Cough and chest pain are the most common symptoms of respiratory diseases. Today I will introduce a disease with chest pain as the main manifestation -plenitis.
Pleurisy (also known as ricitis) is inflammation caused by the pathogenic factor and occurs in the pleura cavity.
The pleura is located on the chest, covering a layer of pulp on the surface of the chest wall and the surface of the thoracic organs (such as the lungs and mediastinum).
The pleural cavity is a closed cavity gap surrounded by pleura of the thoracic wall and thoracic organ, called the pleural cavity.
The pleural cavity is negatively under pressure under normal circumstances. When various pathogenic bacteria such as bacteria and tuberculosis invade the pleural, a series of inflammatory response produced is pleurisitis.
Tipitis is a common clinical disease and multiple onset, which may be related to the causes of pleurisy.
(1) Classification according to the leakage liquid state:
1. Fibrinic plexitis
Also known as dry pleuralitis, mostly caused by the original inferiority of the wall of the wall.Generally, there is no exudate liquid. It is common in the late stages of tuberculosis, silicon lungs, and asbestos. Most patients have no symptoms, a small number of tingling, and a tendency to heal.
2. Plusal effusion by pneumonia
Most of them are caused by lung inflammation such as bacterial pneumonia, pulmonary abscess, or bronchial dilation, which spread to the pleura.Most of the patients have the thoracic effusion. After active treatment, most of the patients have a good prognosis. If the amount of effusion is large, the treatment can be punctured and puzzled.
3. Pyxion
Pygaminity is mostly caused by bacterial infections. Patients may have purulent thoracic effusion. The clinical manifestations are mainly high fever, shortness of breath, chest pain, and difference in nibc.
(2) Classification according to the cause:
1. Tuberculosis pleuralitis
Tuberculus pleuralitis is mostly caused by tuberculosis of the pleura. Tuberculosis can be found in the thoracic effusion. Symptoms are often manifested as fever, dry cough, and chest pain.
2. Tumor pleuralitis
The disease is mainly caused by malignant tumors that directly invade the thyric. Common tumors include lung cancer, breast cancer, and lymphoma. Patients will have bloody thoracic effusion, and the thoracic effusion is large and it is difficult to control. The malignant tumor can be found in the thoracic effusion.cell.
3. fungal pleurisyitis
The disease is mainly caused by fungal infection that affects the pleura, and is mainly found in patients with low resistance such as AIDS.
4. Cholesterol pleuralitis
Patients often manifests as the right thoracic effusion, cholesterol crystals can be found in the thoracic effusion, and clinically manifested as cough, fatigue, chest pain, breath, etc.
5, connective tissue disease pleuralitis
Such pleurisy is mainly caused by connective tissue diseases, such as rheumatoid arthritis; systemic lupus erythematosus; Churg-Strauss syndrome (allergic granulomatocytosis); hybrid connective tissue disease.
It is divided into: it is divided into:
(1) Rheumatitis: It is more common in patients with rheumatoid history for more than 10 years. It is manifested as thoracic effusion and is yellow osmotic liquid. Clinically, cough, chest pain, shortness of breath, and joint pain will occur.
(2) Lupus pleuraitis: Diseases are more common in young women with systemic lupus erythematosus. Patients are mostly manifested in both sides of the thoracic thoracic effusion, bloody thoracic effusion, and can see the manifestation of butterfly red and other organ damage.
(3) Rheumatitis: Clinical is rare in diseases, commonly in patients with rheumatism. Patients are mostly manifested as a small amount of thoracic effusion, which are cellulose, and clinically manifested as fever, cough, chest pain, and dyspnea.
(4) Elertinycosis of eosinophilia: Patients with diseases, and patients can experience pneumonia and blood chest.
Tipitis is an inflammation caused by multiple causes. The cause is mainly divided into three categories: ① Infectious diseases; ② autoimmune disease; ③ malignant tumor.Divided into the area and nature of inflammation::
(1) Basic cause
1. The disease of the pleural itself, such as interactive tumors, lung surgery or external injuries and pleural cause of inflammation.
2. Diseases of tissue organs around pleural, such as pneumonia, pulmonary infarction, chest wall damage, etc.
3. Systemic diseases, such as connective tissue diseases, malignant tumors, sepsis, etc.
4, purulent pleurisy, can be manifested as pygmine or pneumonial effusion, and the properties of the thoracic effusion are manifested as pyoma.
5. Tuberculosis pleurisy is caused by branches infection and can be combined with tuberculosis at the same time.
(2) Treatment of factors
Except for thoracic trauma and medical derived pleural, other types of pleurisyitis mostly have no obvious causes. Pulphicitis occurs when the primary disease is not controlled.
The main symptoms are chest pain and chest tightness, which will cause breathing difficulties in severe cases.It is generally an acute onset process. If delays are treated, it will evolve into a chronic process, and symptoms such as fever, fatigue, and cough will occur.
(1) Typical symptoms
1. chest pain, chest tightness, pain in the pain of tingling or pulling pain, often occur during deep cough or deep inhalation. In severe cases, it is often dare not inhale.
2. Cough, sputum.
3. In severe cases, there is difficulty breathing.
(2) Accompanied by symptoms
1. Tuberculosis pleuralitis
(1) dry pleuralitis
The patient’s chest pain is obvious. Doctors can smell and pleural friction. The examination found that local tenderness, reducing respiratory sound, and some patients with symptoms such as fever, fatigue, low fever, and night sweats.
(2) Expulsive pleurisitis
Most of the patients have fever, fatigue, sweating, loss of appetite, weight loss, dry cough without sputum.The patient’s chest pain is not obvious. In severe cases, you can sit and take breath and hair.
2. Medulent pleurisyitis
Patients are accompanied by high fever, accelerated heart rate, rapid respiratory, fatigue, loss of appetite, chest tightness, pus phlegm.
In severe cases, shock, shock, and sepsis.
Chronic patients can see thinness, anemia, pestle finger, etc.
3. Tumor pleuralitis
Patients with chest tightness, chest pain, and dyspnea are aggravated and developed rapidly.
4. fungal pleurisyitis
The chest wall appears red, swollen, painful, and even abscess, and the surrounding skin is hardened.
5. Rheumatoid pleuralitis
Patients may have the symptoms of joint pain, pestle -like finger, post -activity, and more rheumatoid arthritis such as joint pain and deformities.
6. Systemic lupus erythematosus
Patients with symmetrical distribution of polygonal skin damage, facial butterfly erythema, fever, joint soreness and pain, severe cases can accompany kidney and heart damage.
(1) Examination
The patient signs are mainly related to the amount of effusion.The amount of effusion is small, the signs are not obvious, and the amount of effusion can be performed as follows:
Instead diagnosis, the patient’s thorax is full, and the intercostal gap (rib meter space) increases.
Patriotic, weakened or disappeared for patients’ tactile tremor, doctors can touch pleural friction.
The percussion, doctors can smell and voices or real sounds, trachea or septum bias on the healthy side.
A listening, the patient’s breathing sound weakened or even disappeared.
(2) Laboratory inspection
1. Blood
(1) Pyxular pleurisy, the number of white blood cells has increased significantly.
(2) Tuberculous pleurisy, the number of white blood cells increases or slightly increases, blood sinks are accelerated, PPD test is positive, γ-interferon release test, and anti-tuberculosis antibody test positive.
(3) Tipitis caused by autoimmune diseases, such as systemic lupus erythematosus, shows positive antibody spectrum.
(4) Tipitis, hematic and tumor markers caused by systemic diseases will have abnormal manifestations.
2. chest water
(1) When the patient has the thoracic effusion, the thoracic effusion should be performed.Biochemical analysis of the extracted effusion, bacterial culture, pathogenic examination.
(2) Pyxular pleurisy, can be seen that the number of nuclear cells is 10 × 109/L, a decrease in sugar is ≤40 mg/dl, and LDH ≥ 1000IU/L.
(3) Tuberculous pleurisy, can be seen that adenosine dehydase is greater than 45U/L, thoracic/serum is greater than 1, thoracic effusion tuberculosis may be positive, and the pathological examination of pleural tissue can be abnormal.
(4) The thoracic effusion caused by malignant tumors can see tumor cells.
(3) Imaging examination
1. X -ray inspection
It can be found that the corner of the rib becomes blunt, that is, the unique manifestation of the thoracic effusion.
2. chest CT
The thoracic effusion with less amount can be detected, and the sensitivity is higher than the X -ray.
3. Ultrasound
Ultrasonic accuracy and sensitivity are high, and are recommended in medicine.
4. Magnetic resonance imaging (MRI)
When it is used to check pleuritis, the chest Mili is less used, and it is used in pregnant patients and children.
According to the cause, clinical manifestations and laboratory examinations, exudate pleurisitis can generally be diagnosed.Clinical manifestations are moderate fever, after initial chest pain, dysplasia, and dyspnea.Physical examination, X -ray examination, and ultrasonic examination can make chest fluid diagnosis.The necessary measures to diagnose the diagnostic thoracic pest, routine examination of the thoracic effusion, biochemical examination, and bacterial culture can be diagnosed, and 75%of the cause of the thoracic effusion can be diagnosed.
(1) Classification and identification of pleurisy
The basis of classification and identification is the properties of the thoracic effusion.
When doctors identify leakage and exudate, they need to be given according to the cause, effusion appearance, solidification, proportion, RIVALTA test, protein content, number of cells, LIGHT standards, cholesterol content, thoracic effusion/serum apex ratio, etc.Professional identification.
1. Purgur exudation liquid can be seen in tuberculosis thoracic effusion, which causes pleurisy in infections such as various bacteria, viruses, fungi and other infections.
2. Bloody chest water can be seen in trauma, spontaneous pneumothorax and aortic rupture, and malignant tumors.
3. Valic chest water is mainly found in purulent pleurisy.
4. Cylphic thoracic effusion can be seen in various factors that cause lymphatic injuries such as chest catheter.
(2) Bacterial pneumonia
Patients will also have symptoms of cough and chest pain. Chest imaging examinations can be seen that the lung pattern is rough. It can be seen that the spots shadow is often not accompanied by the thoracic effusion.
(3) Lung cancer pleural metastasis
Patients may have symptoms such as cough, sputum, chest pain, blood in sputum, chest tightness, shortness of breath, hoarse sound, fever, weight loss, etc., but such patients can increase tumor logo in bloodThings and other can be identified.
Treatment of pleurisy is mainly for the treatment of primary diseases, while treating symptomatic treatment at the same time, and timely treatment of chest pain, fever, cough and other symptoms.
(1) Acute stage treatment
When the thoracic effusion is large, the doctor needs to be punctured. For the first time, the solution does not exceed 700ml, 2 to 3 times a week, and patients with chronic thoracic effusion for a long time.
(2) General treatment
Doctors take treatment for primary diseases.
1. When bacterial infection, the doctor gives antibiotics, and antibiotics can be selected according to the results of the thorax drug sensitivity.
2. Secondary thoracic effusion caused by autoimmune diseases, tumors, etc., actively treat primary diseases.
3. Tuberculosis pleurisy, give anti -tuberculosis treatment, thoracic puncture drainage, and take sugar corticosteroid treatment if necessary.
4. Pyxular pleurisy, doctors give control infection, pus drainage, and systemic support treatment (fluid replenishment, nutritional support, cooling).
(3) Drug treatment
1. Antibiotics
Antibiotics should be given for pleurisy caused by bacterial infections.
(1) Gram -positive bacteria: Doctors can choose penicillin, cephalosporin, fluorinone, and large ring dectomial antibiotics.
(2) Gram -negative bacteria: second -generation and third -generation cephalosporin antibiotics can be selected.
(3) Aerobic bacteria: often use metronidazole, tinidazole, etc.
2. Anti -tuberculosis drug
Patients with tuberculosis can be used for 6 to 9 months alternately using alien smoke, bustin, ethylene glycol, and rinsein.
3. Anti -pain drug
When the pain is severe, patients can take painkillers, including aspirin and Sumin.
4. Reduce chest adhesion drugs
Doctors can choose chainstrazy enzymes and in -chest injection treatment.
5. Hormone therapy
The adrenal corticosteroids are used with anti -tuberculosis drugs, which are suitable for acute tuberculosis penetration pleurisy, which has a positive treatment effect on eliminating systemic symptoms of systemic toxicity, promoting effusion absorption, and preventing pleural thickening stickiness.
Hormone can take medicine or local medicine.Orally, orally, when the symptoms of the whole body are improved, and the effusion is obviously absorbed, it is necessary to pay attention to gradually reduced the amount to avoid rejection.4-6 weeks of medication.
(4) Surgical treatment
When the chronic pyommal dysplasia causes the lungs or the thoracic collapse, surgery is required.
Most of the surgical methods are:
1. Infection lesions clearance;
2. Fiber adhesion and pine solution;
3. Partial lobe resection;
4. Closer thoracic drainage.
(5) TCM treatment
Traditional Chinese medicine treatment methods or drugs can relieve symptoms. It is recommended to go to regular medical institutions and treat them under the guidance of physicians.
1. Patients with tuberculosis pleurisy can be tuberculosis, thicken adhesion of tuberculosis, pneumothorax and pleural hypertrophy;
2. The malignant thoracic effusion caused by the tumor, accompanied by symptoms such as the distant metastasis of malignant tumors;
3. Patients with purulent pleurisy can be accompanied by sepsis;
4. Rheumatic immunothelinitis, patients may have a manifestation of rheumatism and immune diseases.
1. Pyxular pleurisy and tuberculosis pleurisy can be cured. Patients are generally good through antibiotics, and the prognosis is generally better.
2. Malignant thoracic effusion is a chronic process. Patients need to actively treat the primary disease. The prognosis is relatively poor and long -term follow -up.
(1) Prevention
Tipitis focuses on prevention and timely treatment of primary disease is an effective measure to prevent pleurisitis.
1. Strengthening nutrition, avoiding trauma, and increasing resistance are the basic methods to prevent pleurisitis.
2. Actively treat primary diseases (such as pneumonia) is an effective measure to prevent pleurisitis.
3. Strict sterile operation is an important measure to effectively avoid medical derived pleural.
(2) Family care
1. Family can establish a health follow -up file of patients and record the patient’s medical treatment and medication.
2. The patient himself and family members actively participate in health education, understand the cause of the disease, early onset symptoms, and the timing of consultation, daily health care methods.
3. Patients should take the medicine on time to take the medicine on time, and strictly monitor the changes in the condition.
4. Regular review.
(3) Life management
1. Patients can do respiratory function training, deep inhalation, screen gas, and slowly exhale, each time it lasts 5-10 minutes, 1 or 2 times a day.
2. Patients can rest in bed and should keep their mood comfortable and exercise appropriately.
3. Patients can eat high protein, high -calorie, and balanced diet.
(4) Condition monitoring
1. Regularly monitor patients with chest pain and cough symptoms.
2. Monitor whether the patient has complications.
3. Patients should regularly go to the hospital to review chest tablets, blood routines, etc.
(5) Special precautions
When patients are punctured, if the pleural reaction occurs, the symptoms such as palpitations, chest tightness, irritability, sweat, pale complexion should be informed in time, and the doctor will stop the smoking immediately, go to the pillow to lie on the pillow, and give it to the patient, and give it to give it to the patient, and give it to give it, and give it to the patient, and give it to give it, and give it to the patient, and give it to the patient, and give it to the patient, and give it to give it.Corresponding treatment.
When treating tuberculous pleurisy, patients need to regularly review liver and kidney skills. Patients should use drugs that protect liver cells if necessary.
Tipitis should diagnose early and take timely treatment.If the patient has chest water, the doctor will puncture the chest water as soon as possible to clarify the nature of the chest water and treat the treatment.If patients have difficulty in breathing, they should go to the hospital for medical treatment in time. Doctors will detect vitality signs and blood oxygen saturation and deal with them in a timely manner.
Section of the Department of Disclosure: Department of Respiratory Department, Department of Infection, Emergency Department, Cheung Surgery, Rheumatology and Immunology.
Summary: Tipitis is inflammation that occurs in the pleural cavity. It is a common disease and multiple onset. It can be caused by a variety of pathogenic bacteria (bacteria, viruses, fungi, parasites, etc.) and infectious factors, such as tumor, perverted reactions, chemistry and traumaCaused by many diseases such as sex.The main symptoms are clinically fever, cough, chest pain, and dyspnea.Treatment of pleurisy is mainly for the treatment of primary diseases, while treating symptomatic treatment at the same time, and timely treatment of chest pain, fever, cough and other symptoms.Most pleurisy prognosis is good, but cancerous pleurisy is poor.
