Systemic symptoms, generally speaking, tuberculosis is a chronic infectious disease. At the beginning, patients did not feel uncomfortable because of mild symptoms, and generally did not attract attention. Symptoms only appear when the disease develops. Some people have poor resistance, and the bacteria infected with tuberculosis are large and toxic, so the symptoms will be obvious. General malaise, fever, fatigue, fatigue, upset, loss of appetite, weight loss for a long time, lesbians sometimes make menstruation abnormal.
1, fever. Fever is one of the common symptoms of many diseases. Tuberculosis is no exception. But the fever of tuberculosis still has its own characteristics: (1) Long-term low fever usually appears in the afternoon and evening. The so-called low fever, that is, below 38℃, can return to normal body temperature in the morning. Many patients may not know that they have a fever at all, and some patients may be bored and uncomfortable. ⑵ The body temperature may be unstable, you may feel fever and fatigue at work, and your body temperature cannot return to normal after a short rest; (3) When the disease worsens and progresses, fever is obvious, especially when there are other bacterial infections in the lungs, high fever may occur, sometimes at 39℃ ~ 40℃. When the body's resistance is extremely low, tuberculosis can spread to the whole body, and then persistent chills and high fever may occur; (4) Lesbians can get fever through blood flow before and after menstruation, but when suffering from tuberculosis, fever will not return to normal immediately after menstruation is clean.
2, night sweats. The so-called night sweats, that is, patients sweating all over when they fall asleep or wake up, generally occur in children with weak constitution (sometimes normal children may also have this phenomenon). Night sweats are more common in patients with severe lung diseases. In severe cases, clothes and quilts can be soaked, and patients feel tired and weak.
What is mentioned above is systemic symptoms, that is, symptoms of systemic poisoning after being infected with tuberculosis. Next, let's talk about the local symptoms of tuberculosis.
1, cough. This is the most common local symptom of tuberculosis. Early cough can be very mild, often a single cough, that is, we say half cough, dry cough without phlegm, and the impact on work and life is not obvious. Cough can be aggravated when the lesion progresses; When accompanied by endobronchial tuberculosis, cough can be aggravated, and sometimes choking can occur. For patients who have been ill for a long time, such as bronchial displacement, tracheal traction caused by pathological adhesion, or bronchial deformation caused by peripheral lymph node compression, irritating cough may occur due to poor ventilation, similar to choking by eating, and even dyspnea.
2, expectoration. At the beginning of the disease, expectoration is not obvious, or there is a small amount of white mucus sputum, but when the lesion expands or even there is a cavity in the lung, the amount of sputum will increase. When infected by other pathogenic bacteria, the amount of sputum will also increase, and yellow pus and phlegm may appear, accompanied by systemic symptoms of fever and chills.
3, chest pain. Chest pain is also the main local symptom of pulmonary tuberculosis, but it usually has to spread to the pleura, especially in parietal pleura. Parietal pleura is the front chest tuberculosis, and parietal pleura is as shown in Figures 2 and 3. Sometimes there will be dull pain in uncertain parts, which is caused by nerve reflex and is not affected by lung breathing movement. If there is a fixed tingling sensation in this part, which is aggravated with breathing and coughing, it means that inflammation has stimulated the pleura, and some patients often feel pain in the shoulder or upper abdomen, which is probably caused by inflammation stimulating the diaphragm through nerve reflex.
4. Hemoptysis. We often find that many patients don't know that he has tuberculosis in advance. I don't care if I cough at ordinary times, and I don't feel a fever. However, when they cough, they find bloodshot sputum, blood clots and even a mouthful of blood, and then go to the hospital to see a doctor. After examination, they found that there were many lesions in the lungs, and some even had cavities. Hemoptysis patients account for about 1/3 of the total patients. It is impossible for any patient to have hemoptysis. Blood comes from blood vessels. Therefore, it will only happen when the lesion affects the permeability of the blood vessel wall or directly damages the blood vessel. The amount of bleeding depends on the degree of vascular damage. We believe that the number of lung lesions is not proportional to the amount of bleeding. Some patients have small lesions but damaged blood vessels, so they will bleed. On the contrary, there are many lesions, but there is little or no bleeding, and blood vessels are not damaged. Of course, the more pathological changes, the more chances of blood vessel bleeding.
5. others. The structure of the lung has been introduced in detail. Because of its huge compensatory function and huge reserve potential, mild lesions will not cause pulmonary respiratory dysfunction. Lung is the main organ for oxygen exchange between human body and natural environment, and oxygen exchange mainly depends on alveolar tissue in lung tissue. Pulmonary tuberculosis begins with alveoli. When the lesions are extensive, a large number of alveolar tissues are destroyed and oxygen exchange is blocked, the body will have difficulty breathing due to lack of oxygen, and even the whole body will be in a state of lack of oxygen, and the lips will turn purple (the tip of the tongue can appear first). Long-term chronic hypoxia will make the phalanges of fingers change like a drum hammer, which we call it. Due to systemic hypoxia, the functions of various organs and tissues of the body will change to varying degrees. For example, digestive system hypoxia can lead to indigestion and malnutrition, brain hypoxia can lead to lethargy and even coma, and heart hypoxia can lead to angina pectoris and so on.
Clinical manifestations of pulmonary tuberculosis
Patients with pulmonary tuberculosis at the initial stage or with slight pathological changes often have no symptoms or mild symptoms, which are easy to be ignored by patients. Compared with many other respiratory infections, the general symptoms are generally less characteristic except for persistent symptoms.
(1). general symptom
1. Fever: seen in the progressive stage of the disease, characterized by low fever in the afternoon (which may be caused by the increased absorption of tissue destruction products into the blood after a day of physical activity). Severe patients have irregular high fever or even heat loss, and fever often represents the activity of tuberculosis.
2. Night sweats When you fall asleep or wake up, you are all sweaty and your underwear is wet.
3. Fatigue, listlessness, weight loss, loss of appetite, rapid heartbeat (consistent with body temperature) and menstrual disorder.
(2) Local symptoms
1. Cough and expectoration
With the development of the disease, the cough is aggravated and the amount of sputum is increased. Phlegm (mucus sputum-mucus sputum mixed with yellow and white purulent small pieces)
2. Hemoptysis
Blood in sputum-inflammatory focus, increased capillary permeability;
Moderate hemoptysis-small vessel injury;
Massive hemoptysis-hollow rupture.
3. Chest pain
The position is uncertain, and it often hurts faintly. If it is a needle-like pain, and it is aggravated with respiratory movement, it means that the pleura is involved. Pleura at the apex of lung is involved, and chest pain can radiate to shoulder. Our respiratory department is a comprehensive ward, not an infectious department, so we don't accept infectious tuberculosis. Most patients have tuberculous pleurisy, so chest pain is typical.
4. Difficulty breathing
The lung has a great compensatory function, and mild and moderate lesions will not cause dyspnea.
In recent years, the number of tuberculosis patients in the elderly over 60 years old in China is on the rise, with hematogenous disseminated type and chronic fibrosis being more common, tuberculosis in young people in Chongqing is on the rise, and pleurisy is more common. Many diseases and factors have adverse effects on tuberculosis, and diabetes is one of them. With the increase of blood sugar and ketone bodies, tuberculosis is easy to reproduce. Diabetes complicated with pulmonary tuberculosis, if urine sugar is not controlled, the focus progresses rapidly, often showing cheese necrosis and bronchial diffusion. Pregnancy has a bad influence on pulmonary tuberculosis, and active pulmonary tuberculosis needs artificial abortion. Under the full protection of anti-tuberculosis drugs, the focus will not recur during delivery.
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