Diagnosis and Treatment of Hemoptysis

Question 1. Write short note on hemoptysis.
Answer. Hemoptysis is defined as coughing out of the blood which includes stained sputum.

Causes of hemoptysis

• Pulmonary infection: Tuberculosis, lung abscess, bronchiectasis, aspergilloma
• Mitral stenosis
• Tumor: Carcinoma, adenoma, endobronchial, metastasis.
• Pulmonary infarction.
• Trauma: Pulmonary contusion, transbronchial biopsy, transthoracic needle biopsy.
• Hemorrhagic diathesis: Purpura, leukemia, hemophilia.
• Pulmonary hemorrhage: Hemorrhagic fever, systemic lupus erythematous.
• Vascular abnormalities.
• Anticoagulants.
• Idiopathic: Symptoms and signs are of pulmonary and cardiac disease.

Read And Learn More: Oral Medicine Question And Answers

Investigations of hemoptysis

• Hemodynamic resuscitation and bronchoscopy is done.
• Chest radiograph for TB, pneumonia, tumor, pulmonary infarction.
• Full blood count and hematological tests.
• Bronchoscopy to exclude central bronchial carcinoma and to provide tissue diagnosis for the suspected.
• CT scan: For peripheral lesion investigation which are seen on chest radiograph.

Management of hemoptysis

• Establishing a diagnosis is a first priority.
• When hemoptysis is maintained, adequate gas exchange preventing blood from spleening into unaffected area of lung and avoiding asphyxiation are the highest priority.
• Keeping the patient at rest and partially suppressing cough are helpful to subside bleeding.
• If origin of blood is known and is limited to one lung, then bleeding lung should be placed in the dependent position so that blood is not aspirated to the affected lung.
• Endotracheal intubation and mechanical intubation are necessary to maintain the airways.
• Balloon catheters and inflattening balloon at the bleeding site are helpful in control of the bleeding.
• LASER phototherapy, embolotherapy and surgical resection of involved area of lung are the other methods. Surgical resection is done in life-threatening hemoptysis.

Question 2. Write short note on halitosis.
Answer. Halitosis is the term used to describe noticeably unpleasant odor exhaled in breathing.

Classification of Halitosis

• Genuine Halitosis: Physiologic halitosis.
  • Oral
  • Extraoral.
• Pseudohalitosis: Halitophobia.

Etiology

Causes for Physiologic Halitosis

• Mouth breathing.
• Medications.
• Aging and poor dental hygiene.
• Fasting/Starvation.
• Tobacco.
• Foods and alcohol.

Causes for Pathologic Halitosis

• Periodontal infection: Odor from subgingival dental biofilm. Specific diseases such as ANUG and pericoronitis.
• Tongue-coating harbors microorganisms.
• Stomatitis, xerostomia.
• Faulty restorations retaining food and bacteria.
• Unclean dentures.
• Oral pathologic lesions such as oral cancer, candidiasis.
• Parotitis, cleft palate.
• Aphthous ulcer, dental abscess.

Management of Halitosis

The treatment of halitosis is a step-by-step problem-solving procedure.

• The simplest way from distinguishing oral from non-oral origin is to compare smell from mouth and nose. If origin is from nose patient is referred to concerned specialist, and if origin is from mouth, patient is referred to the dentist for treatment.
• For genuine halitosis with oral causes the treatment is as follows:
  • Reduction of anabolic load by improving oral hygiene and basic periodontal health by basic dental care, if necessary incorporate advanced oral hygiene methods including oral irrigation and sonic or ultrasonic tooth brushes.
    • If halitosis persists in spite of adequate conventional oral hygiene, tongue brushing is advised.
    • Use of chlorhexidine mouth rinses causes reduction of micro organisms which leads to reduction of halitosis.
    • Conversion of volatile sulfur compounds by using various metal ions. Zinc is an ion which bond to twice negatively charged sulfur radicals to reduce expression of volatile sulfur compounds. Halita is a new solution containing 0.55 %, chlorhexidine, 0.05% cetylpyridinum chloride and 0.14 % zinc lactate with no alcohol is more efficient than 0.2 %. Chlorhexidine formulation in reducing volatile sulfur compounds.