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? ?(hemoptysis)

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• Professor?Doctor director ?Neurologist

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Hemoptysis
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• Hemoptysis is the expectoration of blood from
  airway blow larynx.
• Hemoptysis patients should be examined the
  nose, mouth and upper respiratory tract to be
  found the hemorrhagic spot.

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Hemoptysis

• the quantity of blood may vary from streaks
  and flecks in the sputum to massive
  
  hemorrhage.
• minimal bleeding may be an early indicator
• of the presence of serious bronchopulmonary
  disease.
• hemorrhages of even moderate degree may
• life threatening.

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Hemoptysis

• About 50 percent of the chest films of the
  hemoptysis patient show no abnormalities
• or only minimal nonspecific change.
• Hemoptysis may be the initial or the
  sole(???)symptom of bronchopulmonary disease.
• These factors sometimes cause the
  diagnostic problem.

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The distinction between hemoptysis and hematemsis
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Etiology

• 1.Bronchial disease
• 2.lung disease
• 3.cardiovascular disease
• 4.constitutional disease

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1.Bronchial disease

• hemoptysis occur in bronchiectasis,
  chronicbronchitis, endobronchial tuberculosis and
  bronchogenic carcinoma.
• Also occur in the benign bronchogenic tumor,
• foreign body, bronchogenic nonspecific
  ulceration.

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• The inflammatory process lead to the increase
• the permeability (???) of capillary and
  rapture of vessels in bronchial mucosa and then
  induce
• hemoptysis.
• blood-streaked sputum occasionally occur in
• the course of acute bronchitis.

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2.Lung disease

• The sputum of pneumococcal pneumonia is
• described as rusty in appearance.
• Pulmonary TB is the common cause of the
• hemoptysis.
• Cavitious TB may cause the expectoration
• of frank blood from pulmonary cavity.

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• Lung abscess may be related to putrid smelling
• sputum and expectoration of blood.
• hemoptysis occur in 25 percent of the patient
• of pulmonary embolism and infarction.
• pulmonary fungi and parasite infection may also
• serve as the sources of hemoptysis.

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3.Cardiovascular disease

• Pink frothy sputum --- acute pulmonary edema
• blood streaked sputum--acute pulmonary congestion
• blood comes from pulmonary capillaries
  which ruptured under high intravascular pressure.

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• Hemoptysis due to mitral stenosis is frequently
  induced by physical exercise or excitement.
• Blood comes from a break in the pulmonary
  veins which have ruptured under high pressure.
• The bleeding is due to rupture of
  endobronchial
• vessels that from collateral(???) channels
  between the bronchial veins and pulmonary venous
  system.

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• Many pulmonary emboli do not lead to pulmonary
• infarction, when they do, frank hemoptysis
  occurs
• in the minority (??)of instance.
• when hemoptysis occur in the pulmonary
  infarction
• of the heart failure patient, the blood sputum
  usually
• appears within a few hours to a day after the
  embolus,
• and this is due to necrosis and hemorrhages
  into the alveoli.

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• Hemoptysis is also associated with congenital
  cardiac disease and aortic
• aneurysms

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4.Constitutional disease

• Blood spitting may also occur in the patients
• suffering from certain disease, such as
  hemophilia(???), leukemia and infectious disease,
  connective tissue disease.

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Clinical manifestation

• 1.the patients age.
• 2.the amount of coughing up blood.
• 3.color and character

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1.The patients age

• Hemoptysis is often seen in pulmonary TB,
• bronchiectasis and rheumatic heart disease
• (mitral stenosis) for most youth.
• Cancer is now the disease that patients think of
  when they expectorate blood, just as it was TB 50
  years ago.

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• Elder patient with bloody sputum or streaked of
  bloody sputum, especially in the males with long
  history of smoking. cancer should be taken into
  account.
• Patients close contact with TB suffer, TB should
  be considered.

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• Paragonimiasis (??) may suspected in the people
  with history of eating raw or improperly cooked
  crabs or crayfish.
• Epidemic hemorrhagic fever, lepto-spirosis also
  can cause hemoptysis, they are endemic disease.

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2.The amount of coughing up blood

• Hemoptysis can be classified into three groups
• according to the amount of coughing blood.
• Massive expectoration gt 500ml/24hr.
• Moderate 500mlgt expectoration gt100ml/24hr
• minimal expectoration lt100ml/24hr

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• massive hemoptysis often occurs in pulmonary
  TB cavity, chronic lung abscess and
  bronchiectasis.

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3.Color and character.

• To a hemoptysis patient,it is necessary to
• ascertain the exact nature of the sputum,
• the sputum must be examined both grossly and
  microscopically.

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• Brisk (??)bleeding is commonly associated with
• specific focal ulceration of the bronchus,
  such
• as bronchogenic carcinoma, a foreign body,
• bronchiectasis or a bleeding aortic
  aneurysm.
• Slow bleeding strongly suggests venous bleeding
• which is more likely to be the result of
  increased
• in blood flow through the bronchial venous
  system
• such as may occur as a result of mitral
  stenosis or
• bronchiectasis.

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Accompanying symptom

• Hemoptysis with fever pulmonary
  tuberculosis,pneumonia, lung abscess,
  lopeospirosis, epidemic hemorrhagic fever,
  bronchogenic carcinoma.
• Hemoptysis with chest pain lobar pneumonia
  ,pulmonary infarction, pulmonary TB, lung cancer.

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• Hemoptysis with putrid sputum lung abscess
• cavitious TB, bronchiectasis.
• Hemoptysis with irritating cough bronchogenic
  carcinoma, mycoplasma pneumonia.

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• Hemoptysis with skin and mucosa bleeding
• hematological disease, epidemic hemorrhagic
• fever, rheumatism, leptospirosis.
• Hemoptysis with jaundice leptospirosis, lobar
  pneumonia, pulmonary infarction.

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