The first thing to note in evaluating hemoptysis was to determine whether the bleeding originated from the lower respiratory tract, from the upper airway (eg, epistaxis), or from the gastrointestinal tract (haematemesis). Determination of the source of bleeding is important because it determines the next management step. History and examination is crucial in determining whether there is bleeding that hemoptysis, epistaxis, or hematemesis.
To make a diagnosis, as well as in other diseases needs to be done sequences of a thorough history and physical examination until the investigation so that treatment can be adjusted.
Anamnesis In Hemoptysis
- To obtain a complete medical history should be sought to obtain these data:
- The amount and color of blood
- The duration of bleeding
- Cough is productive or not
- Cough occurred before or after the bleeding
- Chest pain, substernal or pleuritic
- Bleeding conjunction with: rest, physical movement, body position and cough
- History of pulmonary disease or previous heart.
- Bleeding at other places along with coughing up blood
- Heavy smoker and has a long
- Pain or swelling in the leg and chest pain
- History of previous drug use.
To distinguish between coughing up blood throwing up blood can be used with the following instructions:
Hemoptysis state Haematemesis
- Prodromal Discomfort in the throat, coughing like nausea, stomach distress
- Onset of Blood coughed blood can induce vomiting with cough
- Not bubbly froth of blood appearance
- Colors Red Dark red fresh
- Content of leukocytes, microorganisms, macrophages, hemosiderin Leftover food
- Reaction alkaline (high pH) Acid (low pH)
- History of pulmonary disease Long Disorder Suffer from stomach disorders, liver disorders
- Sometimes anemia is always
- Normal stool color stool Guaiac test (-) Feces can be black, guaiac test (+)
- Benzidine test (-) Benzidine test (+)
Physical examination can help diagnose the cause of hemoptysis. Upper airway examination should be done carefully to rule out the possible source of bleeding other than the lungs or lower respiratory tract. The mouth also needs to be checked on the possibility of lacerations and tumors. Indirect laryngoscopy examination to rule out the possibility of bleeding from around the pharynx.
Additional breath sounds such as stridor or wheezing may provide clues tumor / foreign body trakeolaring area, ronkhi wet with or without wheezing showed bronchiektasis. Bleeding from the bronchial arteries or capillary pulmonary crackles reflected from the discovery of wet or dry crackles locally.
On examination of the heart could be found indicating the typical murmur of mitral stenosis as a cause of hemoptysis. Picture of saddle nose or septum perforation may indicate Wegener’s granulomatosis. Clubbing (clubbing) give directions and the possibility of malignancy intratorakal intratorakal suppuration (lung abscess, bronchiectasis) .
Laboratory In Hemoptysis
Peripheral blood complete examination should be conducted to determine the number of red blood cells, hemoglobin and blood clotting factors (PT, aPTT). Getting the hemoglobin can quickly find out the amount of bleeding and further penatalaksanaaan. Blood gas analysis, electrolytes, renal and liver function should be examined to determine the clinical state of patients due to hemoptysis and analyze the possible causes.