Pleurisy, tuberculosis
Symptoms and diagnosis
The most common symptom of pleurisy is chest pain. Chest pain often occurs suddenly, and the degree varies greatly. It can be inconspicuous discomfort or severe tingling. It can only occur when the patient takes a deep breath or coughs, or it can persist and be aggravated by deep breathing or coughing. Chest pain is caused by inflammation in parietal pleura, which usually appears on the chest wall facing the inflammation site. It can also be manifested as abdominal, neck or shoulder pain.
Because deep breathing can cause pain, it often causes shallow breathing, and the muscle movement of the affected side is weaker than that of the side. If there is a large amount of accumulation, the two pleura can be separated from each other and the chest pain can disappear. A large amount of pleural effusion can cause unilateral or bilateral lung dilatation limitation during breathing, resulting in dyspnea.
According to the characteristics of chest pain, pleurisy can often be diagnosed. Doctors can smell a squeaky fricative sound when using a stethoscope, which is called pleural fricative sound. Chest X-ray examination can not show pleurisy, but rib fracture, lung lesions or a small amount of pleural effusion can be found.
Sudden chest pain is the main symptom of pleurisy. Typical chest pain is tingling, which is aggravated when breathing and coughing, and the degree can be different. It can only be a slight discomfort, or it will only appear when the patient takes a deep breath or coughs. Visceral pleura has no pain; Pain is caused by parietal pleura's pain.
1) clinical manifestations
1. Mild patients are asymptomatic.
2. The main clinical manifestations are chest pain, cough, chest tightness, shortness of breath and even dyspnea. When infectious pleurisy or pleural effusion is secondary to infection, aversion to cold and fever may occur.
3. Pleurisy caused by different reasons may be accompanied by clinical manifestations of corresponding diseases.
2) Diagnosis
1. 10 is generally divided into the following types:
① Fibrous pleurisy: that is, "pleurisy sicca", with a small amount of fibrin oozing locally from the pleura and no pleural effusion. Most of them are caused by lung inflammation spreading to pleura, most of them are asymptomatic, and a few patients have localized needle-like pain.
② Serous cellulose pleurisy: exudative pleurisy, in which serous fluid and fibrin ooze and accumulate in the chest cavity, which is often caused by tuberculous pleurisy, purulent pleurisy and neoplastic pleurisy. Chest pain and shortness of breath are the main manifestations.
③ Tuberculous pleurisy: It is caused by mycobacterium tuberculosis reaching the pleura from the primary syndrome lymph nodes through lymphatic vessels, or the subpleural tuberculosis spreading to the pleura. There are mainly tuberculous pleurisy sicca, tuberculous exudative pleurisy and tuberculous empyema. There are often symptoms of chest pain, shortness of breath and tuberculosis poisoning.
④ Tumor pleurisy; It is caused by intrathoracic or extrathoracic cancer and directly invades or metastasizes to pleura. The main manifestations are chest tightness, progressive dyspnea, and corresponding symptoms of primary lesions.
⑤ Suppurative pleurisy: It is mostly caused by the spread of lung, esophagus and abdominal cavity infection to pleura. It is characterized by aversion to cold, high fever, chest pain, cough and expectoration.
⑥ Fungal pleurisy: It is mostly caused by actinomycetes and Candida albicans involving pleura.
All landowners connective tissue disease pleurisy: common in rheumatoid arthritis and systemic lupus erythematosus. Chest pain, shortness of breath and primary symptoms are the main manifestations.
Cholesterol pleurisy; There are a lot of free cholesterol crystals in pleural effusion, which may be related to the disorder of fat metabolism, and the clinical symptoms are mild.
Pet-name ruby chylothorax: Pleural effusion contains lymphatic chylothorax, which is mostly caused by tumor, lymph node tuberculosis and filariasis granuloma compressing or damaging thoracic duct and chylothorax. Chest tightness and shortness of breath are the main manifestations.
⑩ Hemothorax: It refers to obvious intrathoracic hemorrhage. It is caused by spontaneous pneumothorax, pleural adhesion and vascular tear or hemorrhagic pancreatitis. The main manifestations are chest pain, chest tightness and even shock.
2. Physical examination: dry pleurisy: respiratory movement is limited, local tenderness, respiratory sounds are weakened, and pleural fricative sounds can be heard. Exudative pleurisy: when there is a large amount of effusion, the breathing movement of the affected side is limited, and even forced posture, shortness of breath, increased heart rate, chest fullness, tracheal displacement to the healthy side, percussion, tremor, weakened or disappeared breathing appear.
3.x-ray examination: There is no obvious change in patients with localized pleurisy. When pleural effusion is less, the costal septum angle is fuzzy and obtuse. When there is more pleural effusion, the density of the lower lung field increases, and the upper edge of the shadow is curved from armpit to bottom.
4. Ultrasonic examination: the dark area of liquid with good sound transmission can be found, and the range, position and depth of puncture can be indicated.
5. Laboratory inspection:
① Routine, biochemical and culture of pleural effusion can judge the nature of pleural effusion and find tuberculosis or other pathogenic bacteria.
② The tuberculin test and the positive anti-tuberculosis antibody are helpful for the diagnosis of tuberculous pleurisy.
③ The white blood cell count can be normal or increased by routine blood examination, and the erythrocyte sedimentation rate is often accelerated.
6. This disease should be differentiated from pleural metastasis of bronchial lung cancer and pleural effusion caused by liver, kidney and heart diseases.
treat cordially
The treatment of pleurisy depends on its etiology. Those caused by bacterial infections should be treated with antibiotics. Virus infection does not require anti-infection treatment. For patients caused by autoimmune diseases, treatment of basic diseases can make pleurisy subside.
1. western medicine treatment:
① Antibiotic therapy
A. Anti-tuberculosis drug therapy: it is suitable for treating tuberculous dry or exudative pleurisy. Isoniazid 300 mg/day, or rifampicin 300 mg/day, or ethambutol 0.75- 1 g/day, 1 time, for 3 months. Streptomycin 0.75- 1g daily, intramuscular injection 1-2 months, alternately used with oral drugs, with a total course of treatment of 6-9 months.
B. Non-tuberculous pleurisy: corresponding drugs should be selected according to the primary disease (such as infection and tumor).
C. Purulent pleurisy or tuberculous empyema with infection: penicillin C is injected intramuscularly for 4 times per day1.60-3.2 million units, and 807 units can be injected into the chest cavity.
② Analgesia: Take aspirin 0.6 g or indomethacin 50 mg orally, 1 3 times a day, or 15-30 mg codeine 3 times a day, 1.
③ Thoracic puncture and drainage: it is suitable for patients with exudative pleurisy with large pleural effusion and obvious dyspnea, or with effusion still not absorbed after long-term treatment. Do not exceed 1000ml each time, 2-3 times a week.
④ Hormone therapy: Combined with anti-tuberculosis drugs, it has a positive therapeutic effect on eliminating systemic toxic symptoms, promoting the absorption of effusion and preventing pleural thickening and adhesion. Prednisone 15-30mg can be taken orally in three times. When the systemic symptoms improve and the absorption of hydrops is obviously reduced, it can be gradually reduced, usually for 4-6 weeks.
2. Chinese medicine treatment:
① Pathogens invading the chest and lungs: aversion to cold and fever, cough with little phlegm, stabbing pain in chest and hypochondrium, bitter mouth and dry throat, red tongue with thin coating and rapid pulse.
Treatment: reconciliation and clearing heat, regulating qi and dredging collaterals.
Prescription: Trichosanthes kirilowii and Trichosanthes kirilowii each 30g, Bupleurum chinense and Paeonia lactiflora each 65438 05g, Scutellaria baicalensis, Pinellia ternata, Fructus Aurantii, Platycodon grandiflorum and Cortex Mori each 65438 00g, and Glycyrrhiza uralensis each 6g.
② Stop drinking in chest and hypochondrium: Coughing and spitting will cause pain and difficulty in breathing. Coughing and wheezing can't make you lie flat, with white and greasy tongue coating and heavy pulse.
Treatment: Drain water and drink water.
Prescription: Stemona Stemona 30g, Fructus Trichosanthis and Poria15g, Semen Lepidii1g, Cortex Mori, Su Yu, Pericarpium Citri Tangerinae, Rhizoma Pinelliae, Fructus Zanthoxyli, Bulbus Allii Macrostemonae, and Orange 10.
③ Stagnation of phlegm and blood stasis: chest pain, chest tightness, dyspnea, persistent, dark purple tongue with white fur and thready pulse.
Treatment: resolving phlegm and promoting blood circulation, regulating qi and dredging collaterals.
Prescription: Semen Coicis 30g, Fructus Trichosanthis, Radix Paeoniae Rubra, Poria 15g, Inula, SEAO, Semen Armeniacae Amarum, Rhizoma Pinelliae, Rhizoma Cyperi, Pericarpium Citri Tangerinae, Fructus Aurantii, Fructus Lipuidambaris 10g, and modified milk (including decoction) 6g.
④ Internal heat due to yin deficiency: cough with little phlegm, dry mouth and throat, hot flashes, night sweats, fever of the five senses, red cheekbones, emaciation, red tongue with little fur and rapid pulse.
Treatment: nourishing yin and clearing heat.
Prescription: Radix Adenophorae, Radix Ophiopogonis, Rhizoma Polygonati Odorati, Pollen and Stemonae each 65438±05g, Radix Pseudostellariae 65438±03g, Cortex Mori, Cortex Lycii, Folium Mahoniae, Radix Bupleuri, Radix Curcumae and Semen Armeniacae Amarum each 65438±00g, and Bulbus Fritillariae Cirrhosae powder 6g (orally).
4) Prevention and aftercare
Pay attention to rest and eat a diet with high protein and vitamins.
2. The treatment should be lasting and thorough.
Love tip: please consult the local regular Chinese medicine hospital for the above prescriptions, and select the prescriptions according to their own physiological characteristics and different pathological changes.
These are all reference materials. It is best to go to the hospital for diagnosis and symptomatic treatment as soon as possible!