What Are Causes of Fluid Retention?

Pulmonary hydrocephalus is commonly called "pleural effusion" in medicine. Water accumulates outside the lungs. It can be caused by infection (such as pneumonia, tuberculosis, etc.). It can also be caused by some autoimmune diseases. (Such as lupus erythematosus), many other lung diseases will be associated with pleural effusion.

Chinese name: Hydronephrosis

Foreign name: Pleural effusion
Department: Respiratory

Causes of hydronephrosis

Common causes of hydronephrosis

cough

Is the most common cause of hydronephrosis. The early cough can be very light, often a monophonic cough, which is what we say is a half-cough, no sputum and dry cough, and the degree of impact on work and life is not obvious. When the disease progresses, the cough can be aggravated; when accompanied by bronchial endometrial tuberculosis, the cough can be exacerbated, and sometimes coughing can occur. For patients who have not been cured for a long time, such as bronchial displacement, trachea being stretched due to focal adhesions, When the bronchi are forced to deform by the pressure of the surrounding lymph nodes, an irritating cough can occur due to poor ventilation. This cough is like coughing caused by eating food and even breathing difficulties.

Sputum

Sputum is not obvious at the beginning of the onset, or there is a small amount of white mucus sputum, but the sputum volume will increase when the lesion enlarges or even there are holes in the lungs. When there are other pathogenic infections, the amount of sputum will also increase, and yellow purulent sputum may appear, and fever and chills may be accompanied by systemic symptoms.

Chest pain

Chest pain is also the main cause of hydronephrosis, but chest pain can occur when the lesion must spread to the pleura, especially to the parietal pleura. The parietal pleura is the anterior thoracic and pulmonary tuberculosis. The parietal pleura is shown in Figures 2 and 3. Occasionally, there is faint pain in an undefined area, which is caused by the reflex effect of nerves and is not affected during lung breathing. If the site is stinging and becomes worse with breathing and coughing, this means that the inflammation stimulates the pleura. Some patients often feel pain in the shoulder or upper abdomen, which is probably because the inflammation has stimulated the diaphragm to pass through the nerve reflex. To.

Main causes of hydronephrosis

The heart can be divided into left and right sides, which are responsible for different circulation paths. The left heart is responsible for the circulation of blood through the aorta to the whole body, and then flows back to the right heart through the superior and inferior vena cava, which is called the systemic circulation (also known as the large circulation); the right heart is responsible for transporting blood through the pulmonary artery to the lungs and then through The pulmonary veins flow back to the left heart and are called the pulmonary circulation (also called the small circulation). When left heart failure, it can cause increased pulmonary venous pressure and cause hydronephrosis. If the causative factors come quickly and urgently, it can cause acute hydronephrosis. The treatment of hydronephrosis mainly depends on the cause of the disease. Common causes are hypertension heart disease, coronary heart disease, aortic valve disease, and mitral regurgitation. Arrhythmias, severe anemia, and excessive infusions of L can also cause pulmonary congestion and effusion.

There are many reasons for hydronephrosis, such as pulmonary hypertension, hypertension, liver disease, renal insufficiency, and heart failure. However, heart disease causes a higher proportion of hydronephrosis. Heart disease causes the blood that was originally delivered to the whole body to stagnate in the heart. When the blood in the lungs wants to return to the heart, the return pressure is blocked due to the increased pressure in the heart, causing the water in the blood to penetrate into the tissue space and cause the lungs to change. The obstruction of air causes hydronephrosis. Of course, the cause of hydronephrosis must be treated.

Hydronephrosis symptoms

The early symptoms of acute hydronephrosis may only be cough, especially in the middle of the night, and the inability to lie down flat is often mistaken for tracheal inflammation or a cold and is not taken seriously. In fact, if you have dyspnea, shortness of breath, paroxysmalnocturnaldyspnea (PND), sitting breath (thopnea), or even sitting and sleeping, you should not neglect these symptoms. These are all acute pulmonary hydrops One of the clinical symptoms.

Acute hydronephrosis often occurs in the autumn and winter when the weather is cold. The main causes are coronary artery disease, systemic hypertension, enlarged cardiomyopathy, valvular heart disease, myocarditis, and uremia. If poor blood pressure control, arrhythmia, infections, fluid overload, anemia, stress, or poor patient compliance can easily worsen the condition of heart failure and cause acute hydronephrosis.

Diagnosis of hydronephrosis

Hydropulmonary appearance

The leaked liquid is transparent and clear, and does not solidify after standing, and the specific gravity is less than 1.016 to 1.018. The exudate was mostly grass yellow and slightly turbid, with a specific gravity> 1.018. If purulent pleural fluid is infected with E. coli or anaerobic bacteria, it usually smells bad. Bloody pleural fluids show different degrees of washing water samples or venous blood samples; milky pleural fluid is chylothorax; if the pleural fluid is chocolate-colored, the possibility of amoebic liver abscess rupture into the chest cavity should be considered; black pleural fluid may be aspergillus .

Hydronephrotic cells

There are a small amount of mesothelial cells or lymphocytes in normal pleural fluid. During pleural inflammation, various inflammatory cells and proliferating and degenerating mesothelial cells can be seen in pleural fluid. The number of leaked cells is often less than 100 × 106 / L, mainly lymphocytes and mesothelial cells. Leukocytes from exudate often exceed 500 × 106 / L. In empyema, the number of white blood cells is more than 1000 × 106 / L. Neutrophil counts suggest acute inflammation; lymphocytes are mostly tuberculous or malignant; eosinophils often increase during parasite infection or connective tissue disease. When the red blood cells in the pleural fluid exceed 5 × 109 / L, they can be light red, which are mostly caused by malignant tumors or tuberculosis. Thoracic puncture damage to blood vessels can also cause bloody pleural fluid, which should be carefully identified. When red blood cells exceed 100 × 109 / L, trauma, tumor or pulmonary infarction should be considered. About 60% of malignant pleural fluid can detect malignant tumor cells, and repeated detection can improve the detection rate. Malignant tumor cells in pleural fluid often have characteristics such as enlarged nuclei and different sizes, nuclear aberrations, deep nuclear staining, abnormal nuclear plasma ratio, and abnormal mitotic division, which should be identified. Interstitial cells of pleural fluid are often deformed and easily misdiagnosed as tumor cells. Non-tuberculous pleural fluid has more than 5% intermediate cells, and tuberculous pleural fluid often has less than 1%. When systemic lupus erythematosus is complicated by pleural effusion, the anti-nuclear antibody titer in the pleural fluid can reach more than 1: 160, and lupus cells are easy to find.

pH Hydronephrosis pH

The pH of tuberculous pleural fluid is often <7.30; pH <7.00 can only be seen in empyema and pleural effusion caused by esophageal rupture. The pH of pleural fluid caused by acute pancreatitis is <7.30; if the pH is <7.40, malignant pleural fluid should be considered.

Hydrocephalus

Pleural fluid smears can find bacteria and culture, which can help diagnose the pathogen. After tuberculous pleurisy pleural fluid is precipitated and cultured for tuberculosis, the positive rate is only 20%. Chocolate-colored pus should be examined microscopically for amoeba trophozoites.

Hydronephric protein

The protein content of the exudate, the pleural fluid / serum ratio was greater than 0.5. When the protein content is 30g / L, the specific gravity of the pleural fluid is about 1.018 (each 1g of protein is added or subtracted to increase or decrease the weight by 0.003). Leakage protein content is low (<30g / L), mainly albumin, and mucin test (Rivalta test) is negative. Carcinoembryonic Antigen (CEA): CEA levels in malignant pleural fluid appear earlier and more significantly than serum. If the pleural fluid CEA value is> 15 to 15 g / L or the pleural fluid / serum CEA> 1, malignant pleural fluid is often indicated. Increased ferritin content in malignant pleural fluid can be used as a reference for differential diagnosis. Combined detection of multiple markers can increase the positive detection rate.

Hydropneumolipids

Chylothorax has a high content of neutral fat and triglyceride in the pleural fluid (> 4.52mmol / L), which is milky and turbid. Sudan III is stained red, but the cholesterol content is not high, which can be seen when the thoracic duct is ruptured. "Chyloid" or cholesterol pleural fluid (cholesterol> 2.59mmol / L) is related to the accumulation of old effusion cholesterol, which can be seen in old tuberculous pleurisy, malignant pleural fluid or liver cirrhosis, rheumatoid arthritis and so on. Although cholesterol-containing pleural fluid contains high cholesterol, triglycerides are normal, pale yellow or dark brown, and contain cholesterol crystals, fat particles, and a large number of degenerative cells (lymphocytes, red blood cells).

Hydronephrosis glucose

The glucose content in normal human pleural fluid is similar to that in blood, and changes with the rise and fall of blood glucose. Determination of pleural glucose can help identify the cause of pleural effusion. The glucose content of the exudate and most of the exudate was normal; the glucose content in tuberculous, malignant, rheumatoid arthritis, and suppurative pleural effusions was <3.35 mmol / L. If the pleural lesions have a wide range, it is difficult for glucose and acidic metabolites to penetrate the pleura, which can lower the glucose content, which indicates that the tumor is widely infiltrated and the rate of malignant tumor cells in the pleural fluid is also high.

Hydronephrase

The content of lactate dehydrogenase (LDH) in the pleural fluid increased, more than 200 U / L, and the ratio of pleural fluid LDH / serum LDH was greater than 0.6, suggesting that it is an exudate. It shows that the inflammation is more obvious. LDH>? 00U / L often indicates that the malignant tumor or pleural fluid has been complicated by bacterial infection. Elevated pleural amylase can be seen in acute pancreatitis, malignant tumors, and so on. When acute pancreatitis is accompanied by pleural effusion, amylase leakage causes the content of the enzyme to be higher in pleural fluid than in serum. Some patients have severe chest pain and difficulty breathing, which may conceal their abdominal symptoms. At this time, the pleural fluid amylase has increased, and clinical diagnosis should be paid attention to. Adenosine deaminase (ADA) is higher in lymphocytes. In tuberculous pleurisy, due to the stimulation of cellular immunity and a significant increase in lymphocytes, ADA in pleural fluid can be higher than 100 U / L (generally no more than 45 U / L). It is more sensitive in the diagnosis of tuberculous pleurisy.

Hydronephrosis immunological examination

With the development of cell biology and molecular biology, immunological examination of pleural fluid has attracted attention. It plays a role in identifying benign and malignant pleural fluid, studying the pathogenesis of pleural effusion, and developing biological treatment of pleural effusion in the future. In tuberculous and malignant pleural effusions, T lymphocytes increase, especially tuberculous pleurisy, which can be as high as 90%, and T4 (CD + 4) is the main factor. The function of T cells in malignant pleural effusion is inhibited, and its killing activity on autologous tumor cells is significantly lower than that of peripheral blood lymphocytes, suggesting that the local immune function of patients with malignant pleural effusion is inhibited. Systemic lupus erythematosus and rheumatoid arthritis-induced pleural effusions reduce complement C3 and C4 components, and increase the content of immune complexes. Ten, pleural biopsy Percutaneous pleural biopsy can help identify tumors and determine pleural granulomatous lesions. When planning to diagnose tuberculosis, in addition to pathological examination, biopsy specimens can also be used for tuberculosis culture. Pleural biopsy is not recommended for empyema or bleeding. If necessary, biopsy can be performed through thoracoscopy. Ultrasound can identify pleural effusion, pleural thickening, and fluid pneumothorax. The cystic effusion can provide a more accurate localization diagnosis and is helpful for pleural puncture and aspiration.

Hydronephrosis treatment

The treatment of hydronephrosis mainly depends on the cause of the disease. Common causes are hypertension heart disease, coronary heart disease, aortic valve disease, and mitral regurgitation. Arrhythmias, severe anemia, and excessive infusions can also cause pulmonary congestion and effusion. Diuretics, some vasodilators, and morphine can be used to treat hydronephrosis, which all have a great soothing effect in the acute stage. These are symptomatic treatments. In order to achieve the goal of radical cure, it should be treated according to its underlying diseases, such as controlling hypertension, improving coronary blood supply and promoting the pumping function of the heart. Severe heart valve diseases can be corrected by surgery, drugs can normalize the heart rhythm and Cure anemia, etc. In the early stages of the disease, if the underlying cause can be effectively controlled, it is not difficult to cure hydronephrosis; but if it is a late stage disease and the heart function has failed, it is more difficult to cure.

Classification of hydronephrosis

Western medicine treatment is: The treatment principle is antituberculosis chemotherapy and pleural drainage. 1 Antituberculosis chemotherapy. 2 Thoracic drainage. 3 Adrenal cortex hormone application. Ask your doctor specifically.

Treatment mainly uses diuretics to improve the excretion of sodium and water, which helps reduce blood volume and reduce pulmonary blood vessel congestion; cardiac strengthening agents to increase myocardial contractility, improve left ventricular function, and increase cardiac output; use arterial vasodilators Dilate small arteries, reduce systemic vascular resistance; use venous vasodilators to reduce blood volume to the heart, and reduce left ventricular filling pressure. Non-drug treatment includes correction of predisposing factors, salt limitation (less than 2 grams per day), water limitation (less than 1200cc per day), and moderate activity limitation.

Hydropulmonary fluid treatment principles

Western medicine treatment is: The treatment principle is antituberculosis chemotherapy and pleural drainage. 1. Chemotherapy with anti-TB drugs. 2. Thoracic puncture and drainage. 3. Application of adrenal cortex hormones. Ask your doctor specifically.

Treatment mainly uses diuretics to improve the excretion of sodium and water, which helps reduce blood volume and reduce pulmonary blood vessel congestion; cardiac strengthening agents to increase myocardial contractility, improve left ventricular function, and increase cardiac output; use arterial vasodilators to Dilate small arteries, reduce systemic vascular resistance; use venous vasodilators to reduce blood volume to the heart, and reduce left ventricular filling pressure. Non-drug treatment includes correction of predisposing factors, salt limitation (less than 2 grams per day), water limitation (less than 1200cc per day), and moderate activity limitation.

Pay attention to nutritional balance

Regular diet, do not overeating, eat on time. Diet should be light, eat spicy, fried, fried, spirits and other indigestible and irritating foods, eat more fruits, vegetables and fiber foods, drink plenty of water, especially Laxative food of bananas, apples, honey.

Keep your emotions good, don't be pessimistic.

Food therapy plan

Usually pay attention to eat more foods rich in vitamin A, carotene and vitamin B2; at the same time, choose foods high in phospholipids to strengthen the brain, such as egg yolk, fish, shrimp, walnuts, peanuts, etc .; but also consciously choose to protect the eyes Foods such as eggs, animal livers, kidneys, carrots, spinach, millet, Chinese cabbage, tomato, daylily, water spinach, wolfberry.

The diet is far from three white (sugar, salt, lard) and nearly three black (black sesame, mushrooms, black rice). From a nutritional point of view, four legs (pig, cow, sheep) are not as good as two legs (chicken, duck ), Two legs are not as good as one leg (mushroom), one leg is not as good as no leg (fish). Often eating kelp, river fish, fish oil can reduce the rate of cell death.