General clinical examination of sputum
Sputum is a pathological detachable of the lungs and respiratory tract( bronchi, trachea, larynx).Clinical analysis of sputum includes a description of its nature, general properties and microscopic examination.
GENERAL PROPERTIES
The amount of sputum usually ranges from 10 to 100 ml per day. Few sputum is separated in acute bronchitis, pneumonia, congestion in the lungs, at the onset of an attack of bronchial asthma. At the end of an attack of bronchial asthma, the amount of sputum is increased. A large amount of sputum( sometimes up to 0.5 liters) can be released during pulmonary edema, as well as during suppuration in the lungs, if the cavity with the bronchus is reported( abscess, bronchiectasis, gangrene of the lung, tuberculosis in the lung, accompanied by tissue decay).It should be borne in mind that a decrease in the amount of sputum released during suppuration in the lungs may be due to the abatement of the inflammatory process, as well as the result of impaired drainage of the purulent cavity, which is often accompanied by worsening of the patient's condition. The increase in the amount of sputum may be regarded as a sign of worsening of the patient's condition, if it depends on exacerbation, for example, of a suppuration process;in other cases, when an increase in the amount of sputum is associated with an improvement in the drainage of the cavity, it is regarded as a positive symptom.
Sputum color. Most sputum is colorless, the attachment of a purulent component gives it a greenish tinge that is observed with an abscess of the lung, gangrene of the lung, bronchiectasis, actinomycosis of the lung. When sputum appears in fresh sputum, sputum is colored in various shades of red( sputum during hemoptysis in patients with tuberculosis, actinomycosis, lung cancer, lung abscess, with lung infarction, cardiac asthma and pulmonary edema).
Sputum of rusty color( with croupous, focal and influenza pneumonia, with pulmonary tuberculosis with curdled decay, stagnation in the lungs, pulmonary edema, with pulmonary form of anthrax) or sputum brown( with lung infarction) indicates the content in it is not fresh blood, but the products of its decay( hematin).
Dirty-green or yellow-green color may have sputum, separated by various pathological processes in the lungs, combined with the presence of jaundice in patients.
Yellow-canary color of sputum is sometimes observed with eosinophilic pneumonia. The ophthalmic sputum discharge is possible with lung siderosis.
Blackish or grayish sputum occurs with coal dust and smokers.
Sputum may be stained with some drugs, for example, rifampicin stains the discharge into red.
Odor. Sputum is usually odorless. The appearance of odor contributes to a violation of outflow of sputum. Putrid odor it acquires in the abscess, gangrene of the lung, with putrefactive bronchitis as a result of joining putrefactive infection, bronchoectatic disease, lung cancer, complicated by necrosis. For the revealed echinococcal cyst is characterized by a peculiar fruity smell of phlegm. Spaciousness of sputum. Purulent sputum on standing is usually divided into 2 layers, putrefactive - on 3 layers( upper frothy, medium serous, lower purulent).Especially characteristic is the appearance of a three-layer sputum for gangrene of the lung, while the appearance of double-layered sputum is usually observed in the abscess of lung and bronchiectasis.
Reaction. Sputum usually has an alkaline or neutral reaction. The decomposed sputum gets an acid reaction.
Sputum character
■ Mucous sputum is excreted in acute and chronic bronchitis, asthmatic bronchitis, tracheitis.
■ Mucous purulent sputum is typical for abscess and gangrene of light, purulent bronchitis, exacerbation of chronic bronchitis, staphylococcal pneumonia.
■ Purulent-mucous sputum is typical for bronchopneumonia.
■ Purulent sputum is possible with bronchiectasis, staphylococcal pneumonia, abscess, gangrene, actinomycosis of the lungs.
■ Serous sputum is separated in case of pulmonary edema.
■ Serous-purulent sputum is possible with an abscess of the lung.
■ Bloody sputum is secreted with a mild infarct, neoplasms, pneumonia( sometimes), trauma of the lung, actinomycosis and syphilis.
It should be noted that hemoptysis and impurity of blood to sputum are not observed in all cases of lung infarcts( in 12-52%).Therefore, the absence of hemoptysis does not give grounds for refusing the diagnosis of a lung infarct. It should also be remembered that not always the appearance of an abundant impurity of blood in the sputum is due to pulmonary pathology. To simulate pulmonary bleeding can, for example, gastric or nasal bleeding.