Summary: With the aggravation of cough, the sputum will gradually thicken and become purulent sputum, and the appearance is mostly pale yellow.
Etiology: Thick phlegm is mostly caused by bronchitis, bronchopneumonia or mixed lung infection, tuberculosis and other diseases, and is also common in acute and chronic pharyngitis or suppurative tonsillitis. If the condition is further aggravated, there will be yellow pus and phlegm, mostly yellow-green thick blocks or opaque pus. At this time, we should suspect lung abscess, chronic bronchitis, bronchiectasis, cavitary pulmonary tuberculosis complicated with serious infection and other diseases.
Examination and diagnosis
First, medical history
Understanding and observing the amount, color, smell and characteristics of sputum can often prompt diagnosis.
1, character
(1) Mucinous sputum is thick, colorless, transparent or slightly white, which is more common in the early stage of bronchitis, bronchial asthma and pneumococcal pneumonia.
(2) Mucinous purulent sputum, which is between mucinous sputum and purulent sputum. In addition to mucus, there is also some pus in sputum, which is yellow and white and sticky; Common in bronchitis, tuberculosis, lung inflammation and so on. This is due to the formation of pus in lung tissue during inflammation, and a large number of mucus secretions are mixed at the same time.
(3) Purulent sputum is purulent, yellow or green, thick and smelly, which is common in purulent bronchitis, bronchiectasis, lung abscess, empyema or bronchial fistula caused by liver and spine, mediastinal abscess and lung rupture. The smell of pus and phlegm often suggests anaerobic infection.
2. Phlegm amount
Diseases with excessive phlegm include pulmonary edema, lung abscess, bronchiectasis, alveolar cell carcinoma, empyema or abdominal abscess forming bronchial fistula, etc. The amount of sputum is generally based on 24 hours, and the increase of sputum reflects the progress of bronchial and pulmonary inflammation; Phlegm cannot be discharged smoothly. Although the amount of sputum is reduced clinically, the condition is still developing and the symptoms of poisoning will be aggravated.
Step 3 smell
Generally, phlegm is odorless. If it is left for a long time, it will produce odor due to the decomposition of bacteria in sputum. When infected by anaerobic bacteria, the sputum has a bad smell, which can be seen in gangrene, lung abscess, bronchiectasis and advanced bronchial lung cancer.
Step 4 color
Yellow or green phlegm indicates purulent infection in respiratory tract. Green sputum is often caused by bile, denatured hemoglobin or pyocyanin, which is found in jaundice, slow-absorbing pneumococcal pneumonia, pulmonary Pseudomonas infection, lung cancer blood sputum, tuberculosis, bronchiectasis and rust-colored sputum, pneumococcal pneumonia, etc. Acute pulmonary edema can be seen in pink or bloody foam sputum. Red-brown or chocolate-colored sputum, seen in pulmonary amebiasis caused by amebic liver abscess protruding into the lungs.
Second, physical examination
When chronic pulmonary tuberculosis and atelectasis occur, the trachea can move to the affected side, and the supraclavicular lymph nodes are enlarged. Primary branchial cleft carcinoma in Kyoto; Tuberculosis should be paid attention to in the diagnosis of lung apical voiced sound, and lung inflammation or pleural effusion should be considered in the diagnosis of chest voiced sound. The localized rales in any part of the lung suggest inflammation or cavity in the lung; The localized fine moist rales in the upper lung suggest pulmonary tuberculosis; Localized lower field continuous moderate moist rales consider bronchiectasis, and scattered wheezing on both sides suggests bronchial asthma, and dry rales on cc side suggest chronic bronchitis.
Third, the laboratory inspection
1, microscopic examination
1. Visually, the positive rate of smear microscopy is high when suspicious parts, such as purulent cheese-like or granular sputum, are selected.
(1) epithelial cells, round, columnar or squamous epithelial cells can be seen in sputum, which generally have no special significance. A large number of deformed and necrotic columnar epithelial cells and goblet cells can be seen in the sputum of chronic bronchitis.
(2) There are some white blood cells in the sputum of white blood cells, which generally have no special significance, or suggest mild inflammation. When a large number of pus cells appear, it indicates purulent inflammation of respiratory system.
(3) There are a large number of eosinophils in the sputum of eosinophils, which are found in bronchial asthma and parasitic diseases.
(4) Red blood cells indicate respiratory bleeding, which is seen in tuberculosis. Bronchiectasis and so on.
(5) Pigment cells are called pigment cells after phagocytosis of pigment particles by macrophages. Those who swallow hemosiderin are seen in idiopathic pulmonary hemosiderosis, those whose heart function will not cause pulmonary congestion, and those who swallow carbon particles are seen in various pneumoconiosis or those who inhale more smoke and dust.
(6) The cancer cells in the sputum of patients with lung cancer have diagnostic significance.
(7) Bacterial Gram staining can distinguish cocci from bacilli, and acid-fast bacilli can be found by acid-fast staining.
(8) Paragonimus westermani eggs can be found in the sputum of patients with parasitic Paragonimus westermani, the head and small hooks of echinococcosis can be found in the sputum of patients with pulmonary echinococcosis, and amoeba trophozoites can be found in the sputum of Aiba pulmonary abscess.
(9) Patients with Actinobacillus pleuropneumoniae may have yellow particles of sesame size, namely sulfur particles. When the sulfur particles are crushed, the fungal hyphae arranged in line can be seen in the central part, and the ends of the fungal hyphae expand into rods.
(10) sharp-edged crystal, colorless and transparent octahedral crystal, with two sharp ends, originated from eosinophils and can be seen in bronchial asthma and paragonimiasis.
2. Bacterial culture
Identification of pathogenic bacteria, and drug sensitivity test to guide clinical rational selection of antibiotics.
Fourth, the instrument inspection
1 x-ray examination is an important diagnostic method for cardiopulmonary diseases. Most of the large inflammatory shadows in the lungs are pulmonary inflammation; If chest pain, shortness of breath, shock and other symptoms are obvious, the shadow is fan-shaped and the base is facing the pleura, lung infarction should be ruled out. Infiltrative tuberculosis is first considered as an infiltrative shadow of the upper lung. Lung mass shadow and lung swelling, lung cancer, tuberculosis. Pulmonary diffuse shadow should consider miliary tuberculosis, alveolar cell carcinoma, hemosiderosis, silicosis, lung metastatic carcinoma, etc. For those who are suspected of bronchiectasis, bronchography can be done to determine the diagnosis and treatment plan.
2.CT can distinguish the lung structures that ordinary X-rays can't show, and CT-guided percutaneous lung biopsy is accurate and safe.
3. Suspected lung cancer patients should be examined by fiberoptic bronchoscopy to observe the focus. People infected with lung can suck out or brush out secretions from deep bronchioles under fibrobronchi for pathogen culture to avoid oral pollution. The positive rate is high, and bronchoalveolar lavage is feasible if necessary, so as to make the diagnosis of lung diseases clear.