth through coughing. Hemoptysis can be caused not only by respiratory diseases, but also by circulatory diseases, trauma, and other systemic or systemic factors. It should be differentiated from oral, pharyngeal, episodic hemorrhage and hematemesis.

What is hemoptysis? What are the causes, clinical manifestations, examinations, and treatments for hemoptysis?

Cause
Diseases that cause hemoptysis are not limited to respiratory diseases, although hemoptysis is more common in respiratory diseases. Listed below are various diseases that cause hemoptysis.

1.Respiratory disease
Such as tuberculosis, bronchiectasis, bronchitis, lung abscess, lung cancer, pneumonia, paragonimiasis, pulmonary amoebiasis, pulmonary hydatidosis, pulmonary fungal disease, pulmonary cysticercosis, bronchial stones, pulmonary metastatic tumors, lungs Adenoma, silicosis, etc. These inflammations lead to increased osmotic permeability of the bronchial mucosa or lesions, or ulceration of the submucosal vessel wall, causing bleeding.


2. Circulatory diseases
Common rheumatic heart disease mitral stenosis, hypertensive heart disease, pulmonary hypertension, aortic aneurysm, pulmonary infarction and pulmonary arteriovenous fistula.

3. Trauma
Chest trauma, contusion, rib fracture, gunshot wound, blast injury, and medical procedures (such as chest or lung puncture, biopsy, bronchoscopy, etc.) can also cause hemoptysis.

4. Systemic bleeding tendency disease
Common such as leukemia, hemophilia, aplastic anemia, leptospirosis with pulmonary hemorrhage, epidemic hemorrhagic fever, pulmonary plague, thrombocytopenic purpura, disseminated intravascular coagulation, chronic renal failure, uremia, etc.

5. Other less common diseases or abnormal conditions
Such as alternative menstruation (not from vaginal bleeding), oxygen poisoning, pulmonary hemorrhagic nephritis syndrome, bronchiectasis, sinusitis, visceral translocation syndrome.

Clinical manifestation
Hemoptysis with fever, more common in tuberculosis, pneumonia, lung abscess, pulmonary hemorrhagic leptospirosis, epidemic hemorrhagic fever, bronchial cancer.
Hemoptysis with chest pain, common in lobar pneumonia, pulmonary embolism, tuberculosis, bronchial cancer.
Hemoptysis with cough, can be seen in bronchial cancer, mycoplasmal pneumonia and so on.
Hemoptysis with skin mucosal hemorrhage can be seen in blood diseases (such as leukemia, thrombocytopenic purpura), leptospirosis, and epidemic hemorrhagic fever.
Hemoptysis with jaundice, more common in leptospirosis, lobar pneumonia, pulmonary infarction.

An examination
1. Medical history inquiry
The bleeding is first or multiple times. If it is multiple times, it is different from the past. Young adults with cough and hemoptysis with low fever should consider tuberculosis. People over the middle age, especially male smokers, should pay attention to the possibility of lung cancer; they should carefully inquire and observe the color of hemoptysis, with or without sputum, and pay attention to the history of TB contact when inquiring about personal history, the history of smoking for many years, the history of menstruation, History of occupational dust exposure, raw crabs, etc.
Hemoptysis with chest pain is more common in pulmonary infarction, pneumococcal pneumonia; hemoptysis with cough is more common in bronchial lung cancer, blood stasis is seen in lung abscess; a large number of hemoptysis are more common in cavitary tuberculosis, bronchodilator aneurysm rupture. Domestic literature reports that no jaundice-type leptospirosis also causes large hemoptysis that causes disease.

2. Physical examination
Patients with hemoptysis should be carefully examined repeatedly. Some chronic heart and lung diseases can be combined with clubbing (toe), and patients with progressive tuberculosis and lung cancer often have significant weight loss. Some blood diseases have a generalized hemorrhagic tendency.

3. Laboratory inspection
Sputum examination can help find tubercle bacilli, fungi, bacteria, cancer cells, parasite eggs, heart failure cells, etc.; bleeding time, clotting time, prothrombin time, platelet count and other tests help to diagnose bleeding disorders; red blood cell count The determination with protoerythrin helps to infer the degree of bleeding, and eosinophilia suggests the possibility of parasitic diseases.

4. Device inspection

• X-ray examination Patients with hemoptysis should be examined by X-ray, chest fluoroscopy, and chest radiographs. If necessary, bronchography can be used to assist diagnosis.
• CT examination helps to find small bleeding lesions.
• Bronchoscopy patients with unexplained hemoptysis or bronchial obstruction of atelectasis should consider bronchoscopy, such as tumors, tuberculosis foreign bodies, etc., and take biopsy pathological examination.
• Radionuclide gallium examination Helps differential diagnosis of lung cancer and other lung masses.

Diagnosis
According to the medical history, clinical manifestations and related examinations can be diagnosed.

Differential diagnosis
Need to be differentiated from hematemesis.

Treatment
1.General treatment
Inhalation, monitoring, hemostasis, blood transfusion, infusion and symptomatic and etiological treatment.

2. Large hemoptysis rescue
Large hemoptysis should be rescued in time, otherwise the patient's life will be threatened.
The effect of massive hemoptysis on the human body, in addition to the amount of hemoptysis and the rate of bleeding, is also related to the general condition of the patient. If the patient is chronically sick, even if the bleeding is less than 300 ml, it may be fatal.
The direct dangers caused by massive hemoptysis are mainly asphyxia and hemorrhagic shock. The indirect risk is secondary lung infection or clot bronchial blockage caused by atelectasis. For patients with tuberculosis, they can also spread through blood.

• Keep your posture calm, don't panic, let the patient take the position, head to one side, encourage the patient to gently push the blood out to avoid blood retention in the respiratory tract. If the lesion is known, the lateral position is taken to prevent blood from flowing into the healthy lung. If the bleeding site is unknown, take the supine position and turn the head to one side to prevent suffocation.
• Calm to avoid mental stress, give spiritual comfort, if necessary, can give a small amount of sedatives, such as oral stability.
• Patients with severe cough and severe coughing severe hemoptysis, can be given an appropriate amount of antitussives, but must be careful, disable severe sedative cough medicine, so as not to excessively inhibit the cough center, so that blood stasis of the airway, causing suffocation.
• Observing the condition and closely observing the patient's hemoptysis, respiration, pulse, etc., to prevent the occurrence of shock.
• Do not use force to prevent bowel movements and increase hemoptysis.
• Keep the airway open. If the patient feels chest tightness, shortness of breath, and wheezing, help the patient to clear the secretions of the mouth and nose, keep the indoor air circulation, and give oxygen when there are conditions.
• If the suffocation patient's rescue occurs with massive hemoptysis, immediately drain the body position, take the head low and high (can raise the bed tail by about 45 degrees), or pat the back.

After initial treatment, the hemoptysis is slightly relieved. When the patient's blood pressure, pulse and breathing are relatively stable, the patient should be escorted to a nearby hospital as soon as possible for further treatment. If the bleeding is not enough, please ask the emergency doctor of the emergency center to carry out local rescue, once the condition is slightly stable. When the transfer is allowed, the hospital still needs to be sent to the hospital for oxygen, monitoring, hemostasis, blood transfusion, infusion and symptomatic and etiological treatment.