Isikhwehlela: imigomo nezindlela

Isikhwehlela imfihlo ikhishwe ngesikhathi ukuvuvukala kuqhoqhoqho, bronchi kanye namaphaphu. ukubukeka kwakhe kumakwe kuphela ukunqotshwa umgudu wokuphefumula, kodwa futhi ngoba inhliziyo neziyaluyalu semithambo. Izindlela isikhwehlela ehilela definition macroscopic, ezincane kanye amakhemikhali zezici zalo.

Ukuhlaziya kwembula ukuthi

Isikhwehlela kwenza kube nokwenzeka ukubona nezilwanyana ezincane ezibangela inqubo isifo, bonisa khona sofuba Mycobacterium, ukukhomba amangqamuzana omdlavuza, igazi ubovu ukungcola, futhi ukunquma ukuzabalaza kwama-bacterium nemithi.

Ngaphansi ukuhlaziywa yini izimo kuboniswa

Isikhwehlela ekucubunguleni jikelele wenziwa ngaphansi kwale mibandela elandelayo:

• ukukhwehlela;
• ukuvuvukala emaphashini;
• ukuvuvukala bronchi;
• wamaphaphu ithumba;
• sofuba;
• bronchiectasis;
• esibhibhayo yamaphaphu;
• wamaphaphu isimila;
• Ukucinana kwemigudu yomoya emaphashini ngendlela acute;
• ukucinana kwemithambo yomoya emaphashini;
• e namathansela ezingamahlalakhona;
• sofuba;
• ukunqamulela kwekhibhodi
• silicosis;
• ifomu acute Ukucinana kwemigudu yomoya emaphashini obstructive;
• ukuvuvukala emaphashini;
• yalesisifo.

Survey Ukulungiselela

Slime uzobe kangcono esabiwe, uma ngosuku olwandulela phambi sokunikela ukuthatha ithuluzi kokuhlahlela expectoration, noma kudla imali enkulu iziphuzo efudumele. Ngaphambi kokuqoqa Kunconywa ukuhlanza amazinyo futhi ngalo ingaphakathi ngomlomo, uhlambulule ngayo amanzi abilisiwe afudumele anosawoti.

Imithetho eyisisekelo ukuqoqa

Ukuqoqa isikhwehlela luhlolo bacteriological okunxanelekayo ukukhiqiza ekuseni (yena iqoqa ebusuku ngaphambi kokuba kudliwe) esitsheni oyinyumba, okuyinto ekhishwe laboratory. Ukuze ukuhlaziywa lemali okwanele 5 ml. Ukuhlaziya uketshezi senziwa amahora kungakadluli 2 emva iqoqo yabo. Kuze mzuzu ukuthumela ukufunda okuqukethwe isitsha kufanele igcinwe avaliwe kule esiqandisini.

Inani isikhwehlela yezifo ezihlukahlukene

Inombolo uketshezi labelwe luyehluka kuye ngokuthi uhlobo inqubo sokugembula. Ngokuvamile, it kuyahlukahluka kusuka amathe ambalwa 1 ilitha ngosuku. Inani elincane ikhishwe ngesikhathi yisishiso ze- bronchi, izinqubo congestive oqala amaphaphu bronchial somoya kuhlasela. Ekupheleni kuhlasela ivolumu iyakhula. Kungaba kuze kufinyelele 0.5 amalitha, ume ngamanani amakhulu, uma kukhona edema yamaphaphu.

isikhwehlela Okuningi ikhishwe ngesikhathi inqubo ubovu emaphashini lapho ukuxhumana bronchi, nge esibhibhayo, bronchiectasis nezilonda ezingapholi.

isikhwehlela wamaphaphu TB izicubu libonisa kwamazinyo. Ikakhulukazi, inqubo enjalo kuphakamisa umgodi okuyinto baxhumana bronchi.

Kusukela yini edale ukwehla noma ukwanda uketshezi ngabodwa

excretion Ukwandiswa uketshezi kungenzeka ukuthi umataniswe nesimo Ukuwohloka nesineke futhi ziqashwe ngesikhathi exacerbation. Ukwanda kungase futhi ubheke Dynamics omuhle yentuthuko isifo.

Ukwehlisa inani isikhwehlela ethakwa kungase kubonise ekuhlehleni ukuvuvukala noma ukwephula e amanzi ingaphakathi ligcwele ubomvu. Kulokhu, Ukuwohloka impilo nesineke.

ubunjalo ukudedelwa

uketshezi lwamafinyila imele ukucinana kwemigudu yokuphefumula ngefomu oyingozi noma ezingamahlalakhona yesifuba somoya bronchial, inyumoniya, umdlavuza, izimila yamaphaphu, bronchiectasis, yamaphaphu simila hydatid, ephelezelwa suppuration, actinomycosis.

Isikhwehlela nge admixture we ubomvu siyenzeka ephashini ithumba, bronchiectasis futhi echinococcosis.

Amafinyila kuxutshaniswe negazi noma ehlanganisa ngokuphelele igazi nobuntu sofuba. Ukubukeka igazi kungase kubonise khona umdlavuza, bronchiectasis, iphaphu iqhubeka. Futhi, into enjalo is nasemkhakheni syndrome Lobe phakathi, isilethikusebenza e iphaphu, ukuhlukumezeka, actinomycosis kanye izilonda syphilitic. Igazi kungenzeka inyumoniya aqhelelene futhi lobar futhi ebalulekile, izinqubo congestive, isifuba somoya zenhliziyo edema yamaphaphu.

isikhwehlela Serous is ebonwe edema yamaphaphu.

umbala isikhwehlela

Isikhwehlela, lokho kuhlolisisa kwembula ke ezinemibala eyehlukile. osenyameni lwamafinyila kanye serous akanayo nombala ofanayo noma ube luhlaza olumhlophe.

Ukujoyina ubomvu ukunika ithemba luhlaza ogqamile ephawula izinqubo sokugembula ezifana wamaphaphu ithumba, esibhibhayo, bronchiectasis, iphaphu actinomycosis.

Ukukhethwa nge touch of nokugqwala noma umbala onsundu kubonisa ukuthi lingabe igazi fresh, futhi imikhiqizo yayo kwamazinyo - hematin. Le mfihlo kungenziwa ikhishwe nge lobar inyumoniya, umbendeni, infarction yamaphaphu.

umbala ogqamile nge touch of ukungcola ophuzi noma ubufakazi Imfihlo nezifo zokuphefumula lihambisana jaundice.

Esikhanyayo umbala ophuzi isikhwehlela is ingcoliswe inyumoniya eosinophilic.

Amafinyila ocher ivela ku siderosis lula.

imfihlo Blackish noma lemicu empunga elinamathela othini kuphawulwe khona amalahle uthuli amanyela. Lapho yamaphaphu edema isikhwehlela serous ebonwe izinombolo ezinkulu. Njengomthetho, it is ngesineke umbala nombala pink ngenxa yokubakhona kwamangqamuzana egazi abomvu. Okunjalo ngokwahlukana ketshezi like cranberry juice.

Painted ikani imfihlo futhi abanye izidakamizwa. Ngokwesibonelo, ama-antibiotic "rifampicin" ongasinika yona umbala obomvu.

iphunga

Ubunjalo inqubo sokugembula kule ipheshana zokuphefumula kungase kubonise uketshezi kanye nephunga. Isikhwehlela unika iphunga bola nge esibhibhayo yamaphaphu noma bronchus izilonda Putrid, umdlavuza, izimila, necrosis nzima bronchiectasis.

Ukuba khona izingqimba

Ngokuvamile isifundo wembula khona uketshezi izingqimba. Lapho phlegm amile nge admixture we ubomvu siyenzeka nge iqhubeka wamaphaphu bronchiectasis.

Imfihlo ukubola admixture iqukethe izingqimba ezintathu. Isendlalelo phezulu iyafana foam naphakathi serous, kanye doped esiphansi kanye ubomvu. ukwakhiwa okunjalo libhekene esibhibhayo wamaphaphu.

ukungcola

Admixture ukudla kungabonakala nasemkhakheni khona isimila esibulalayo we kuqhoqhoqho ekukhulumisaneni yayo ne bronchi kanye kuqhoqhoqho. Ngemva contact nge tapeworm ku bronchi e isikhwehlela kungatholakala noma izingwegwe scolex amagciwane. Kakhulu lengatfolakali abadala Ascaris ukuthi zingene umgudu wokuphefumula kubantu immunocompromised.

wamaphaphu yisikhohliso Iqanda izinhlumba zivele ikhefu esenzelwa kule wamaphaphu khona ezidala.

Esibhibhayo futhi wamaphaphu ithumba kubangele ukubukeka izingcezu wamaphaphu necrosis. Lapho izimila zingase uketshezi izingcezwana yalo.

Convolution equkethe fibrin atholakala in iziguli ukucinana kwemigudu yokuphefumula fibrinous, isifo sofuba kanye nenyumoniya.

Ilayisi ithole lens noma Koch sofuba esingokwemvelo.

Ukuvimba Dietrich, okubandakanya imikhiqizo yokubola bacterium wamaphaphu izicubu amaseli acid okunamafutha, kwenzeka ukucinana kwemigudu yokuphefumula Putrid noma esibhibhayo wamaphaphu.

Okungalapheki namathansela ifomu kuhilela ukuhlukana amalaka plugs efana bavimbe Dietrich.

Indlela chemical

Isikhwehlela imithi kuhilela ukuthola:

• amaprotheni Inkomba ongasisiza e uphethwe umehluko ifomu ezingamahlalakhona Ukucinana kwemigudu yomoya emaphashini kanye nesifo sofuba. Ukucinana kwemigudu yomoya emaphashini ifomu ezingamahlalakhona imakwe iminonjana imfihlo amaprotheni, futhi kuyoba okuningi ephakeme e izilonda tubercular inani iphrotheni isikhwehlela, futhi okungenzeka ukuthi ishiwo izinombolo (kufika ku 100-120 g / l).
• Bile zombala. Atholakala isikhwehlela e kokunqotshwa umgudu wokuphefumula lihambisana kwesibindi. Kulokhu kwesibindi baxhumana emaphashini. Bile zombala kukhona inyumoniya esingokwemvelo ukuthi kubangelwa ukuwohloka yamaphaphu ngaphakathi erythrocyte futhi ushintsho kamuva e-hemoglobin.

Cytological imfihlo ucwaningo indlela

Ukuze kuhlonzwe umehluko sofuba kanye nezinye eziningi izilonda wamaphaphu kuba Pap indlela ezisetshenziswa kakhulu, esakhiwa ngezigaba ezimbili: luhlolo emitholampilo ezincane of isikhwehlela.

ucwaningo Clinical kusiza ukucacisa lapho indlela bugcogcwe impahla ukuthola umphumela lesifanele yokuhlaziya.

Kunezinhlobo ezimbili eziyinhloko zezinto zokusebenza, edinga luhlolo ezincane of isikhwehlela: okuvele encishisiwe. Uhlobo uketshezi wesibili etholwe kwethonya ezishukumisa ahlukahlukene (i-expectoration ejenti, inhalations nokunye okunjalo. D.).

Material etholwe a biopsy inaliti

luhlolo Cytological ka isikhwehlela kuhilela ekutadisheni luhlolo macroscopic futhi ezincane amaseli ayo.

Iningi ulwazi ukuhlaziywa cytological ka isikhwehlela uthethe ekuseni esiswini esingenalutho. Ngaphambi isifundo kufanele agcinwe akukho amahora angaphezu kwangu-4.

• Ngo isikhwehlela zenzeka amaseli i-squamous EPITHELIAL, okuyinto kufundvwe microscopically. Kodwa ukuze kuhlonzwe, abanakho incazelo. columnar amaseli EPITHELIAL - kokubili single futhi eqenjini - kungabonakala nasemkhakheni izifo njengesifuba somoya bronchial, ukucinana kwemigudu yokuphefumula nomdlavuza wamaphaphu. Qaphela ukuthi epithelium columnar zingavela ngenxa Ukungena we isikhwehlela acinene.
• ama-macrophage Alveolar namangqamuzana reticuloendothelial. Ama-macrophage zitholakala cytoplasm (uthuli noma amaseli phagocytic) kungatholakala iziguli uthuli eside imuncwe.
• Ama-macrophage protoplasm (ezakhiwe ukubhidlika-hemoglobin) inhliziyo isici ngokuthi amaseli. Abakwazi zenzeka phakathi izinqubo amile emaphashini, mitral valve stenosis, infarction yamaphaphu.

• Idlanzana leukocyte equkethwe isikhwehlela. okuqukethwe kwabo eliphezulu kuphawulwe admixture kuvuze ubomvu uketshezi.
• Eosinophils. amaseli okunjalo isikhwehlela ocebile asthmatics. Amangqamuzana angase imakwe ne uhlobo eosinophilic inyumoniya izilonda umzimba helminths, isifo sofuba kanye infarction yamaphaphu.
• Erythrocyte. amangqamuzana ngamanye abomvu engaveli isithombe lesi sifo. Ukuvela isamba anda ubufakazi bokuba khona ezophayo emaphashini. I fresh igazi erythrocyte kunqunywa njalo. Uma kukhona admixture we igazi, okuyinto stagnated emaphashini isikhathi eside, wathola erythrocyte leached.
• Umdlavuza amaseli. Bona ingatholakala amaqembu imfihlo. Abonisa khona kuwuphawu lwesimila. Uma eyodwa kaningi esitokisini ngobunzima uphethwe. Ezimweni ezinjalo, ukuphinda ukuhlaziya isikhwehlela.
• imicu enwebekayo yezicubu, osimo kubangelwa ngokuwa wamaphaphu izicubu, isifo sofuba sokucasuka, ithumba, esibhibhayo, isimila. kuthiwa esibhibhayo amaseli ezifana ngaso sonke isikhathi kwachazwa ngokuthi ngenxa isenzo enzyme, okuyizinto oluyimfihlo, bangase siphela.
• Kurshmana Kuvunguza. Lokhu umzimba ezikhethekile, efana tube. Atholakala isifundo ngaphansi ngesibonakhulu. Ngezinye izikhathi obonakalayo futhi iso. Ngokuvamile Helix izifo esingokwemvelo njengesifuba somoya bronchial, isifo sofuba yamaphaphu kanye nenyumoniya.
• SikaCharcot-Leyden zinhlayiya zitholakala isikhwehlela nge wokuqukethwe lelisetulu eosinophils kulezi izilonda, isifuba somoya bronchial, inyumoniya eosinophilic. Autopsy sofuba Ukuqubuka kwalesi sifo ngo mafutha anciphisa isikhala esingaphakathi ze- bronchi kungenzeka libhekene khona ku uketshezi of nokunwebeka Imicu yotshani cholesterol zinhlayiya, futhi amorphous lime MBT (okubizwa ngokuthi tetrad Ehrlich) - 100%.

Ukusetshenziswa microscopy

Ukuqoqwa isikhwehlela smear microscopy lapho kutadishwa indlela kuhilela ukuhlaziya uketshezi ukuze kutholwe we Mycobacterium ethize ukuze sofuba. Bafana nama-abancane, obukhulu ezinhlangothini noma phakathi nomzimba izinti anobude obungalingani, okuyinto okungadingeki kokubili singly futhi emaqenjini.

Ukuthola kabanzi baba nesifo Mycobacterium akuyona yisici esivelele for sitholakele futhi kudinga isiqinisekiso nge indlela bacteriological. Mycobacterium sofuba ngesilinganiso iyimfihlo ayikwazi ukutholwa.

Isisekelo ukuhlaziywa izinhlansana ubovu zithathwa aphume ezindaweni ezahlukene amane nesithupha futhi triturated ubebushelezi amafasitelana ezimbili. Okulandelayo, basuke omisiwe emoyeni futhi omiswe ilangabi sikaphalafini.

luhlolo bacteriological ka isikhwehlela Ziehl-Nielsen staining kuphakamisa abomvu. Kulokhu, zonke izimfihlakalo kuyizinhlayiyana, kwasinda mycobacteria, kuba tinged nge blue, futhi mycobacteria abe bomvu.

Lapho isifo sofuba umzimba esolwa lesion emva izifundo ezintathu ngoba khona mycobacteria basabele kahle aye ayisebenzisa kaningi ukusetshenziswa indlela flotation (ukuhlaziywa Pottenger).

Indlela evamile ukufunda ibala smear MTB inika yi omuhle kuphela uma isibalo MTB okungenani 50 amayunithi 000 1 ml isikhwehlela. Ngokusho inani sofuba Mycobacterium ukuba yahlulele khona engenakwenzeka.

iziguli Bacterioscopy nge izifo zamaphaphu nonspecific

Laboratory izifundo of isikhwehlela ebukhoneni yezifo ezingathathelani eqondene wama-phaphu ngokuphindwe microscopy kungembula amabhaktheriya ezilandelayo:

• Lapho ukuvuvukala emaphashini - pneumococci, diplococci Frenkel, Friedländer bacterium, streptococci, staphylococci (100%).
• Lapho esibhibhayo ukukhanya kungatholakala induku lokuphotha lihambisana spirochaete Vincent (80%).
• Imvubelo isikhunta (70%), ukunquma uhlobo esidinga imbewu imfihlo.
• actinomycete Drusen (100%) e-actinomycosis.

Umthamo uketshezi kubantu enempilo

Displacement isikhwehlela ethakwa kuqhoqhoqho kanye bronchi kubantu abahlushwa iyiphi pathologies, ezisukela 10 kuya ku-100 ml / usuku.

Ngokuvamile amazinga aphansi leucocytes, inhlolo-vo ephathelene namabala smear mycobacteria inika yi ezimbi.