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(新しいページ: 'Investigations in Respiratory Diseases General investigations worth addressing which point out disease in the respiratory organs include peripheral blood picture, total and di...') |
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Investigations in Respiratory Diseases
General investigations worth addressing which point out disease in the respiratory organs include peripheral blood picture, total and differential leukocyte counts and determination of ESR. Lymphocytosis is suggestive of chronic inflammatory disease like tuberculosis whereas neutrophil leukocytosis is situated acute infections like pneumonia. Surge in eosinophils above 10% demands estimation from the absolute eosinophil count. Mild and moderate boost in eosinophils is very common in Indian subjects. This is brought on by factors such as helminthiasis and external allergens. In susceptible subjects even moderate eosinophils may present with the signs of respiratory allergy. High eosinophil counts are normally found in asthma attack, hydatid disease and pulmonary eosinophilia. Chronic hypoxemia results in the roll-out of secondary polycythemia. Elevation of ESR is often a nonspecific indicator of inflammatory and neoplastic lesions inside lungs. Erythrocyte sedimentation rate is not just a reliable parameter for diagnosis, however in the followup of a chronic disease like tuberculosis, the ESR may be helpful.
Sputum examination Sputum must be examined macroscopically, microscopically after proper staining, and bacteriologically. Total level of sputum in 24 hours, color, consistency and other characteristics like odor and presence of blood are of great value in diagnosis. Presence of fungi in mycotic infections, asbestos bodies in asbestosis and Absolute Neutrophil Count motile amoebae in pulmonary amoebiasis may be detected by direct microscopy of fresh sputum. Gram's stain and Ziehl-Neelsen's stain are employed to identify the bacterial pathogens inside the smear. Malignant cells can be detected by cytological examination, Wet preparations stained with methylene blue may suggest a good malignant cells, some staining help to identify the malignant cells further.
Bacteriological tests Sputum culture is performed to identify the organisms and their sensitivity to varied antibiotics. Proper number of the specimen is crucial getting reliable results. Sputum ought to be taken straight into sterile receptacles. Contamination by oropharyngeal organisms contributes to fallacious results on culture. Uncontaminated specimens of sputum can be purchased by trans-tracheal aspiration. Bronchial washings collected via a bronchoscope or smears collected by the brush during bronchoscopy are ideal specimens for cytological and microbiological studies, wherever facilities are available.
Radiological studies Plain X-ray chest-posteroanterior (PA) view Radiographs are used full inspiration with the film placed in front in the chest along with the way to obtain X-rays kept 1.5-2m behind the person. Along with PA views, lateral views may also be taken using the affected side towards the film to locate the bronchopulmonary segment which is the seat of disease. In normal skiagrams, the lungs appear as translucent zones through which bronchovascular markings are clearly detectable and will be traced almost to the periphery.
The trachea, mediastinum, costophrenic, and cardiophrenic angles as well as the a higher level the diaphragm are taken as landmarks within the interpretation of chest skiagram. On each side the lung fields are compared zone by zone. For purposes of description the lung fields are split up into the top, middle, as well as the lower zones. A horizontal line with the a higher level the bottom margin of the anterior end from the second rib separates the upper from middle zone, plus a horizontal line passing over the lower margin with the anterior end of the fourth rib separates the middle in the lower zone. Chest radiographs give proof of morphological lesions. Most often, radiological appearances assist to infer the aetiology too.
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