Healthcare

 Retrieve Password
 join us
search

Hemothorax

Read in CN

   

[Intro]

Overview: hiccup (hiccough) refers to the diaphragm (diaphragmatic) involuntary intermittent contraction, inhalation of air suddenly and digestive tract.

[Cause]

hiccups What are the causes?

(a) causes

1. nervous system lesions

(1) central nervous system lesions: such as encephalitis, meningitis, brain tumors, hydrocephalus, cerebral vascular disease and so on. When the disease spread to the medulla oblongata are more prone to hiccups.

(2) spinal cord lesions: such as myelitis, spinal cord or spinal tuberculosis complicated by diaphragmatic lesions crisis.

(3) peripheral neuropathy: hiccups mainly due to the vagus nerve and phrenic nerve stimulation. A variety of digestive diseases, pleural and mediastinal diseases, and so is caused by a common cause of hiccups.

diaphragmatic the following intra-abdominal lesions:

A. common in all causes of gastric distension or bloating.

B. stomach, intestinal paralysis.

C. pyloric obstruction.

D. bowel obstruction or intestinal flatulence.

E. hepatic flexure or splenic flexure syndrome, hepatic flexure of the colon or splenic flexure height of flatulence.

F. height of post-operative abdominal distention. In the gallbladder surgery, gastrointestinal surgery, prostate or bladder surgery were more common occurrence of hiccups.

G. liver abscess, subphrenic abscess, or liver cancer.

H. cholecystitis or cholelithiasis.

I. diffuse peritonitis.

J. massive ascites caused by diaphragmatic elevation and so on.

② above the diaphragm chest lesions: more common in:

A. lung, bronchial and pleural disease, as leaf pneumonia, exudative pleurisy, bronchiectasis, and so on.

B. mediastinal tumor.

C. esophagus, cardia tumors.

D. Acute myocardial infarction, pericarditis.

E. Acute pulmonary embolism.

F. descending thoracic aortic aneurysm.

G. chest after major surgery.

diaphragmatic disease itself: more common in diaphragmatic pleurisy, such as congenital diaphragmatic hernia or hiatal hernia.

2. systemic disease or toxic hiccups can be found in systemic infections such as sepsis, acute pancreatitis, typhoid fever, poisoning, dysentery, etc.; in acute alcoholism, strong acid, alkali or uremic poisoning may also cause hiccups were; a small number of diabetes with gastroparesis, also can cause hiccups.

3. hysteria or nervous hiccups common in aerophagia (neurological, belching), often due to continuous swallowing air, free to the performance of the action for the hiccups.

(B) the pathogenesis

hiccups, the mechanism is more complex. Generation is undoubtedly a hiccup reflex activity, the low-level reflex center is generally located on the 3rd, the first four cervical spinal cord (but still subject to the control of the medullary respiratory center), the incoming stimulus or impulse came from the phrenic nerve or the vagus nerve sensory fibers . In addition to the occurrence of hiccup reflex, it also must be involved to complete the respiratory muscles, diaphragm, intercostal muscles and other paroxysmal spasm of respiratory muscles, since contraction is an important factor in synergy.

[Sign]

hiccups early symptoms?

hiccup when accompanied by the closed vocal cords, so I often have a special sound, a judge is to hear the sound hiccups can be caused.

cause hiccups as the cause of many, so its etiological diagnosis should be based on medical history, clinical manifestations, physical examination, combined with the necessary laboratory tests and other laboratory examinations to complete.

detailed history, to understand the incentive hiccups occur, the frequency, duration, whether the impact of eating or sleeping, past hiccups attack status is important. Over the years, such as patients often have episodes of hiccups, no treatment or symptomatic treatment by the general to stop hiccups, multi-line diet tips hiccups, gastrointestinal or neurological factors caused by flatulence; if hiccups are the chest, after major abdominal surgery, more tips hiccup was due to gastrointestinal paralysis, flatulence or diaphragm caused by the stimulation; frequent episodes of hiccups during the day if no other symptoms associated with, does not affect sleep at night (when the hiccups to stop the onset of sleep), is more due to neurological factors; If the patient is accompanied by hiccups have severe headache, nausea, vomiting and other symptoms, and associated with pathological reflex, is more prompt hiccup is caused by central nervous system disease; such as hiccups accompanied by cough, expectoration, dyspnea, or chest pains symptoms, you should consider the lung, bronchial or mediastinal lesions; hiccups accompanied by acid reflux, chest burning sensation, abdominal pain, nausea, vomiting, feeding a sense of obstruction, should take into account the hiccup was due to peptic ulcer, gastric cancer, anti- esophagitis, cardia, esophageal cancer, hiatal hernia, or liver, biliary tract disease caused. Therefore, after detailed history, careful physical examination, the majority of patients with hiccups can be broadly identify their cause.

[Aftertreat]

hiccup ate?

[Prevent]

hemothorax should be how to prevent?

idiopathic hemothorax should be placed once the diagnosis is coarse-caliber thoracic drainage, and add volume. Reexpansion of the lung tissue can supplement blood vessels to stop bleeding parietal pleura purpose. However, the possible relapse after cure.

spontaneous pneumothorax should be in bed that once diagnosed, additional blood volume, thoracic drainage placed as soon as possible to achieve the purpose of the exhaust to stop bleeding. After conservative treatment after bleeding, leakage or shock can not be corrected to be an emergency surgery. Closed drainage observed 3 ~ 4h, if more than 100ml of blood drained per hour, with a downward trend in blood pressure and hemoglobin were also urgent surgery.

idiopathic hemothorax surgical indications: that there is evidence for hemothorax, should seek immediate thoracotomy bleeding blood vessels, to be ligated, if necessary, for pulmonary wedge resection, bleeding to the top of the pleural suture. Electrocautery to stop bleeding can get a certain effect, but the possibility of recurrence of bleeding. chest tube drainage can not effectively discharge blood in the chest should also be an early thoracotomy to remove the blood clot and stop bleeding. pleural cavity to prevent fibrosis.

Recently, some authors used video-assisted thoracoscopy, the net absorption of blood electrocautery or hemostatic titanium clip is set to achieve good results. treatment of traumatic hemothorax is to prevent shock, stop the bleeding of active bleeding, clear hemothorax, infection prevention and control.

1. hemothorax during the transfusion, infusion and anti-shock therapy at the same time for thoracotomy, according to the intraoperative findings of vascular or thoracic intercostal vascular rupture to be sewn tied to stop bleeding; do suture rupture of pulmonary bleeding, severe lung tissue damage or possible partial lobectomy; of broken heart, great vessels repair.

of temporarily unable to determine whether there is active bleeding, the thoracic drainage should be placed as soon as possible, in order to facilitate further observation and judgments, and to prevent the accumulation of blood in the chest.

2. hemothorax non-progressive intrathoracic blood estimated at less than 200ml, can be self-absorbed. Without aspiration. blood volume more than 200ml should be early thoracentesis, as exhausted blood, promote lung expansion, improved respiratory function. For more than 500ml of blood, chest, we advocate the early placement of thoracic drainage. Discharged as soon as possible of blood and gas accumulation, so that timely reexpansion lung, chest infection is an effective preventive measures, while monitoring the leak and the role of active bleeding.

3. coagulated hemothorax best to stop bleeding after a few days in the thoracotomy for small thoracotomy incision to remove a blood clot in the lung and attached to the membrane surface of the fibrin . After placing closed drainage, and for the low-pressure suction, respiratory function line training, to promote early lung expansion. Small amount of coagulated hemothorax can be absorbed in a few months, without special treatment. If the clot has formed fibers of the chest machine, you should strive for early surgery for fiber stripping.

4. Ruoyi infected hemothorax secondary infection should be promptly placed closed drainage, excluding the empyema, and keep the drainage open. While high-dose systemic antibiotic sensitivity of pathogenic bacteria to avoid the formation of chronic empyema.

5. attention should be noted that, regardless of any type of hemothorax are not suitable for treatment with hemostatic drugs to stop bleeding, in other words, drugs to prevent bleeding hemothorax bleeding is invalid, otherwise it will cause serious adverse consequences.

[Treat]

hiccups precautions before treatment?

(a) treatment

only when a clear cause and mechanism of hiccup after the order for different causes take a different treatment. For example, gastrointestinal tract, biliary tract and other intra-abdominal surgery patients frequently can not terminate the hiccups, mainly due to a high degree of abdominal flatulence, intestinal paralysis or inflammation, mechanical irritation caused by the diaphragm, the main treatment is to take this time to reduce or elimination of bloating, increased bowel movements, reduce inflammation and other measures, the active treatment phase after onset of hiccups often. Another example, the history taking, careful physical examination, relevant laboratory or special examinations showed no abnormality, combined with the characteristics of episodes of hiccups, the exclusion of a variety of organic disease, the patient can determine the cause of hiccups is mainly due to psychological factors (also known as nervous or hysterical hiccups), the main treatment in patients with predisposing factors for the patient to do psychotherapy, and supplemented by sedatives or antidepressant treatment, often get satisfactory results. For mild or transient episodes of hiccups, usually without treatment, often natural to stop seizures. A small number of patients with frequent episodes of hiccups, long duration (continuous hiccups those days), seriously affecting drinking water, food and sleep, and lead to mental stress in patients, and even a certain fear, for such intractable hiccups in the treatment of In addition to actively seeking the cause of hiccups occur outside, try the following therapeutic measures.

1. mechanical

(1) After the patient took a deep breath choked air, and forced to do call air movement (abdominal strength muster, but do not exhale the air), and then continued more than 10 seconds the gas exhaled, this method can be repeated many times.

(2) with a cotton swab or spatula, chopsticks and other things to stimulate the palate or posterior pharyngeal wall hanging, patients with nausea or vomiting induced by the action, sometimes reflective of the hiccups suddenly stopped.

2. determine the initial drug therapy should be severe or intractable hiccups may cause, on this basis, to take a different medication.

(1) application of gastrointestinal prokinetic drugs: the gastrointestinal system, such as considering hiccups flatulence or intestinal paralysis caused by a high degree, can be applied to prokinetic agents. How these drugs domperidone (trade name: Motilium), mosapride (trade name: Vegas, clear, Rachael, etc.), and three methoxy Itopride urethane phenylbutyrate (trade name: Shuli qi energy), etc. can be selected as appropriate. When the accumulation of a large number of gastrointestinal gas after hiccups can be excreted gradually ease.

(2) application of anti-secretory drugs and gastrointestinal mucosal protective agents: such as hiccups Department of reflux esophagitis, peptic ulcer and other upper gastrointestinal inflammation caused by ulcerative lesions , you can use anti-secretory drugs and treatment of gastrointestinal mucosal protective agent. The former can use h2 receptor antagonists, including cimetidine (trade name of: Tagamet), ranitidine, famotidine (one brand name: High Suda), proton pump can also be used inhibitor omeprazole (brand name are: omeprazole, Oak, Ogilvy & Mather, etc.), lansoprazole (NASDAQ Prontera), pantoprazole or rabeprazole (trade name: pollitt .) mucosal protective agent optional aluminum magnesium carbonate (trade name: of joy, prestige in the United States), sucralfate, misoprostol (brand name: Hi g ulcer), bismuth preparation (trade name: bismuth pectin, Bitenuoer etc. ), compound magnesium trisilicate (cover stomach flat) or sixteenth corner montmorillonite (Smectite), etc.

(3) application of methylphenidate (methylphenidate) injection, trade name ritalin or benefit too forests (Ritalin): intramuscular injection or intravenous injection , also intravenous infusion. The drug is less effective respiratory stimulants, for most patients with intractable hiccups, no matter what the cause is caused by the ritalin treatment obtained temporary relief from hiccups or slow down the frequency of seizures, or extend the interval between the two episodes time, a small number of patients after termination of seizures. Most of this effect has been confirmed after the treatment hiccups. But its therapeutic mechanism has not yet fully understood, it may have excited the respiratory center in the Department of Ritalin, and then reflex inhibition of the hiccup reflex arc attack, it could be promoted ritalin ascending brainstem reticular activating system, norepinephrine, dopamine and 5 - ht and other neurotransmitter release. Commonly used dose of 20mg intramuscular injection, can be invalid repeat interval of 4 ~ 6h 1, such as 2 to 3 times still can not terminate the hiccups after injection, the muscle is generally not appropriate to continue to use. Better than the intramuscular intravenous injection, the method for the 20mg 10ml normal saline slow intravenous injection; injection process, such as hiccups to an abrupt end to stop the bolus (some patients can be expressed as euphoria). In the injection process can not terminate the hiccups, and patients without any discomfort, you can continue to push the liquid end. Also can be used infusion method, 40mg of methylphenidate (Ritalin) by adding 50 ~ 100ml normal saline drip rate can be slightly faster, and close observation of patient response, once the hiccups terminated, stop infusion. In case of hypertension, coronary heart disease or cerebral vascular disease, should be used with caution or disabled.

(4) application of lidocaine or intravenous infusion of chlorpromazine treatment: For a few patients with intractable hiccups, temporarily unable to determine its cause, treatment fails in many ways when the may consider the application of lidocaine or intravenous chlorpromazine treatment, the purpose is to terminate hiccup reflex arc, and lift the diaphragm, respiratory muscle spasm of sustained contraction, can often achieve better results. method of adding glucose or saline 100ml lidocaine 100mg, slow intravenous infusion, and close observation and heart rate and rhythm, can be discontinued when the hiccups stopped. If not drop after termination of hiccups, the interval of 4h after repeated infusion of 1, if 2 are invalid, no lidocaine. 25 ~ 50mg chlorpromazine can be used also by adding 100ml of glucose or saline infusion slowly, and close observation of the condition and changes in blood pressure, hiccups can be discontinued once the termination invalid interval when repeated 4 ~ 6h after infusion of 1 If the 2 invalid should stop infusion.

(5) acupuncture or herbal therapy: clinical practice shows that some patients with intractable hiccup by acupuncture, ear acupuncture or herbal treatment, hiccups can be terminated or reduced.

(b) the prognosis

is usually good.

hiccups Chinese medicine treatment methods

No information

hiccups western treatment

No information

[Examine]

hemothorax should be how?

1, a history of chest trauma (including iatrogenic induced) cough spontaneous hemothorax, increased abdominal pressure, weight, fatigue, exercise, and suddenly changing position and other incentives. there is a corresponding clinical manifestations and chest x-ray examination results usually diagnosis can be made. thoracentesis to establish the diagnosis.

2, blood in the pleural cavity can cause fever, but if there chills, fever, increased white blood cell count and other signs of purulent infection, puncture fluid should be sent for bacterial smear and culture examination.

3, the evolution of the formation of fibrous hemothorax chest, such as a large range of diseases may occur side thorax collapse, respiratory motion decreases, trachea, mediastinal shift to the side of disease, reduced lung ventilation. x-ray examination showed dense fiber caused the shadow.

[Diff]

hemothorax easy to confuse the symptoms with which?

hemothorax in the differential diagnosis:

1, pneumothorax

(1) closed (simple) pneumothorax

in expiratory lung retraction, or serous exudate due to the visceral pleura break their own closed, no more air leakage into the pleural cavity. pleural cavity pressure measurement shows the pressure has increased, the exhaust, the pressure drops instead of re-l, indicating the break will not leak. pleural cavity residual gas will be self-absorbed, the pressure to maintain negative pressure pleural cavity, lung reexpansion also come gradually.

(2) tension (hypertension) pneumothorax

the formation of pleural rupture valve obstruction, inspiratory open air leakage into the pleural cavity; exhale close, pleural cavity gas can no longer break back through the respiratory tract and excreted. The result is a greater accumulation of pleural cavity gas to form a high pressure, the lung pressure, difficulty breathing, into the contralateral mediastinal, circulation is impeded, need emergency venting to relieve symptoms. If the ipsilateral pleural cavity pressure, negative pressure exhaust to after, and soon resumed positive pressure, continuous pleural cavity should be installed exhaust devices. tension pneumothorax as a sudden increase in the chest, lung is compressed, mediastinal shift, severe respiratory and circulatory disorders, patients face tension, chest tightness, or even arrhythmia, often struggling to sit up, irritability, have cyanosis, cold sweat, rapid pulse , collapse, and even respiratory failure, unconsciousness.

(3) communicating (open) pneumothorax

due to adhesion between two layers of pleura and stretch, so that continued to break open, inhale and exhale, the air free access to the pleural cavity. Ipsilateral pleural cavity pressure down to 0, extraction was observed after a few minutes, the pressure is not reduced. Patients often hold heavy objects, breath, strenuous exercise and other predisposing factors, but there are also those who sleep in the pneumothorax, the patient suddenly felt the side of the chest pain, shortness of breath, suffocation, may have cough, sputum, but less shortness of breath before a small amount of closed pneumothorax But after a few hours gradually stable, x-ray may not be able to show lung compression. If the gas is greater or the original plot has been widely lung disease, patients often can not be supine. If the side, in the ipsilateral pneumothorax was forced to relieve shortness of breath. Patients with dyspnea and the amount of product gas and the scope of the original lung lesions. When pleural adhesions and lung function impairment, even a small amount of pneumothorax may also be significant limitations of chest pain and shortness of breath.

2, hemopneumothorax

of spontaneous pneumothorax is severe, the disease is more dangerous, most patients onset have a more significant incentives, such as strenuous activity, excessive weight, etc. hemothorax because most of the two by the chest wall with pleural adhesions sudden tear, due to tumor invasion and a small number of giant bullae rupture caused. As the disease with both pulmonary compression and bleeding, so severe symptoms. Patients both shortness of breath, chest tightness and other respiratory symptoms, there are palpitations, shock and other symptoms of the circulatory system. The severity of patient symptoms and the degree of lung compression and bleeding.

1, a history of chest trauma (including iatrogenic induced) spontaneous hemothorax cough, increased abdominal pressure, weight, fatigue, exercise, and suddenly changing position and other incentives . The corresponding results of clinical examination and chest x-ray diagnosis can be made general. thoracentesis to establish the diagnosis.

2, blood in the pleural cavity can cause fever, but if there chills, fever, increased white blood cell count and other signs of purulent infection, puncture fluid should be sent for bacterial smear and culture examination.

3, the evolution of the formation of fibrous hemothorax chest, such as a large range of diseases may occur side thorax collapse, respiratory motion decreases, trachea, mediastinal shift to the side of disease, pulmonary ventilation reduced. x-ray examination showed dense shadows caused by the fiber.

[Disease]

hemothorax may be caused by the diseases?

hemothorax related diseases

tension pneumothorax hemothorax elderly spontaneous pneumothorax in children spontaneous hemothorax, pneumothorax pneumothorax traumatic hemothorax pneumothorax

more chest symptoms

"multi-temperament" heart sounds "butterfly" shadow co2 retention pas staining large abnormal qrs wave QT interval prolongation t wave flat or inverted one hundred specific symptoms of valve thickening and valve leaflet thickening after satiation chest crackles gallop heart sounds allergic cough pathological q waves atypical chest pain is not complete side of the room block rib pain, unstable angina stitch

小黑屋|Archiver|Healthcare | | 有健康網

GMT+8, 2014-11-26 13:04 , Processed in 0.582872 second(s), 2 queries , Gzip On, Memcache On.

Powered by Discuz! X3.1

© 2001-2013 Comsenz Inc.

Top