sputa prezentare imbunatatita
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sputaTRANSCRIPT
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Dr. Mircea Franciska
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Definitie: totalitatea
materialului eliminat din caile respiratorii ca urmare a tusei productive
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• Mucoasa cailor respiratorii secreta in 24 h pana la 100 ml mucus → dirijat cu ajutorul cililor spre regiunea laringo-faringiana, de unde este inghitit inconstient
Sputa – totdeauna manifestare patologica
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•Exces de secretie al celulelor din epiteliul cailor respiratorii
•Exsudat inflamator laringian, traheal, bronsic sau alveolar
•Transsudatul alveolar ( boli cardiace cu staza in circulatia venoasa pulmonara)
•Sange din leziunile vasculare care intereseaza caile respiratorii
•Produse din procesele patologice pleuropulmonare sau organe din vecinatate care s-au drenat in caile respiratorii
•Corpi straini inhalati accidental
•Secretii faringiene, nazale si salivare
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Analiza dupa criterii semiologice a acestui produs patologic este unul din cele mai importante deziderate in diagnosticul bolilor aparatului respirator (macroscopic, microscopic, bacteriologic).
In acest scop, sputa va fi recoltata in vase de sticla curate (sterile), gradate si prevazute cu un capac (sputa/24 h).
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Examenul macroscopic al sputei
cantitatea aspectul culoarea mirosul gustul
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Cantitatea expectoratiei
Reprezinta volumul in 24 de ore - difera in functie de numerosi factori:
- natura bolii - permeabilitatea cailor
respiratorii - vascozitate si aderenta - forta tusei
*(femeile si copii obisnuiesc sa isi inghita sputa)
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Cantitatea expectoratiei Sputa este abundenta (300-500 ml/24h) in:•bronsiectazie•abcesul pulmonar•gangrena pulmonara•edemul pulmonar acut•pertusis
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Cantitatea expectoratiei
in bronsiectazie cantitatea cea mai mare de sputa se elimina dimineata (pseudovomica matinala), in restul zilei volumul sputei ramane redus.
caracterul matinal - abcesul pulmonar
- gangrena pulmonara
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Cantitatea expectoratiei
Tusea convulsiva:•La sfarsitul acceselor de tuse copiii elimina o sputa abundenta, care debordeaza pe nas sub forma unor bule de aer
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Vomica
Definitie: (forma particulara de “sputa”)eliminarea masiva pe cale bronsica a continutului
uneicolectii de material patologic, lichid sau semilichid
din: -parenchimul pulmonar - abces - TBC - chist hidatic - cavitatea pleurala - empiem - organele din vecinatate - abces hepatic - abces subfrenic - abces mediastinal
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Vomica
poate sa fie spontana sau urmeaza: - unui efort fizic - tusei - traumatismelor
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Vomica - clinic
durere toracica intensa tuse de nestapanit dispnee pana la asfixie anxietate, cianoza, si stare de soc zgomote respiratorii eliminarea unei mari cantitati de
material patologic (100-1000ml)
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Expecoratia din vomica
poate fi formata din: - puroi: - abcese pulmonare - TBC pulmonara - empiem pulmonar - dintr-un lichid clar “ ca apa
de stanca” - chist hidatic
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Vomica TBC
eliminarea unui puroi : - culoare albicioasa, - branzos (cazeum).
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Aspectul si culoarea sputeiSputa seroasa - este clara sau tulbure - vascozitate scazuta - se acopera cu un strat de spuma
( sputa aerata) Apare in : - EPA (abundenta, roza sau
rosie) - carcinom cu celule
alveolare
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Sputa mucoasa
vascoasa alba/gri/neagra intalnita in stadiile initiale ale: - traheitelor - bronsitelor acute - bronsita tabagica - pertusis
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Sputa mucoasa in Astmul bronsic
se elimina in cantitate redusa este : - gelatinoasa - translucida - culoare alba contine: - mucus - cilindrii bronsici -mici
dopuri opalescente ( sputa perlata a lui Laennec)
- elemente in forma de spirala ( spiralele lui Curschmann)
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Sputa purulenta
• formata din puroi, eliminat prin deschiderea treptata in caile respiratorii a unui focar supurativ (abces pulmonar, empiem, abces al unui organ subdiafragmatic)
• abces amebian hepatic rupt intr-o bronsie- aspect de sos anchois
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Sputa mucopurulenta
• Contine: - mucus - puroi• Este: - opaca - densa - galben verzuie/ cenusie Apare in : - bronsita ac - bronsita cr - bronsiectazie
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Sputa seromucopurulenta
Apare in : - bronsiectazie - gangrena pulmonara - sedimentarea prin pastrare a trei
sau patru straturi: - spumos
- seros -
mucopurulent - grunjos
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Sputa sanguinolenta
- aparitia unei cantitati reduse de sange printre celelalte elemente
poate fi considerata o hemoptizie a minima
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Dupa culoarea sangelui se pot descrie:• Sputa striata sau patata: - bronsita cronica - neo
bronhopulmonar• Sputa vascoasa, galben-aurie, caramizie
sau rubiginoasa – in pneumonia pneumococica
• Sputa de culoare rosie-inchisa, aproape neagra, vascoasa si aderenta, in cantitate redusa: in infarctul pulmonar
• Sputa rosie-gelatinoasa, “ ca pelteaua de coacoze” – in cancerul bronhopulmonar
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Tipuri rare:•Sputa semimembranoasa- difterie, bronsita semimembranoasa
•Cu particule in suspensie- membrane si vezicule hidatice, ascarizi, bronsioliti, fire de par, fragmente tumorale
•Colorate artificial- galben in icter; rosu la cei tratati cu rifampicina
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Mirosul si gustul sputei
• Sputa mucopurulenta - miros fad - gust lesiatic• Mirosul fetid ( de oua clocite)-
bronsiectazie
• Miros putrid, cadaveric- gangrena pulmonara
• Vomica hidatica are gust sarat
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Examenul microscopic al sputei
Preparate native Cristale Charcot – Leyden:- astm bronsic - transparente -
aciculare/hexagonale - coexista cu
eozinofile
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Examenul microscopic al sputei• PMN neutrofile• Hematii• Macrofage • Celule scuamoase• Histiocite sau macrofage alveolare• Mucus- perle si spirale• Corpi Creola- celule descuamate,
mucus si proteine• Fibre elastice• Paraziti
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Frotiuri colorate•PMN eozinofile: - AB - sdr Loffler - chist hidatic pulmonar (coloratie May-Grunwald Giemsa)•Celule neoplazice: -neo bronhopulmonar (coloratie Papa Nicolaou)•Fibrele elastice (coloratie Weigerth)
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Examenul bacteriologic al sputei Sputa recoltata steril
Frotiuri colorate, metoda Gram, albastru de metilen- pneumococ, streptococ, stafilococ, Haemophylus, bacil Friedländer
Frotiuri colorate, coloratie Ziehl-Nielsen- bacil Koch
Frotiuri colorate, metoda PAS- ciuperci microscopice
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Examenul bacteriologic al sputei Frotiu de sputã colorat Ziehl-Nielsen
Se observã bastonase rosii (bacili acid-alcoolo-rezistenti = BAAR) pe un fond albastru
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Examenul bacteriologic al sputei
• - culturi: - bacilul Koch (TBC) (mediu Lowenstein-Dubos)
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Examenul bacteriologic al sputei
• Evidentierea sau cultivarea unui microorganism din sputa nu inseamna neaparat implicarea acestuia in procesul patologic
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HemoptiziaDefinitie: eliminarea dupa tuse a sangelui care
provine din etajul subglotic al aparatului respirator (min 2 ml)
Initial senzatie de caldura retrosternala, “intepatura” laringiana, urmata de tuse, dispnee, zgomote respiratorii, gust de sange si apoi expectoreaza o cantitate de sange, la inceput rosu-deschis, apoi mai inchis la culoare, totdeauna aerat (spumos)
Forme comune- inceteaza in prima zi, apoi 24-48 h elimina o sputa hemoptoica, de culoare inchisa- “coada” hemoptiziei
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DIAGNOSTIC DIFERENTIAL
• Hemoragii supraglotice (epistaxis posterior, stomatoragie)
• Hematemeza
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DIAGNOSTIC DIFERENTIAL
HEMOPTIZIE•Senzatie de caldura retrosternala; opresiune toracica•Sange rosu-deschis, aerat, necoagulabil, eliminat in timpul unui efort de tuse•Zgomote respiratorii•Inceteaza rapid (o zi)•“coada hemoptiziei”
HEMATEMEZA•Senzatie de balonare; greata accentuata progresiv•Sange rosu-inchis, negru, neaerat, cu cheaguri, amestecat cu alimente, eliminat in timpul unui efort de varsatura•Fara zgomote respiratorii•Inceteaza brusc, insotita de melena
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CLASIFICAREA HEMOPTIZIEI
Din bolile aparatului respirator: bronsiectazie, bronsita cronica, neoplasmul bronhopulmonar, tuberculoza pulmonara, chist hidatic etc
Din bolile cardiovasculare: SM, IVS acuta-EPA, HTA, anevrism aortic, teleangiectazie ereditara Rendu-Osler, poliarterita
Din diatezele hemoragice: perturbarea hemostazei si coagularii (inclusiv cauza iatrogena- supradozarea anticoagulantelor)
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Hemoptizia precede vomica, mai ales pe cea hidatica (peste 50% din cazuri)
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Va multumesc !!!