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Tuberculosis of the respiratory system


FORMS AND CLASSIFICATION. The main pathological process of tuberculosis is inflammation, which consists in the formation of tuberculous granuloma, or tubercle (infiltrate). Focal inflammation is accompanied by proliferation of connective (fibrous) tissue. The tuberculous focus can be subjected to a cheesy or caseous decay, in which cavities are formed. In exudative inflammation and pulmonary tissue in the alveoli, serous exudate is released and pneumonia develops. Sometimes tuberculous pneumonia proceeds acutely with the subsequent curdled decomposition of pulmonary tissue (transient consumption).
The main clinical forms of pulmonary tuberculosis:
Primary tuberculosis complex.
Tuberculosis of the tracheobronchial lymph nodes.
Acute miliary tuberculosis, which is abundant, small, the size of a millet, foci in all fields of the lung (miliary in translation from Latin - prosovidny).
Hematogenous disseminated tuberculosis, which occurs when the lungs are infected with mycobacteria through the circulatory system.
Infiltrative pulmonary tuberculosis develops usually with exacerbation of focal tuberculosis (infiltration - ie, impregnation, straining mycobacteria from old foci and the emergence because of this new).
Cottage cheese pneumonia.
Tuberculoma lungs (completely or partially calcified infiltrate).
Cavernous tuberculosis of the lungs (cavern - cavity, formed after the decay of the infiltrate).
Fibrous-cavernous tuberculosis. It is a complication of the cavernous, in which there is thickening of the walls of the cavity, compaction and proliferation of the tissues and membranes of the lung.
Cirrhosis occurs as a result of sclerosis and scarring of the lung.
Tuberculous pleurisy is a lesion of the lung membranes.
Other forms of tuberculosis of the respiratory system: tuberculosis of bronchi, trachea, larynx, etc.
Pulmonary tuberculosis has the following characteristics of the course:
1. Phases of development - 1) infiltrative (origin of primary focus
- infiltration); 2) the breakdown of the outbreak and, as a result of this, contamination by the mycobacteria of nearby organs; 3) resorption of the focus - infiltrate;
4) compaction, calcification of the infiltrate.
II. Localization by the lungs and in each lung separately.
III. The degree of compensation is compensated, subcompensated, decompensated. Regardless of the degree of prevalence of the process, it can flow imperceptibly, in a latent form, or, conversely, very violently, with the rapid disintegration of lung tissue. If the process is hidden, expressed only in the growth of connective tissue, it is designated by the letter A (compensated pulmonary tuberculosis). If there is an inflammatory pulmonary process with sputum, often containing tubercle bacilli, then it is denoted by the Latin letter B (subcompensated pulmonary tuberculosis). Stormy tuberculosis with rapid disintegration of lung tissue is denoted by the Latin letter C (decompensated pulmonary tuberculosis).
IV. Bacilli excretion - BK +, BK-, BK + (periodic bacilli release).
With open forms of tuberculosis, tubercle bacilli are found in sputum and are conditionally designated by the letters BK. The presence of a cavity is conventionally denoted by the letters KV.
Common symptoms. The most characteristic is a different kind of fever. Simultaneously with the rise in temperature, and sometimes before it, - irritability or, conversely, apathy; Insomnia or drowsiness; Tearfulness or euphoria (high spirits). Frequent sweating, especially at night or in the morning, palpitations, poor appetite, nausea, headache. These signs are expressed significantly in the outbreak of the process, when it ceases, they are indistinct or completely absent, creating the illusion of well-being. Almost 1/3 of patients with early forms of pulmonary tuberculosis feel healthy, and only a thorough examination reveals the existing pathology.
Cough - dry or with sputum secretion. The cause is the inflammatory process, the accumulation of mucus, pus, blood in the respiratory tract, compression of the bronchi with enlarged lymph nodes, displacement of the mediastinum organs. The resulting irritations of nerve endings in the mucous membrane of the pharynx, larynx, trachea, bronchi, sometimes in the pleura cause excitation of the corresponding cerebral center and cough reflex. The most sensitive zones in the mechanism of coughing are the posterior wall of the larynx, the lower surface of the vocal cords, the area of ​​separation of the trachea into the bronchi and the mouth of the lobar and segmental bronchi. The lower parts of the bronchial system and the lung tissue (the alveoli) are characterized by low sensitivity. The effectiveness of coughing is greater the better and better the respiratory function of the lung. That's why with massive lung damage, coughing is more often dry or with a small amount of hard to separate sputum. Cough intensifies when inhaled cold air, loud conversation, rapid movement. Often, this gives the impression that the patient has bronchial asthma, and the use of various soothing agents is often ineffective. Sometimes a frequent and painful cough greatly disturbs the patient, prevents him from sleeping, causes pain in the chest, is accompanied by cyanosis (blueness), vomiting. It happens that its paroxysms lead to rupture of the lung tissue and even damage to the integrity of the ribs. However, it should be borne in mind that many patients, mainly with early and limited changes in the lungs, cough - dry or with phlegm
- may be absent or observed occasionally. Sometimes coughing does not happen with a cavernous process, if there was a blockage of the draining bronchus.
The phlegm is mucous, mucopurulent and purulent, odorless. Has an unpleasant smell only with mixed infection and concomitant putrefactive bronchitis. The bulk is allocated in the morning or evening. With extensive destructive processes in the lungs can reach 100-200 ml or more per day. Sputum is rarely excreted "full mouth" or only in a certain position (on one side or the other with the head down). In such cases, concomitant abscess (abscess) or bromoectasis (bronchial dilatation) should be suspected. In cirrhotic tuberculosis with multiple decay cavities, the amount of liquid watery sputum reaches 10001500 ml. When, under the influence of the antibacterial drug prescribed by the doctor, the secretion in the bronchi decreases rapidly, and then the secretion in the bronchi completely disappears, the cavity is cleared and as a consequence - cough with sputum stops - this is an important clinical sign of a successful treatment result.
Hemoptysis - in the form of veins or an admixture of a small amount of blood in the sputum occurs as a result of the destruction of capillaries and small blood vessels in the area of ​​inflammation. It happens in patients with infiltrative or exacerbated focal and disseminated tuberculosis.
Pulmonary bleeding - allocation of clean blood from a teaspoon to several hundred milliliters are associated with the destruction of large vessels - ulcerated branches of the pulmonary artery or dilated veins in the lung tissue, in the walls of the bronchi, caverns. Forms are mainly accompanied - chronic cavernous and cirrhotic, others less common.
Hemoptysis and bleeding in the elderly is two to three times more common than in children and adolescents. In some cases, having arisen, "like a bolt from the blue", they first lead to the doctor of a patient with a newly discovered or hidden process, are single and in the future do not significantly affect the course of the disease. Worse, when they serve as a formidable warning of far-reaching tuberculosis. Continuous bleeding causes extensive contamination of the body with mycobacteria, some patients develop pneumonia, sometimes leading to death.
Pain - in the chest with breathing and coughing quite often occur in tuberculosis.
Their cause: involvement in the process of the chest, diaphragm, trachea and major bronchi, a significant displacement of the mediastinum. Sometimes there are also distantbolts of the sciatic nerves, which is associated with irritation of nerve trunks with toxins - the products of the vital activity of bacteria.
Dyspnoea - mainly as a superficial rapid breathing is observed due to a decrease in respiratory area of ​​the lungs.
Occurs during muscular work, less often at rest. Her sufferers are widespread, disseminated, infiltrative, chronic fibro-cavernous and cirrhotic pulmonary tuberculosis with pronounced intoxication of the body.
Heart and pulse. Tuberculosis toxins poison the heart muscle, cause its degeneration (myocardial dystrophy), as a result of which there is a weakening of the heart: dyspnea intensifies, the pulse becomes frequent, weak filling.
Anemia and pohudonche. With tuberculosis, especially hemoptysis and bleeding, anemia develops. Constant fever, debilitating sweat and poor appetite lead to weight loss and general exhaustion of the body.
Flow. Tuberculosis can occur in a variety of ways: from mild forms, when the patient is practically healthy and even does not suspect the presence of the disease, and ending with severe forms (curdled pneumonia, miliary tuberculosis), which are now rare. There are cases of complete cure of pulmonary tuberculosis. In most cases, tuberculosis lasts for years, slowly, chronically. Usually, during the course of the illness, there are fluctuations, periods of deterioration are followed by periods of improvement and even apparent recovery. Exacerbations of the process are observed more often in the spring and autumn, with the subsequent improvement in winter and summer. The course of the disease deteriorates sharply, if various complications are added in the form of the transition of the tuberculosis process from the lung to other organs: the intestine, kidneys, peritoneum, etc. The most serious complications are tuberculosis meningitis and miliary tuberculosis.
Recognition:
Tuberculosis of the lungs should be distinguished from other pulmonary diseases: bronchitis, pneumonia, lung abscess, bronchiectasis. An accurate diagnosis can sometimes be made only after the presence of Koch sticks in sputum or in an X-ray study. Miliary tuberculosis, which sometimes occurs without cough and other pulmonary symptoms, can be mixed with typhoid fever, sepsis, endocarditis.
Bronchoadenitis. Infection with the Koch bacteria (BC) of the intrathoracic lymph nodes and adjacent bronchi (see also Primary TB Complex).
Symptoms and course:
Depend on the age of the patient, the immunobiological state of his body and the degree of involvement of the intrathoracic lymph nodes. If the foci of inflammation in them are small, and the overall reactivity is reduced, the disease can be hidden, or with minor intoxication. With more massive bronchoadenitis, high fever, general weakness, sweating are noted. A common symptom is a dry cough, but rales are rarely heard. Tuberculin reactions often, which is by no means always, are pronounced, the number of leukocytes is slightly increased, the ESR is accelerated. Mycobacterium tuberculosis is more likely to be found in the study of bronchial flushing water than sputum. X-ray differs from the expansion of the root of one or both lungs.
Forecast. Tuberculous lesions of the intrathoracic lymph nodes, even with vigorous specific treatment, are cured relatively slowly (1-2 years). Often, the course of the disease is complicated by pleurisy, the transition of the process to adjacent areas of the lung. When the lymph node melts, a cavity may appear.
The spread of the process through the circulatory system (hematogenous disseminated tuberculosis) from the lymph nodes is rare.
Bronchus tuberculosis. It can occur in the form of infiltration, ulcers, fistulas and scars. Clinically, it is manifested by a superficial dry cough, pain behind the sternum, shortness of breath, dry wheezing, the formation of atelectasis (collapse) of the lung or emphysema bloating, "bloating" or blockage of the cavity, appearance in it Liquid level. Sometimes the asymptomatic course of bronchial tuberculosis is possible.
The diagnosis is confirmed by bronchoscopy or bronchography using contrast media. Sometimes a biopsy is used (microscopic examination of the affected tissue, taken by this or that method).





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