The diagnosis of tubercle is according to _'s treatment
1.It is swelling that the chest image learns to check and show one pair of sides lung door and mediastinal lymph node symmetry, accompany or not with the netted, tubercle or flaky shade in the lung.
2.Histology examine, verify, it has to be the intersection of the universe and the intersection of junket nature and necrosis swollen granulation while being living, resist acid, dye negative.
3.Serum angiotensin rises more than enzyme S A C E activity of melting.
4.Lie between in vain plainly serum or B A L F - 2 receptor (I L - 2 R) The level increases.
5.Old tuberculin (O T) Or it is negative or weak and positive to test P P D.
Lymphocyte count> 10, 4 C D C D 8 ratio gt in the 6 B A L F; =3 .
7.High blood calcium, high urine.
8.Kveim test positive.
9.Except tuberculosis or others granulation is swollen for disease.
In the above-mentioned 9, 1, 2, 8 is the major indicator, the others are secondary indexes.
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Tuesday, January 29, 2013
Symptom of tubercle and _'s symptom of the physical sign
Symptom of tubercle and _'s symptom of the physical sign
Tubercle and symptom depend on being given much trouble the position, there can not be, slight, or serious. At the beginning, can generate heat, the weight lightens and arthralgia. The liver is given much trouble hotly continuously. The peripheral enlargement of lymph nodes is common, often have no symptom. Important lymph node can also have granulation to be swollen even. Organ but function continue person who take place fiber take and damage. Cough and it has difficulty in breathing to be may be very much slight and No.
Chronic the intersection of tubercle and patient often have skin pathological change (spot piece, papule, the skin makes the brief summary) ,Nasal mucosa and combine at the membrane can also take place granulation to be swollenning. Nodular erythema, often with generating heat and arthralgia, it is European's common symptom, less in American philtrums.
70% of the patients make and puncture alive and can find to examine that there is swollen granulation of liver by the leather liver, they can not have symptom and the liver function is checked normally. The patient that 10% are less than has hepatomegaly. The serious going on liver function obstacle accompanies jaundice to be rare.
15% of the patients have swollen plain layer of inflammation of wink of granulation, it is usually dual sides. If not treated, the eyesight that it is serious to be can be caused by that the retina is given much trouble is lowered, there can also be serious vitreous inflammation or then sending glaucoma. There can be swelling lachrymal gland once in a while, the conjunctiva and eyelid are soaked, doing keratitis.
5%~10% of the patient cardiac muscle is given much trouble, can cause angina pectoris, in heart failure, or cause the fatal character to conduct unusually.
Acute much arthritis can be very outstanding. Swelling around the chronic joint and it touches a tender spot to be may be caused by bone qualitative change in the phalange. Inflammation is common around the acute ankle joint, there is not dermatosis that is decreased, are not often thought to have tubercle.
The central nervous system is given much trouble and can be shown as nearly pathological changes of any type, but the most common one is cranial nerve paralysis (especially the facial nerve is paralysed) ,Involve 5% of the patients.
Diabetes insipidus can take place. The intersection of hypercalcemia and disease and high the intersection of calcium and the intersection of urine and disease (alveolus macrophage and tubercle disease granulation swollen to secrete 1, due to 25 - two hydroxy vitamin D increase) Can cause kidney stone and calcium calm disease of the kidney and cause the renal function to be depleted, but prednisone can reduce the incidence of the supersession disorder of calcium. The gland function is hyperfunction to seem to unusually see more by first form, not when hypercalcemia disease does not have fast reaction to the steroids medicine of cortex, should consider this kind of possibility.
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Tubercle and symptom depend on being given much trouble the position, there can not be, slight, or serious. At the beginning, can generate heat, the weight lightens and arthralgia. The liver is given much trouble hotly continuously. The peripheral enlargement of lymph nodes is common, often have no symptom. Important lymph node can also have granulation to be swollen even. Organ but function continue person who take place fiber take and damage. Cough and it has difficulty in breathing to be may be very much slight and No.
Chronic the intersection of tubercle and patient often have skin pathological change (spot piece, papule, the skin makes the brief summary) ,Nasal mucosa and combine at the membrane can also take place granulation to be swollenning. Nodular erythema, often with generating heat and arthralgia, it is European's common symptom, less in American philtrums.
70% of the patients make and puncture alive and can find to examine that there is swollen granulation of liver by the leather liver, they can not have symptom and the liver function is checked normally. The patient that 10% are less than has hepatomegaly. The serious going on liver function obstacle accompanies jaundice to be rare.
15% of the patients have swollen plain layer of inflammation of wink of granulation, it is usually dual sides. If not treated, the eyesight that it is serious to be can be caused by that the retina is given much trouble is lowered, there can also be serious vitreous inflammation or then sending glaucoma. There can be swelling lachrymal gland once in a while, the conjunctiva and eyelid are soaked, doing keratitis.
5%~10% of the patient cardiac muscle is given much trouble, can cause angina pectoris, in heart failure, or cause the fatal character to conduct unusually.
Acute much arthritis can be very outstanding. Swelling around the chronic joint and it touches a tender spot to be may be caused by bone qualitative change in the phalange. Inflammation is common around the acute ankle joint, there is not dermatosis that is decreased, are not often thought to have tubercle.
The central nervous system is given much trouble and can be shown as nearly pathological changes of any type, but the most common one is cranial nerve paralysis (especially the facial nerve is paralysed) ,Involve 5% of the patients.
Diabetes insipidus can take place. The intersection of hypercalcemia and disease and high the intersection of calcium and the intersection of urine and disease (alveolus macrophage and tubercle disease granulation swollen to secrete 1, due to 25 - two hydroxy vitamin D increase) Can cause kidney stone and calcium calm disease of the kidney and cause the renal function to be depleted, but prednisone can reduce the incidence of the supersession disorder of calcium. The gland function is hyperfunction to seem to unusually see more by first form, not when hypercalcemia disease does not have fast reaction to the steroids medicine of cortex, should consider this kind of possibility.
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Monday, January 28, 2013
The intersection of tubercle and the intersection of disease and cause of disease and have illness coming on the intersection of mechanism and the intersection of _ and general knowledge
The intersection of tubercle and the intersection of disease and cause of disease and have illness coming on the intersection of mechanism and the intersection of _ and general knowledge
The mechanism with having illness coming on of the cause of disease: The cause of disease is not so obvious. Infected the factor correctly ' For instance bacterium, virus, mycoplasma, fungi,etc.) Observe, has not obtained the precise conclusion. Carry on research to the inherent cause too, fail to verify. The author finds in the tubercle patient the tubercle bacillus DNA positive rate reaches 50% with PCR technology in recent years, so it is that the branched bacillus invades the result organized to put forward tubercle, but a lot of experiments have not verified this argument. The importance that the majority think cell immunological function and humoral immunological function disorder are tubercle has illness coming on in the mechanism now. A certain ' Some) Cause it under the stimulus of the antigen of tubercle, the macrophages(Am) in the alveolus Activated with T4 cells. Released the leucocyte by Am activated to lie between plainly- 1( IL- 1) ,IL- 1 is a kind of very strong lymphocytic factor, can stimulate lymphocytes and release IL- 2, make T4 cells increase at double and under the function of the lymphokine, make B lymphocytes activate, release immunoglobulin (Ig), the function of one's own antibody is hyperfunction. The lymphocytes activated can release monocyte factor, leucocyte of hastening and melting to inhibit factor and macrophage from moving the conduct and inhibiting the factor. The monocyte trends towards the factor of melting to make the monocyte in the blood around assemble to the quality among the alveolus continually, tubercle the density is nearly 25 times of the blood in his alveolus at the disease. Under a lot of unknown antigen and function of the medium, T lymphocytes, the monocyte and macrophage,etc. are soaked in the alveolus, form the early stage of of tubercle - -Alveolus inflammation stage. With the development of pathological change, the cell composition of alveolus inflammation is reducing constantly, and macrophages are derivatized have one kind of cells of skin to increase gradually, in the granulation that he formated and secreted is swollen stimulates the factor (granuloma-inciting factor) ,etc. function under,is it typical to form gradually cheese tubercle swollen in granulation in disease. On later stage, the fiber that release macrophages links plain(fibronectin, Fn)s Can attract becoming fibrous cells (Fb) of a large number of ,Make it and ground substance adhere to outside the cell, in addition, what macrophage secrete become fibrous the intersection of cell and growth factor (growth factor of fibroblasts, GFF) ,Impel into fibrous cells and count and increase; Meanwhile, inflammation and immune cell around so that disappear while further reducing, and cause the extensive fiber of the lung.
In a word, antigen and the cell immunity of organism and result that the humoral immunological function contends each other that tubercle is unknown. Because of the individual's difference ' Age, gender, race, inherent cause, hormone, HLA) With the immunoreactive regulating action of antibody, look at its promotion factor produced and resist the out-of-balance state between the factors short of moneyly, and determine the swollen development of granulation and disappear, demonstrate tubercle different pathologic state and trend that the nature relieves.
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The mechanism with having illness coming on of the cause of disease: The cause of disease is not so obvious. Infected the factor correctly ' For instance bacterium, virus, mycoplasma, fungi,etc.) Observe, has not obtained the precise conclusion. Carry on research to the inherent cause too, fail to verify. The author finds in the tubercle patient the tubercle bacillus DNA positive rate reaches 50% with PCR technology in recent years, so it is that the branched bacillus invades the result organized to put forward tubercle, but a lot of experiments have not verified this argument. The importance that the majority think cell immunological function and humoral immunological function disorder are tubercle has illness coming on in the mechanism now. A certain ' Some) Cause it under the stimulus of the antigen of tubercle, the macrophages(Am) in the alveolus Activated with T4 cells. Released the leucocyte by Am activated to lie between plainly- 1( IL- 1) ,IL- 1 is a kind of very strong lymphocytic factor, can stimulate lymphocytes and release IL- 2, make T4 cells increase at double and under the function of the lymphokine, make B lymphocytes activate, release immunoglobulin (Ig), the function of one's own antibody is hyperfunction. The lymphocytes activated can release monocyte factor, leucocyte of hastening and melting to inhibit factor and macrophage from moving the conduct and inhibiting the factor. The monocyte trends towards the factor of melting to make the monocyte in the blood around assemble to the quality among the alveolus continually, tubercle the density is nearly 25 times of the blood in his alveolus at the disease. Under a lot of unknown antigen and function of the medium, T lymphocytes, the monocyte and macrophage,etc. are soaked in the alveolus, form the early stage of of tubercle - -Alveolus inflammation stage. With the development of pathological change, the cell composition of alveolus inflammation is reducing constantly, and macrophages are derivatized have one kind of cells of skin to increase gradually, in the granulation that he formated and secreted is swollen stimulates the factor (granuloma-inciting factor) ,etc. function under,is it typical to form gradually cheese tubercle swollen in granulation in disease. On later stage, the fiber that release macrophages links plain(fibronectin, Fn)s Can attract becoming fibrous cells (Fb) of a large number of ,Make it and ground substance adhere to outside the cell, in addition, what macrophage secrete become fibrous the intersection of cell and growth factor (growth factor of fibroblasts, GFF) ,Impel into fibrous cells and count and increase; Meanwhile, inflammation and immune cell around so that disappear while further reducing, and cause the extensive fiber of the lung.
In a word, antigen and the cell immunity of organism and result that the humoral immunological function contends each other that tubercle is unknown. Because of the individual's difference ' Age, gender, race, inherent cause, hormone, HLA) With the immunoreactive regulating action of antibody, look at its promotion factor produced and resist the out-of-balance state between the factors short of moneyly, and determine the swollen development of granulation and disappear, demonstrate tubercle different pathologic state and trend that the nature relieves.
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Check and diagnose _'s symptom in the laboratory of tubercle
Check and diagnose _'s symptom in the laboratory of tubercle
90% of the patient's chests of of tubercle are unusual in X-ray examination. Regular chest X-ray examination can often find that there are mediastinal lymph node pathological changes. It is in fact general for X-ray examination to find ' 90% of the patients) There is lymph node pathological change by door and the right side bronchus of one pair of sides lung, though can be seen single side pathological change once in a while. The lung soaks and presents tiny rubing the hyaline change of sand of disperse on the X-ray stretch, but it appears with lymph node pathological change at the same time or thereafter; Or there is not lymph node pathological change that can be seen; Or is shown as the netted or granulous pathological change of millet; Or take the form of and merge form or big tubercle, is similar to shifting the focus. Cough and it has difficulty in breathing to be may be very much slight and No. The result is a lung fiber in later period of going on disease, the bag turns into and lung source heart disease.
Often there are leucocytes that are reduced. The serum uric acid is often raised, but there is little gout. The result that the liver is given much trouble makes serum alkaline phosphatase and - valley ammonia acyl transfer to peptide enzyme and rise. The inhibition of late hairdo hypersensitivity is the characteristic, but negative second intensity tuberculin reaction must exclude from erupting pulmonary tuberculosis simultaneously. Black philtrum often has high gamma globulin blood disease.
The lung function is checked and shown and breathed limitedly, the complying with is reduced, disperse ability is weakened. CO2 retention is uncommon, though with often having a angry way to block in the lung fiber or great patient that chases with the disease or later period in the bronchus. It is important to act as the lung function and check for estimating the progress of course of disease and guiding treating regularly.
The patient without symptom if has typical chest X-ray slice to behave, can diagnose as tubercle; If chest slice is normal, but above-mentioned symptom and physical sign must consider tubercle. Because differential diagnosis including lymphoma and fungal infection (for example organize the thick liquid fungus disease of afterbirth, sporular fungus disease of ball) ,It is essential to organize examining checking with microbiological histology alive, if there is symptom and have therapeutic indication of steroids of cortex. If there is simple pathological change that may be touched of tables (such as in the cover inside, lymph node or conjunctiva) ,Sample that examined alive, positive rate of tubercle> is 85%.
When the peripheral position can't do alive and examine, it is to offer the first best step of histologic evidence of of tubercle to sample alive and examine through the fibrous bronchus mirror. Can see the granulation in 50%~80% of the patients swollenly, no matter chest X-ray block reveals whether the lung is soaked or there is lung door lymph node pathological change only. Can also adopt the lung to organize the sample through the thorax mirror.
Can make alive position that examine, include the intersection of appearance and normal conjunctiva or mediastinal while being other, the latter can be sampled by the mediastinal incision or mediastinal mirror. Liver live 70% case it is obvious granulation to be swollen examine. Must get rid of the single organ ' Such as liver) Some tubercle of China reacts, the granulation of lung is swollen that infect, hypersensitivity and foreign matter react. When there is doubt, should examine alive in several places, look for infecting or foreign matter to react carefully.
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90% of the patient's chests of of tubercle are unusual in X-ray examination. Regular chest X-ray examination can often find that there are mediastinal lymph node pathological changes. It is in fact general for X-ray examination to find ' 90% of the patients) There is lymph node pathological change by door and the right side bronchus of one pair of sides lung, though can be seen single side pathological change once in a while. The lung soaks and presents tiny rubing the hyaline change of sand of disperse on the X-ray stretch, but it appears with lymph node pathological change at the same time or thereafter; Or there is not lymph node pathological change that can be seen; Or is shown as the netted or granulous pathological change of millet; Or take the form of and merge form or big tubercle, is similar to shifting the focus. Cough and it has difficulty in breathing to be may be very much slight and No. The result is a lung fiber in later period of going on disease, the bag turns into and lung source heart disease.
Often there are leucocytes that are reduced. The serum uric acid is often raised, but there is little gout. The result that the liver is given much trouble makes serum alkaline phosphatase and - valley ammonia acyl transfer to peptide enzyme and rise. The inhibition of late hairdo hypersensitivity is the characteristic, but negative second intensity tuberculin reaction must exclude from erupting pulmonary tuberculosis simultaneously. Black philtrum often has high gamma globulin blood disease.
The lung function is checked and shown and breathed limitedly, the complying with is reduced, disperse ability is weakened. CO2 retention is uncommon, though with often having a angry way to block in the lung fiber or great patient that chases with the disease or later period in the bronchus. It is important to act as the lung function and check for estimating the progress of course of disease and guiding treating regularly.
The patient without symptom if has typical chest X-ray slice to behave, can diagnose as tubercle; If chest slice is normal, but above-mentioned symptom and physical sign must consider tubercle. Because differential diagnosis including lymphoma and fungal infection (for example organize the thick liquid fungus disease of afterbirth, sporular fungus disease of ball) ,It is essential to organize examining checking with microbiological histology alive, if there is symptom and have therapeutic indication of steroids of cortex. If there is simple pathological change that may be touched of tables (such as in the cover inside, lymph node or conjunctiva) ,Sample that examined alive, positive rate of tubercle> is 85%.
When the peripheral position can't do alive and examine, it is to offer the first best step of histologic evidence of of tubercle to sample alive and examine through the fibrous bronchus mirror. Can see the granulation in 50%~80% of the patients swollenly, no matter chest X-ray block reveals whether the lung is soaked or there is lung door lymph node pathological change only. Can also adopt the lung to organize the sample through the thorax mirror.
Can make alive position that examine, include the intersection of appearance and normal conjunctiva or mediastinal while being other, the latter can be sampled by the mediastinal incision or mediastinal mirror. Liver live 70% case it is obvious granulation to be swollen examine. Must get rid of the single organ ' Such as liver) Some tubercle of China reacts, the granulation of lung is swollen that infect, hypersensitivity and foreign matter react. When there is doubt, should examine alive in several places, look for infecting or foreign matter to react carefully.
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Clinical manifestation _ symptom of tubercle
Clinical manifestation _ symptom of tubercle
Tubercle is a kind of whole body granulation swollen disease, involve skin and a lot of internal organs. The position given much trouble has lung, vertical diaphragm and lymph node, phalange, cardiac muscle, central nervous system, liver, spleen, kidney, eyes and parotid gland around besides skin. Tubercle disease can infringe one organ or organization only, can also many kinds of organ or organization are infringed meanwhile. The condition passes slowly, relieves and recurs alternatively. The clinical symptom of this disease is varied.
The skin that first, skin display tubercle behaves
It is many kinds of shapes, often in order that the papule, tubercle, spot piece, red cover are ill, silver bits disease kind, one kind of tumours of scar meat, pigment fail and the bald head is damaged. The cover is decreased and distributed over places such as face and four limbs,etc. asymmetrically. It is flexible that it is touched that rash is hard, expand under the cover gradually, involve the thickness of the whole dermis. The change of the epidermis is not obvious, can become thin, change color slightly, the capillary expands and a few scales bits. It is often rubescent to purple brown, non- routed and broken, there is not subjective symptoms.
1,One kind of tumours of papule meat
Damage it for the syringe needle to the pea size small tubercle, is also called one kind of tumours of grains of meat of millet. Mainly distribute over the face, shank and shoulder. The intersection of glass and block shows faint yellow snack to similar to lupus tubercle, disappear and step back and does not leave the trace while pressing, leave over pigment spot, withers and cicatrix sometimes.
2,One kind of tumours of piece type meat of spot
Hutchinson has reported this unique spot bulk is damaged, as flat and slight high great points of foliate nodular spot pieces that get up of surface at first, common on the cheek, nose and arm.
3,Disease, a kind of meat and one kind of tumours of silver bits
Often the clear spot piece of border happen on truck and four limbs, there are scale bits of disease kind of silver bits on it.
4,Hemorrhoid is one kind of lupus types
On the position of the easy emergence hemorrhoid, for instance: Ear, cheek department, nose, meaning the blue and green red or mauve spot piece with simpler symmetrical infiltration that appears of toe.
5,The cover plays one kind of tumours of meat
Also called one kind of tumours of Darier-Roussy meat. The bean is to son's big solid skin lower tubercle of millet, with the skin adhesion, common on the truck, the face is rare, there is not subjective symptoms.
6,One kind of tumours of meat of cicatrix
Damage and happen on the scar position. For instance: On the scar after burn, folliculitis, herpes zoster. Make the original scar area expand, highly increase, is exactly like the scar hang-up.
7,One kind of tumours of red cover ill type meat
Infiltration erythema and scale's bits patch of the filling the air distribution are unclear in the border.
8,One kind of tumours of nodular erythema type meat
Some patient, disease of tubercle, arthralgic companion generate heat and erythrocyte sedimentation rate increase soon in order to person who occur frequently, enlargement of lymph nodes of X-ray examination lung door. The face, back and four limbs stretch the side and happen scatteredly at pain skin lower tubercle. The skin of surface is ruddy, most common to young women.
9,One kind of tumours of mucomembranous meat
Buccal hard jaw, cheek department, hang and stop up hanging down and big papule of amygdaline syringe needle, troop and merge and form the flat spot piece, small tubercle happens in the conjunctiva of eyelid and lachrymal gland.
10,Other skin damages
Tubercle disease can amalgamate have skin lower calcium calm, itch rash, many shape erythema and folliculitis display. Skin wither and horn take excessive increasing or it fails to be can also caused by this disease by pigment.
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Tubercle is a kind of whole body granulation swollen disease, involve skin and a lot of internal organs. The position given much trouble has lung, vertical diaphragm and lymph node, phalange, cardiac muscle, central nervous system, liver, spleen, kidney, eyes and parotid gland around besides skin. Tubercle disease can infringe one organ or organization only, can also many kinds of organ or organization are infringed meanwhile. The condition passes slowly, relieves and recurs alternatively. The clinical symptom of this disease is varied.
The skin that first, skin display tubercle behaves
It is many kinds of shapes, often in order that the papule, tubercle, spot piece, red cover are ill, silver bits disease kind, one kind of tumours of scar meat, pigment fail and the bald head is damaged. The cover is decreased and distributed over places such as face and four limbs,etc. asymmetrically. It is flexible that it is touched that rash is hard, expand under the cover gradually, involve the thickness of the whole dermis. The change of the epidermis is not obvious, can become thin, change color slightly, the capillary expands and a few scales bits. It is often rubescent to purple brown, non- routed and broken, there is not subjective symptoms.
1,One kind of tumours of papule meat
Damage it for the syringe needle to the pea size small tubercle, is also called one kind of tumours of grains of meat of millet. Mainly distribute over the face, shank and shoulder. The intersection of glass and block shows faint yellow snack to similar to lupus tubercle, disappear and step back and does not leave the trace while pressing, leave over pigment spot, withers and cicatrix sometimes.
2,One kind of tumours of piece type meat of spot
Hutchinson has reported this unique spot bulk is damaged, as flat and slight high great points of foliate nodular spot pieces that get up of surface at first, common on the cheek, nose and arm.
3,Disease, a kind of meat and one kind of tumours of silver bits
Often the clear spot piece of border happen on truck and four limbs, there are scale bits of disease kind of silver bits on it.
4,Hemorrhoid is one kind of lupus types
On the position of the easy emergence hemorrhoid, for instance: Ear, cheek department, nose, meaning the blue and green red or mauve spot piece with simpler symmetrical infiltration that appears of toe.
5,The cover plays one kind of tumours of meat
Also called one kind of tumours of Darier-Roussy meat. The bean is to son's big solid skin lower tubercle of millet, with the skin adhesion, common on the truck, the face is rare, there is not subjective symptoms.
6,One kind of tumours of meat of cicatrix
Damage and happen on the scar position. For instance: On the scar after burn, folliculitis, herpes zoster. Make the original scar area expand, highly increase, is exactly like the scar hang-up.
7,One kind of tumours of red cover ill type meat
Infiltration erythema and scale's bits patch of the filling the air distribution are unclear in the border.
8,One kind of tumours of nodular erythema type meat
Some patient, disease of tubercle, arthralgic companion generate heat and erythrocyte sedimentation rate increase soon in order to person who occur frequently, enlargement of lymph nodes of X-ray examination lung door. The face, back and four limbs stretch the side and happen scatteredly at pain skin lower tubercle. The skin of surface is ruddy, most common to young women.
9,One kind of tumours of mucomembranous meat
Buccal hard jaw, cheek department, hang and stop up hanging down and big papule of amygdaline syringe needle, troop and merge and form the flat spot piece, small tubercle happens in the conjunctiva of eyelid and lachrymal gland.
10,Other skin damages
Tubercle disease can amalgamate have skin lower calcium calm, itch rash, many shape erythema and folliculitis display. Skin wither and horn take excessive increasing or it fails to be can also caused by this disease by pigment.
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Clinical manifestation _ symptom of tubercle
Clinical manifestation _ symptom of tubercle
Clinical manifestation, tubercle of disease it looks at the pressing or otherwise and amounts to involve organ of disease to be but different. Tubercle is too early to often have obvious symptom and physical sign in the chest. Have, cough sometimes, cough a small amount of the intersection of phlegm and liquid, spit blood on a small quantity while being accidental; There can be weak, generating heat, night sweating, appetite failing, weight to lighten etc.. Can present out of breath, even cyanosis uncomfortable in chest when pathological change is extensive. But because amalgamate infection, pulmonary emphysema, bronchiectasis, original heart disease of the lung,etc. and aggravate the condition. If tubercle involves other organs at the same time, corresponding symptom and physical sign can take place. Such as the most common one of skin being nodular erythema, see more the surface shank, shoulder or four limbs. Also there is a kind of lupus (lupus pernio) of hemorrhoid , macule, papule when. Find lower tubercle of the skin sometimes. It can be caused and depilated to infringe the scalp. Probably about 30% of patients can present the skin damage. The eye sufferer nearly has 15% of the cases, there can be iris cilliary inflammation, acute pigment one layer of inflammation, cornea - conjunctivitis,etc.. Can appear eyes ache, eyesight fuzzy and cilliary congest etc. display. Some patients have liver sum ' Or) Splenomegaly, it is obvious bilirubin increases and rises with alkaline phosphatase slightly, or liver function is damaged. The mediastinal and simple table lymph node is often infringed but swelling. Such as involving joint, skeleton, muscle,etc., there can be occuring frequently small bag ossicle defect of short bone which can be seen four limbs, brothers in multiple arthritis, X-ray examination (bone . It can cause some swelling, pain,etc. that the granulation of muscle is swollen. Nearly 50% of the cases involve the nervous system, his symptom is changeful. Can have the intersection of cranial nerve and paralyse, myopathic taking the intersection of location and the intersection of and the intersection of pathological change, meningitis,etc. and clinical manifestation in the brain nerve. Tubercle disease involve cardiac muscle, can have arrhythmia is even in heart failure to display, nearly 5% of the cases involve the heart. Can also present the pericardium and accumulate the liquid. Tubercle can interfere with the supersession of calcium, cause the blood calcium, urine calcium increases, cause kidney calcium salt depositing and kidney stone. Can cause diabetes insipidus involve pituitary, play, depend on mound can take place milk to be too much to secrete, rise usually with the milk of serum give much trouble. To parotid gland, tonsil, throat, thyroid gland, renal gland, pancreas, stomach, reproductive system when given much trouble, can cause relevant symptoms and physical sign, but relatively rare.
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Clinical manifestation, tubercle of disease it looks at the pressing or otherwise and amounts to involve organ of disease to be but different. Tubercle is too early to often have obvious symptom and physical sign in the chest. Have, cough sometimes, cough a small amount of the intersection of phlegm and liquid, spit blood on a small quantity while being accidental; There can be weak, generating heat, night sweating, appetite failing, weight to lighten etc.. Can present out of breath, even cyanosis uncomfortable in chest when pathological change is extensive. But because amalgamate infection, pulmonary emphysema, bronchiectasis, original heart disease of the lung,etc. and aggravate the condition. If tubercle involves other organs at the same time, corresponding symptom and physical sign can take place. Such as the most common one of skin being nodular erythema, see more the surface shank, shoulder or four limbs. Also there is a kind of lupus (lupus pernio) of hemorrhoid , macule, papule when. Find lower tubercle of the skin sometimes. It can be caused and depilated to infringe the scalp. Probably about 30% of patients can present the skin damage. The eye sufferer nearly has 15% of the cases, there can be iris cilliary inflammation, acute pigment one layer of inflammation, cornea - conjunctivitis,etc.. Can appear eyes ache, eyesight fuzzy and cilliary congest etc. display. Some patients have liver sum ' Or) Splenomegaly, it is obvious bilirubin increases and rises with alkaline phosphatase slightly, or liver function is damaged. The mediastinal and simple table lymph node is often infringed but swelling. Such as involving joint, skeleton, muscle,etc., there can be occuring frequently small bag ossicle defect of short bone which can be seen four limbs, brothers in multiple arthritis, X-ray examination (bone . It can cause some swelling, pain,etc. that the granulation of muscle is swollen. Nearly 50% of the cases involve the nervous system, his symptom is changeful. Can have the intersection of cranial nerve and paralyse, myopathic taking the intersection of location and the intersection of and the intersection of pathological change, meningitis,etc. and clinical manifestation in the brain nerve. Tubercle disease involve cardiac muscle, can have arrhythmia is even in heart failure to display, nearly 5% of the cases involve the heart. Can also present the pericardium and accumulate the liquid. Tubercle can interfere with the supersession of calcium, cause the blood calcium, urine calcium increases, cause kidney calcium salt depositing and kidney stone. Can cause diabetes insipidus involve pituitary, play, depend on mound can take place milk to be too much to secrete, rise usually with the milk of serum give much trouble. To parotid gland, tonsil, throat, thyroid gland, renal gland, pancreas, stomach, reproductive system when given much trouble, can cause relevant symptoms and physical sign, but relatively rare.
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Mechanism's _ general knowledge of pathogenic factor and having illness coming on of tubercle
Mechanism's _ general knowledge of pathogenic factor and having illness coming on of tubercle
First, pathogenic factor
The cause of disease of tubercle has not been bright so far, it may be one kind and infects factor, immune factor, one's own immune system disease associating with inherent cause at the same time. The pathological hypothesis of the immunity thinks, tubercle is under the function of some unknown antigen, mainly started the cell immunity of tubercle to reply by macrophages; Macrophages release many kinds of factors, such as IL-1, cause T to assist cell gathering and hyperplasia; T assists cells to secrete the cell factor, hastens and melts and gathers other inflammatory cells. In addition, are produced immunoglobulin (Ig) to increase by B lymphocytes after stimulating, begin hyperplasia too as fibrous cells. The above-mentioned immunology changes interaction to lead to the fact it is being swollen that the inflammatory cell is being given much trouble the hyperplasia of organ and formed the granulation.
Second, have illness coming on in the mechanism
It is the important amynologic characteristic of tubercle that the cell immunological function is low, are shown as peripheral blood lymphocytes are reduced, to many kinds of late person who send the intersection of skin and test react, subside or disappear, irritate lotion (BALF) to patient of tubercle disease the intersection of bronchus and alveolus Finding,increase macrophage at BALF and lymphocyte absolute number obviously, but the proportion that macrophages account for drops but the lymphocyte proportion rises, indicate the position of disease T cell function is obviously strengthened, drop and form the contrast with peripheral blood T lymphocytes, the two present and separate the phenomenon. Until the intersection of T and the intersection of cell and inferior group analyze, find activity issues of patient of tubercle disease T assist and induce cells (CD4) further in the BALF Obviously increase, and T inhibiting malicious cells (CD8) of cell It is normal to be lower than. Make CD4/CD8 ratio obviously rise.
Tubercle disease granulation is swollen from at there make up is skin kinds of cell, macrophage and some effect cell. Its mechanism is under the function of the outside antigen, T cell and macrophages in the alveolus are activated, release a series of lymphocytic factor, the ones that include T cells to emerge are lain between in vain plainly - 2 (IL-2)s , the factor (MCF) of hastening and melting of the monocyte , the monocyte moves the conduct and inhibits the factor (MIF) The ones that produce with macrophages are lain between in vain plainly - l (IL-1) . IL-1 can impel T lymphocytes to move the conduct to the intersection of pathological change and activity department, and impel its hyperplasia and division, form alveolus inflammation finishing a disease and relying mainly on the fact that inflammation cells or immune effect cells such as T cells, the monocyte and alveolus macrophage,etc. are soaked in early days, IL-1 can also make IL-2 receptor in surface of T cell expose, and impel T cells to release IL-2, IL-2 stimulates B cells, produce immunoglobulin (Ig) in the form of cloning more, can be seen high 's globulin blood disease at being clinical, as pathological change continues progress, the cell composition of alveolus inflammation is reducing constantly, have one kind of cells of skin and increase gradually, and it is not that the cheese granulation is swollen to form a typical one under the swollen function of stimulating the factor of granulation that it secretes gradually. On tubercle later stage, the fibrous conjugated proteln that release macrophages absorbs a large number of fibrous master cells, meanwhile, inflammation and immune effect cell around so that disappear while further reducing, cause the extensive fiber finally.
Organize pathology, the early pathology of tubercle displays mainly T lymphocyte, monocyte and macrophage soak alveolus inflammation caused in the alveolus; Until pathological change develop, the intersection of cell and composition, alveolus of inflammation reduce constantly, and upper the intersection of peel and kinds of cell that macrophage derive and become increase and preponderate gradually, under formating and secreting swollen function which stimulate the factor of the granulation, it is not that a kind of tubercle granulation of cheese is swollen to form a typical one gradually; Pathological change later stage, the connection that alveolus macrophages release is plain can be attracted and become fibrous cells in a large amount, make it and ground substance stick outside the cell, in addition what macrophage secrete become fibrous the intersection of cell and growth factor impel fibrous the intersection of cell and hyperplasia, cause the extensive fiber of lung. Acute the intersection of tubercle and the intersection of disease and arthritis and the intersection of patient and the intersection of joint and slippery membrane and tendon sheath of tenosynovitis examine pathology, show cheese swollen kind of granulation changes while being living, and there are T lymphocytes that are soaked; Chronic the intersection of tubercle and the intersection of joint and slippery membrane, disease of arthritis become extensive hyperplasia, tubercle joint, disease of arthritis accumulate liquid, ooze out liquid for inflammation nature; Patient's slippery membrane of inflammation is organized normally around the tubercle joint.
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First, pathogenic factor
The cause of disease of tubercle has not been bright so far, it may be one kind and infects factor, immune factor, one's own immune system disease associating with inherent cause at the same time. The pathological hypothesis of the immunity thinks, tubercle is under the function of some unknown antigen, mainly started the cell immunity of tubercle to reply by macrophages; Macrophages release many kinds of factors, such as IL-1, cause T to assist cell gathering and hyperplasia; T assists cells to secrete the cell factor, hastens and melts and gathers other inflammatory cells. In addition, are produced immunoglobulin (Ig) to increase by B lymphocytes after stimulating, begin hyperplasia too as fibrous cells. The above-mentioned immunology changes interaction to lead to the fact it is being swollen that the inflammatory cell is being given much trouble the hyperplasia of organ and formed the granulation.
Second, have illness coming on in the mechanism
It is the important amynologic characteristic of tubercle that the cell immunological function is low, are shown as peripheral blood lymphocytes are reduced, to many kinds of late person who send the intersection of skin and test react, subside or disappear, irritate lotion (BALF) to patient of tubercle disease the intersection of bronchus and alveolus Finding,increase macrophage at BALF and lymphocyte absolute number obviously, but the proportion that macrophages account for drops but the lymphocyte proportion rises, indicate the position of disease T cell function is obviously strengthened, drop and form the contrast with peripheral blood T lymphocytes, the two present and separate the phenomenon. Until the intersection of T and the intersection of cell and inferior group analyze, find activity issues of patient of tubercle disease T assist and induce cells (CD4) further in the BALF Obviously increase, and T inhibiting malicious cells (CD8) of cell It is normal to be lower than. Make CD4/CD8 ratio obviously rise.
Tubercle disease granulation is swollen from at there make up is skin kinds of cell, macrophage and some effect cell. Its mechanism is under the function of the outside antigen, T cell and macrophages in the alveolus are activated, release a series of lymphocytic factor, the ones that include T cells to emerge are lain between in vain plainly - 2 (IL-2)s , the factor (MCF) of hastening and melting of the monocyte , the monocyte moves the conduct and inhibits the factor (MIF) The ones that produce with macrophages are lain between in vain plainly - l (IL-1) . IL-1 can impel T lymphocytes to move the conduct to the intersection of pathological change and activity department, and impel its hyperplasia and division, form alveolus inflammation finishing a disease and relying mainly on the fact that inflammation cells or immune effect cells such as T cells, the monocyte and alveolus macrophage,etc. are soaked in early days, IL-1 can also make IL-2 receptor in surface of T cell expose, and impel T cells to release IL-2, IL-2 stimulates B cells, produce immunoglobulin (Ig) in the form of cloning more, can be seen high 's globulin blood disease at being clinical, as pathological change continues progress, the cell composition of alveolus inflammation is reducing constantly, have one kind of cells of skin and increase gradually, and it is not that the cheese granulation is swollen to form a typical one under the swollen function of stimulating the factor of granulation that it secretes gradually. On tubercle later stage, the fibrous conjugated proteln that release macrophages absorbs a large number of fibrous master cells, meanwhile, inflammation and immune effect cell around so that disappear while further reducing, cause the extensive fiber finally.
Organize pathology, the early pathology of tubercle displays mainly T lymphocyte, monocyte and macrophage soak alveolus inflammation caused in the alveolus; Until pathological change develop, the intersection of cell and composition, alveolus of inflammation reduce constantly, and upper the intersection of peel and kinds of cell that macrophage derive and become increase and preponderate gradually, under formating and secreting swollen function which stimulate the factor of the granulation, it is not that a kind of tubercle granulation of cheese is swollen to form a typical one gradually; Pathological change later stage, the connection that alveolus macrophages release is plain can be attracted and become fibrous cells in a large amount, make it and ground substance stick outside the cell, in addition what macrophage secrete become fibrous the intersection of cell and growth factor impel fibrous the intersection of cell and hyperplasia, cause the extensive fiber of lung. Acute the intersection of tubercle and the intersection of disease and arthritis and the intersection of patient and the intersection of joint and slippery membrane and tendon sheath of tenosynovitis examine pathology, show cheese swollen kind of granulation changes while being living, and there are T lymphocytes that are soaked; Chronic the intersection of tubercle and the intersection of joint and slippery membrane, disease of arthritis become extensive hyperplasia, tubercle joint, disease of arthritis accumulate liquid, ooze out liquid for inflammation nature; Patient's slippery membrane of inflammation is organized normally around the tubercle joint.
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