Pulmonary tuberculosis details _'s general knowledge
[The basic pathology of pulmonary tuberculosis changes ]The basic pathological change of pulmonary tuberculosis is divided into exudative pathological change and proliferating two kinds of pathological changes. Strong in organism resistance, or after resisting the tuberculosis treatment, the focus can be dissipated, harden, the fiber, calcification; On the contrary, focus can spread, blood competent to sow scattered, appear the intersection of cheese and necrosis and cavity,etc..First. Oozing out pathological change, see it is low to tuberculosis resistance, or is infected with fungus quantity the large one. Display and organize congestion edema, there are monocytes and a cell that assemble in the alveolus, loosen and ooze out things in the composition containing fibrin. The focus contains a lot of small and lax integration soft tubercles, or tuberculosis pneumonia of small one even large area. Necrosis of cheese is very common. The ones that oozed out development and development of the cooking stove of venereal disease and depended on the allergy of the organism with immunity are balanced each other, and resist the tuberculosis treatment. The focus can be totally absorbed, can also develop into all kinds of pulmonary tuberculosis.Two. Increase pathological change of the natural disposition, also called and hardened festival, it is characteristic pathological change of tuberculosis: Tuberculosis and tubercle. See that few in tuberculosis fungus amount, organism resistance powerhouse. Pathological change is by macrophages, lymphocytes, plasma cell, fibrous cells make up, arrange on the peripheries of a small amount of cheese things radially. The connective tissue disperses between various cells, make it become durable structure. Cheese the intersection of thing and centre organize granulation parcel often, turn kind into later leather the intersection of cell and big and small afterbirth and fibrous organization mix each other, also destroy and amalgamate the existence with the fiber in an organized way. Can form star-shaped tubercle in the developing focus, or glass, calcification and wrapping up by collagenous thread, and become steady.Three. The intersection of millet and grains of tuberculosis, rare in children, when the elderly immunological function low organism have, a large number of tuberculosis funguses enter lung artery and pulmonary vein, a grain of tuberculosis of millet of congestion, can limited to the lung is dirty, can also spread all over all internal organs, with the lung, kidney, the skeleton is the common growth position, more see in meninx. Or cheese by the the intersection of room and enter due to cerebrospinal fluid (CSF) tuberculosis most serious meningitis while being routed with under the the intersection of tubercle and close the intersection of spider and omentum among them, millet grains of tuberculosis also can have soft tubercle and harden section is or exudative increasing natural disposition two pathologic differencing of structure, comparatively see more with the phenotype. Fourth, liquefaction of cheese and cavity take shape, reflect that pathological change worsens. Without benefiting the host, latent fungus and obstinate fungus of the cheese thing centre in the peripheral macrophages of cheese thing were successively getting active, secrete, release a large number of destructive enzyme qualities, make the cheese transform into liquefaction rapidly, after the liquefaction thing is corroded and entered the bronchus, the cavity takes shape. Fifth, parcel cheese calcification tubercle, for the disease type aptest to find in the general survey of X-ray, reflect that the host has immunity. Can be organized parcels as the fiber in the cheese centre of the focus, but calcification, ossify once in a while[Clinical manifestation ]First. Symptom(1) Whole body symptomMainly tuberculosis is poisoned symptom in whole body symptom of pulmonary tuberculosis, there is no specificity. Generate heat for pulmonary tuberculosis and most common whole body symptom, most are long-term low-heat, or begin at dusk in the afternoon, drop to gradually normally before dawn next day; A few people's body temperature abnormality, or the hyperpyrexia appears, it is cold to fear. Other manifestation have appetite that drop, become thin, tired, languid, women's menoxenia or amenorrhea and slight diagonosis of disorder of nerve function of plant, for instance: Palpitation, irascible, the face is flush,etc..(2) Respiratory system symptom1.Cough, expectoration, pulmonary tuberculosis appears coughing to cough for being chronic for a long time more, weight and pathological change range, intensity and continuing and taking place and infecting relevantly. Soak the cooking stove of venereal disease and cough slighter, can be shown as doing cough or there is a small amount of mucus and a kind of phlegm, phlegm quantity increases, can present suppuration phlegm of mucus when cavity taking shape or companion takes place and is infected with.2.Cough the blood, about 1/3 --1/2 of the patients cough the blood. Patient seek medical advice because of coughing the blood often, cough blood can take place different the intersection of disease and period, cough blood volume to be generally little, include the intersection of blood and silk or clot in the phlegm, because the intersection of tuberculosis and focal the intersection of inflammation and card make penetrating of capillary increase, come. Pathological change coughs more blood volume like damaging the small blood vessel, when aneurysm in of pulmonary tuberculosis cavity break, can cause and cough the blood, even the death of suffocating because great to cough the blood big.(3) Have difficulty in breathingWhom general patient have obviously have difficulty in breathing, a few because pathological change to amalgamate the pleura, increase thick, when the pulmonary emphysema, or chronic serious the intersection of crux and nuclear patient, cause the breathing function obstacle, can present gradual advancement and have difficulty in breathing, cyanosis. The ones that broke out would consider the angry thoracic possibility of spontaneity while having difficulty in breathing seriously suddenly.(4) The chest achesCan cause pain of the corresponding position when the tuberculosis pathological change inflammation card in the lung involves one storey of pleuras of wall. It is side of the fixity limitation often, pain along interval of rib, breathe and cough and aggravate at the same time, suffering from and lying on one's side the location can lighten, if involve the diaphragm pleura, pain and can radiate to shoulder and upper abdomen.Second, physical signWith the intersection of pathological change and property, intensity, position, range relevant, early pathological change little or position can have positive physical sign while being dark, if the range is relatively large, then observation suffers from the side and breathes sports to weaken, the percussion affected part voiced sound, auscultation respiration subside and the intersection of alveolus and respiration turn bronchus alveolus respiration into or have detailed wet rales; The enormous cavity can present the empty urn sound; When chronic fibrous cavity type pulmonary tuberculosis or pleura increases the thick adhesion. Can suffer from the side thoracic cage and collapse, the interval of rib becomes narrow, the vertical diaphragm of trachea shifts, the percussion sound is turbid, the auscultation respiration is reduced, and is strong in the side and can display physical sign of pulmonary emphysema.[Clinical type ]Our country national tuberculosis prevent and cure the working conference, make the new categorised method of pulmonary tuberculosis 1978, divide it into five types: Type. Primary pulmonary tuberculosis, have illness coming on in the cooking stove in the lung originally, guide lymphangitis, the lung door and/or lymphocytic tuberculosis inflammation card of vertical diaphragm. See more children, the adult whom accidental Yu Wei is infected, this kind of patient's clinical symptom of the majority is relatively light.2Type. Blood competent to sow scattered pulmonary tuberculosis, acute, subnormal temperature is and chronic. Lead to the fact blood walk, it sows scattered focuses to be can because of take place, dive the intersection of tuberculosis and fungus in the the recessive focus, break, enter the intersection of blood and dish while being routed infect, originally in source, a few is continued the hair active tuberculosis focus and is corroded and close to the lymphocytic way by the lung or other positions, but forming of blood one. Acute blood competent to it sows getting scattered to be caused by that a large number of tuberculosis funguses invade the blood circulation at the same time or within extremely short time, have serious poisoning symptom clinically. Subnormal temperature and chronic blood competent to it sows scattered pulmonary tuberculosis to be whether a small amount of the intersection of tuberculosis and fungus invade whom blood circulation cause group by group, it is poisoned symptom that the former can be intermediate, the chronic case has slight symptom only or has no symptom completely, can find while checking sometimes. Type. Soaking pulmonary tuberculosis, is shown as and oozed out --Take exudative pathological change as the core, hyperplasia --Take hyperplasia pathological change as the core, cheese --Including the cheese focus developed by pulmonary tuberculosis of the former two is the master's pulmonary tuberculosis, pneumonia of cheese, and cavity and tuberculosis ball. Symptom behaves and differs, can generate heat, cough, expectoration, cough the blood, the pneumonia of cheese person is poisoned symptom more serious. Type. Chronic fibrous cavity type pulmonary tuberculosis, soaking pulmonary tuberculosis is developed but comes, the pathologic characteristic is organized by thick fiber surrounding for the cave wall, there is obvious sowing scattered cooking stove and repair fiber to organize, the focal lobe of the lung shrinks, trachea and vertical diaphragm are movable towards the side of disease, it is angry and swollen that my lung is presented the compensating. It is chronic to cough for patient to have, expectoration, generate heat, cough the blood, shortness of breath,etc. behind the activity disconnectedly. Type. Tuberculosis pleurisy.
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