How to take sputum for analysis. Taking sputum for bacteriological examination General clinical analysis of sputum Purpose of the study
Bacteriological examination of sputum can detect pathogens of lung diseases. A purulent, bloody lump of sputum is rubbed between two glass slides. The dried smears are fixed on fire, then one is stained according to Gram (see Gram staining method), the other according to Tsil - Nelsen. Gram staining allows you to detect gram-positive microbes - capsular pneumococcus (Fig. 17),; gram-negative - Friedlander's capsular diplobacillus (Fig. 18), Pfeiffer's bacillus (Fig. 19), etc. Mycobacterium tuberculosis is searched for in a smear stained but by Tsil - Nelsen. A piece of filter paper is placed on the smear, equal in area to the smear, Ziel's fuchsin is poured onto it (1 g of basic fuchsin is ground in a mortar with a few drops of glycerin, then with 10 ml of 96% alcohol and poured into 90 ml of 5% phenol solution) and heated for low flame until fumes appear. The paper is discarded, the smear is dipped in a 5-10% solution (or 3% solution in alcohol) until it becomes discolored, washed well with water, stained for 20-30 seconds. 0.5% methylene blue solution and washed with water. Red mycobacteria are clearly visible (with an immersion system) against a blue background of the preparation (Fig. 20). If mycobacterium tuberculosis is not found in the smear, they resort to the method of their accumulation - flotation. 10-15 ml of sputum is placed in a 250 ml bottle with sloping shoulders, a double volume of 0.5% solution is added and shaken until the sputum is completely dissolved. Add 100 ml of distilled water and 1 ml (xylene, gasoline), shake for 10-15 minutes, add water to the neck and leave for 1-2 hours. The creamy layer formed on top is sucked off with a pipette with a spray can and applied dropwise to a heated glass, each time to the previous dried drop. The preparation is fixed and stained according to Tsil - Nelsen. If the result is negative, they resort to sowing sputum (bacteriological examination) or inoculating it into an animal (biological examination). Sputum cultures are also used to determine the sensitivity of its flora to antibiotics.
Chemical research. The reaction of sputum to litmus, as a rule, is slightly alkaline, it can become acidic when sputum decomposes and when gastric contents are mixed (sour eructation, gastrobronchial fistula). The protein in sputum comes from the inflammatory exudate and from the breakdown of leukocytes. It is small (traces) in mucous sputum, a lot (1-2%) in sputum with pneumonia, even more with pulmonary edema. To determine it, a double amount of a 3% solution of acetic acid is added to the sputum, vigorously shaken, filtered, and the protein is determined in the filtrate by one of the usual methods (see Urine). Triple dilution is taken into account.
Bacterioscopic, bacteriological and biological research. The study of the microbial flora of sputum is necessary to clarify the diagnosis and to choose the right method of treatment. This purpose is served by bacterioscopic, bacteriological and biological research. A bacterioscopic examination achieves its goal with a relatively high content of microbes in sputum. To prepare preparations, a purulent lump is transferred to the outer third of a slide, covered with the same part of another slide and rubbed between them. The smears are allowed to dry, fixed by passing through the flame of a gas burner three times and stained, one by Gram (see Gram method of staining), the other by Ziehl-Nelsen (see Tuberculosis, laboratory tests). Gram-staining reveals gram-positive capsular pneumococcus, gram-negative capsular pneumococcus Friedlander, Pfeifer's bacillus (printing. Fig. 5, 6 and 8), staphylococcus aureus, streptococcus, Vincent's bacillus, spirillum, catarrhal micrococcus, etc. In the study, note the number found in the field of view bacteria (few, moderate, many) and the predominance of any species. The Ziel-Nelsen method stains acid-resistant microbes, mainly Mycobacterium tuberculosis. Mycobacteria with this color are red and are clearly visible on a blue background (tsvetn. Fig. 1).
A slightly larger percentage of Mycobacterium tuberculosis is detected using fluorescent microscopy (see). Luminous mycobacteria are clearly visible when examining a smear with a dry X40 objective with an XYu eyepiece. Smears are prepared and fixed as usual, then poured for 5-10 minutes. dye solution (auramine 1: 1000, acridine orange, a mixture of auramine and rhodamine), washed with water, discolored for 5 minutes. hydrochloric alcohol, washed again with water and treated
a solution of acid fuchsin (sour fuchsin 1 g, acetic acid 1 ml, distilled water 500 ml) or methylene blue, which quench the background glow. The drug is viewed in ultraviolet light (tsvetn. Fig. 2).
To facilitate the search for Mycobacterium tuberculosis, they resort to accumulation methods, of which the flotation method is more often used. 10-15 ml of sputum are placed in an Erlenmeyer flask or a bottle with sloping shoulders with a capacity of 250 ml, an equal volume of 0.5% sodium hydroxide solution is added and the mixture is shaken until it is homogenized. Add 50 ml of distilled water and 1 ml of toluene (xylene, gasoline), shake, add water again to half the bottle and shake for 10-15 minutes, then add water to the neck and leave for 1-2 hours. The creamy layer formed on top is sucked off with a pipette with a spray can, applied to a heated glass slide, dried, fixed and stained according to Ziehl-Nelsen.
Bacteriological research is used to identify microbes, determine their drug resistance, virulence, etc. Sputum is inoculated on appropriate nutrient media - dense (blood agar) or liquid (sugar broth, Tarozzi media), Shkolnikova's semi-synthetic medium; (tsvetn. Fig. 3 and 4). Microbes grown on appropriate nutrient media identify, determine their pathogenicity (in some cases) and drug resistance, and preliminarily determine the drug resistance of the entire sputum flora as a whole. This is done by inoculating pieces of sputum, previously washed with saline, on the surface of blood agar in a Petri dish. Standard antibacterial paper discs are laid out for sowing. The sensitivity of the flora is judged by the size of the zone of growth inhibition of the flora around the disc. Then, the final determination of the resistance of each bacterial species isolated from sputum is performed separately. To do this, an 18-hour broth culture of each type of bacteria (staphylococci, streptococci, Klebsiella, etc.) is seeded with a lawn on Petri dishes with blood agar. Standard paper discs with antibiotics are laid out on the lawn, pressing them with tweezers to the surface of the agar so that they tightly touch the agar with the entire surface. The cups are left at room temperature for 1.5-2 hours; during this time there is sufficient diffusion of the drug from the disks into the surrounding agar layers. Then the Petri dishes are placed in a thermostat at t°37° for 18-24 hours. The stability of the studied strain is judged by the zone of bacterial growth inhibition around the disks. In the absence of a delay zone, the strain is considered resistant. If a zone of 1.5-2 cm in diameter is formed, the strain is considered weakly sensitive, and if the zone is more than 2 cm, it is sensitive to this antibiotic.
For sputum cultures for Mycobacterium tuberculosis, see Pulmonary Tuberculosis, Sputum Test for Mycobacterium Tuberculosis; for determining their sensitivity to antibiotics, see Pulmonary tuberculosis, drug resistance of mycobacteria.
In a biological study of sputum, animals are infected. As a diagnostic method, this method is supplanted by cultural methods.
Target:
Diagnostic.
Indications:
Respiratory diseases and cardiovascular diseases.
Equipment:
Clear glass wide-mouth jar made of transparent glass, direction.
Sequencing:
1. Explain the collection rules, get consent.
2. In the morning, brush your teeth and rinse your mouth with boiled water.
3. Cough up and collect 3-5 ml of sputum in a jar, close the lid.
4. Issue a referral.
5. Deliver to the clinical laboratory within 2 hours.
Note:
To determine the daily amount, sputum is collected during the day in one large dish and stored in a cool place.
It is not allowed to contaminate the can from the outside.
Estimated: consistency (viscous, gelatinous, vitreous), color (transparent, purulent, gray, bloody), cellular composition (presence of leukocytes, erythrocytes, epithelium, additional inclusions.
Collection of sputum for bacteriological examination:
Target:
Identification of the causative agent of the disease and determination of its sensitivity to antibiotics.
Equipment:
Sterile test tube or jar with a lid (ordered in the laboratory tank), direction.
Sequencing:
1. Explain the purpose and essence of sputum collection, obtain consent.
2. In the morning on an empty stomach after the toilet of the oral cavity and before the appointment of a / b.
3. Bring the test tube or jar to your mouth, open it without touching the edges of the dishes with your hands and cough up sputum with your mouth and immediately close the lid, observing sterility.
4. Send the analysis to the bacteriological laboratory within 2 hours in a container by special transport. Note: the sterility of dishes is maintained for 3 days.
Sputum collection for MBT (mycobacterium tuberculosis):
Target:
Diagnostic.
Sputum collection procedure:
1. Explain the essence and purpose of the appointment, obtain consent.
2. Issue a referral.
3. In the morning on an empty stomach after the toilet of the oral cavity, after several deep breaths, cough up sputum into a clean, dry jar (15-20 ml), close the lid. If there is little sputum, then it can be collected within 1-3 days, keeping in a cool place.
4. Deliver the analysis to the clinical laboratory.
Note: If sputum culture is prescribed for VC, then sputum is collected in a sterile dish for 1 day, stored in a cool place, and delivered to the bacteriological laboratory.
Sputum collection for atypical cells:
Target:
Diagnostic (diagnosis, exclusion of oncopathology).
Collection sequence:
1. Explain to the patient the rules for collecting sputum.
2. In the morning after using the oral cavity, collect sputum in a clean, dry jar.
3. Issue a referral.
4. Deliver to the cytology laboratory immediately, because abnormal cells are rapidly destroyed.
Rules for using a pocket spittoon:
The spittoon is used by patients who produce sputum.
It is forbidden:
Spit sputum on the street, indoors, in a handkerchief, towel;
Swallow mucus.
The spittoon is disinfected as it is filled, but at least once a day. With a large amount of sputum - after each use.
To disinfect sputum: pour 10% bleach at a ratio of 1:1 for 60 minutes or dry bleach at the rate of 200 g/l of sputum for 60 minutes.
When allocated or suspected of VK- 10% bleach for 240 minutes or dry bleach for 240 minutes in the same proportions; 5% chloramine for 240 min.
After disinfection, the sputum is drained into the sewer, and the dishes in which the sputum was disinfected are washed in the usual way, followed by disinfection.
Disinfection of pocket spittoons: boiling in 2% soda solution for 15 minutes or in 3% chloramine for 60 minutes.
Sputum examination involves the determination of the physical properties of sputum, its microscopic examination in a native smear and bacteriological examination in stained preparations.
Collection of material
Sputum obtained by coughing in the morning before meals is collected in a clean, dry bottle. Before the examination, the patient should brush their teeth and rinse their mouth thoroughly with water.
Physical properties
Sputum is placed in a Petri dish, examined against a light and dark background, and its properties are described. The amount of sputum per day for various pathological processes can be different: for example, with bronchitis - scanty (5-10 ml), with a lung abscess, bronchiectasis - a large amount (up to 200-300 ml).
The division into layers is observed in cases of emptying of large cavities in the lung, for example, lung abscess. In this case, sputum forms 3 layers: the lower layer consists of detritus, pus, the upper layer is liquid, sometimes there is a third layer on its surface - a foamy layer. Such sputum is called three-layer.
Character: the nature of sputum determines the content of mucus, pus, blood, serous fluid, fibrin. Its character can be mucous, mucous-hyoid, mucous-purulent-bloody, etc.
Color: depends on the nature of the sputum, on exhaled particles that can color the sputum. For example, a yellowish, greenish color depends on the presence of pus, "rusty" sputum - from the breakdown of red blood cells, occurs with croupous pneumonia. Blood streaks in sputum or red sputum may be mixed with blood (tuberculosis, bronchiectasis). Gray and black color gives sputum coal.
Consistency: depends on the composition of sputum, liquid - mainly on the presence of serous fluid, sticky - in the presence of mucus, viscous - fibrin.
Odor: Fresh sputum is usually odorless. The unpleasant smell of freshly excreted sputum usually appears with a lung abscess, with lung gangrene - putrefactive.
microscopic examination
Native preparations are prepared by selecting material from different places of sputum, and all particles that stand out in color, shape, and density are also taken for research.
The selection of the material is carried out with metal sticks, placed on a glass slide and covered with a coverslip. The material must not extend beyond the coverslip.
Leukocytes: always found in sputum, their number depends on the nature of the sputum.
Eosinophils: are recognized in the native preparation by a darker color and the presence of a clear, uniform, light-refracting granularity in the cytoplasm. Often located in large clusters. Eosinophils are found in bronchial asthma, other allergic conditions, helminthiasis, lung echinococcus, neoplasms, eosinophilic infiltrate.
Erythrocytes: have the appearance of yellow discs. Single erythrocytes can be found in any sputum, in large numbers - in sputum containing an admixture of blood: neoplasms of the lung, tuberculosis, pulmonary infarction.
Squamous epithelial cells: get into the sputum from the oral cavity, nasopharynx, do not smolder of great diagnostic value.
Cylindrical ciliated epithelium: lines the mucous membrane of the larynx, trachea, bronchi. It is found in large quantities in acute catarrhs of the upper respiratory tract, bronchitis, bronchial asthma, lung neoplasms, pneumosclerosis, etc.
Alveolar macrophages: large cells of various sizes, often round, with black-brown inclusions in the cytoplasm. They are more common in mucous sputum with a small amount of pus. They are found in various pathological processes: pneumonia, bronchitis, occupational diseases of the lungs, etc. Alveolar macrophages containing hemosiderin, the old name is "cells of heart defects", have golden yellow inclusions in the cytoplasm. To identify them, a reaction to Prussian blue is used. Reaction course: a piece of sputum is placed on a glass slide, 2 drops are added 5% hydrochloric KIOLOTE solution and 1-2 drops 5% yellow blood salt solution. Stir with a glass rod and cover with a coverslip. Hemosiderin lying intracellularly stains blue or blue. These cells are found in sputum during congestion in the lungs, lung infarcts.
Fatty degeneration of cells (lipophages, fat balls): more often rounded, their cytoplasm is filled with fat. When Sudan III is added to the preparation, the drops turn orange. Groups of such cells are found in neoplasms of the lung, actinomycosis, tuberculosis, etc.
Elastic fibers: in sputum they look like crumpled shiny fibers. As a rule, they are located against the background of leukocytes and detritus. Their presence indicates the decay of lung tissue. They are found in abscess, tuberculosis, neoplasms of the lung.
Coral fibres: Rough branching formations with tuberous thickenings due to the deposition of fatty acids and soaps on the fibres. They are found in sputum with cavernous tuberculosis.
Calcified elastic fibers are coarse rod-shaped formations impregnated with lime salts. They are found during the collapse of a petrified focus, lung abscess, neoplasms, the element of decay of a petrified focus is called Ehrlich's tetrad: I) calcified elastic fibers; 2) amorphous lime salts; 3) cholesterol crystals; 4) Mycobacterium tuberculosis.
Spirals Kurshma on_- mucus formations are compacted, twisted into a spiral. The central part sharply refracts light and looks like a spiral, along the periphery, free-lying mucus forms a mantle. Curshman spirals are formed with bronchial ace tme.
Crystal formations: Charcot-Leiden crystals, elongated shiny diamonds, can be found in yellowish sputum pieces containing a large number of eosinophils. Their formation is associated with the breakdown of eosinophils,
Hematoidin crystals: have the shape of rhombuses and golden needles. They are formed during the breakdown of hemoglobin during hemorrhages, the decay of neoplasms. In the preparation of sputum are usually visible against the background of detirit, elastic fibers.
Cholesterol crystals: colorless quadrilaterals with a broken off step-like angle, are found during the decay of fatty degenerate cells, in cavities. Meet with tuberculosis, lung abscess, neoplasms.
Dietrich's plugs: small yellowish-gray grains with an unpleasant odor, found in purulent sputum. Microscopically they are detritus, bacteria, crystals of fatty acids in the form of needles and droplets of fat. Formed during stagnation of sputum in the cavities with lung abscess, bronchiectasis.
Bacteriological research
Test for tuberculosis mycobacteria: The drug is prepared from purulent sputum particles, dried
in air and fixed over the flame of the burner. Dyed by
Tsil-Nilson.
Staining method: Reagents:
I) carbolic fuchsin,
2) 2% alcoholic solution of hydrochloric acid,
3) an aqueous solution of 0.5% methylene blue.
Coloring progress:
1. A piece of filter paper is placed on the preparation and a solution of carbolic fuchsin is poured.
2. The drug is heated over the flame of the burner until vapors appear, cooled and heated again (so 3 times).
3. Remove the filter paper from the cooled glass. Discolor the smear in hydrochloric alcohol until the paint is completely gone.
4. Washed with water.
5. Finish the preparation with methylene blue for 20-30 seconds.
6. Rinse with water and air dry. Microscopically with an immersion system. Mycobacterium tuberculosis stains red
all other elements of sputum and bacteria - in blue. Tuberculous mycobacteria have the appearance of thin, slightly curved rods with thickenings at the ends or in the middle.
Acid-resistant saprophytes are also stained red when stained according to Ziehl-Nielson. Differential diagnosis of tuberculous microbacteria and acid-resistant saprophytes is carried out by methods of sowing and infection of animals.
Sputum examination can also be carried out by the flotation method. Potenger method: research progress:
1. Freshly isolated sputum (no more than 10-15 ml) is placed in a narrow-necked bottle, a double amount of caustic alkali is added, the mixture is vigorously shaken (10-15 minutes).
2. Pour in 1 ml of xylene (you can use gasoline, toluene) and about 100 ml of distilled water to thin the sputum. Shake again for 10-15 minutes.
3. Add distilled water to the neck of the bottle and leave to stand for 10-50 minutes.
4. The resulting upper layer (whitish) is removed drop by drop with a pipette and applied to glass slides preheated to 60°. Each subsequent drop is applied to the dried previous one.
5. The preparation is fixed and stained according to Ziehl-Nilson.
Test for other bacteria:
Other bacteria found in sputum, such as streptococci, staphylococci, diplobacilli, etc., can only be recognized by culture. Bacteriological examination of the preparation in these cases is only of approximate value. Preparations are stained with methylene blue, fuchsin or g frame. Gram stain: Reagents: I) carbolic solution of gentian violet,
2) Lugol's solution,
3) 96° alcohol,
4) 40% solution of carbolic fuchsin.
Research progress:
1. A strip of filter paper is placed on the fixed preparation, a solution of gentian violet is poured, stained for 1-2 minutes.
2. The paper is removed and the drug is poured with Lugol's solution for 2 minutes.
3. Lugol's solution is drained and the drug is rinsed in alcohol until gray.
4. Washed with water and stained for 10-15 seconds with a solution of magenta.
Bacteriological examination of sputum makes it possible to detect pathogens of various diseases. The presence of tuberculosis mycobacteria in the sputum is important for the diagnosis. Sputum for tank - research for sowing is collected in a sterile dish (wide-mouthed). The dishes are issued by the tank - laboratory.
ATTENTION!!!
If there is not enough sputum, it can be collected up to 3 days, keeping it in a cool place.
Sputum on the tank - sowing in tuberculosis patients for the reliability of the result is collected within 3 days, in different sterile containers (3 jars).
If it is necessary to prescribe antibiotics, sputum is examined for sensitivity to them. To do this, the patient in the morning, after rinsing his mouth, coughs and spits sputum several times (2-3 times) into a sterile Petri dish, which is immediately sent to the laboratory.
ATTENTION!!!
Give clear instructions to the patient about the use of sterile utensils to collect sputum for analysis:
a) do not touch the edges of the dishes with your hands
b) do not touch the edges with your mouth
c) after expectoration of sputum, immediately close the container with a lid.
THEN item 7
To the tank - laboratory
Sputum for microflora and
sensitivity to
antibiotics (a/b)
Sidorov S.S. 70 years old
3/IV–00 signed m/s
Sputum analysis for bacteriological examination.
Target: to ensure high-quality preparation for the study and timely receipt of the result.
Training: informing and educating the patient.
Equipment: sterile jar (spittoon), direction.
Execution sequence:
Explain to the patient (family member) the meaning and necessity of the upcoming study and obtain his consent to the study.
A) in stationary conditions:
briefing and provision of laboratory glassware to be carried out the night before;
B) in outpatient and inpatient settings explain to the patient the features of preparation:
brush your teeth thoroughly the night before;
in the morning after sleep, rinse your mouth thoroughly with boiled water
Instruct the patient on how to handle sterile laboratory glassware and how to collect sputum:
Cough, open the lid of the jar (spittoon) and spit out sputum without touching the edges of the jar;
Close the lid immediately.
Ask the patient to repeat all the information, ask questions about the technique of preparation and collection of sputum.
Indicate the consequences of violating the nurse's recommendations.
A) on an outpatient basis:
Give a direction for the study by filling it out in the form;
Explain to the patient where and at what time he (the family) should bring the bank and referral.
B) in a hospital setting:
Indicate the place and time where to bring the jar (spittoon);
Deliver the collected material to the bacteriological laboratory no later than 1.5 - 2.0 hours after the collection of the material.
Storage of material even in cold conditions is unacceptable!
Taking feces for analysis.
A great help in recognizing a number of diseases, including gastrointestinal ones, is the study of feces. Determination of the basic properties of feces by examination makes it possible to draw a number of diagnostic conclusions and is available to the sister.
The daily amount of feces in a healthy person depends on the quality and quantity of food, and on average is 100 - 120 g. If absorption is impaired and the rate of movement through the intestines is increased (enteritis), the amount of feces can reach 2500 g, with constipation, feces are very small.
Fine- bowel movements are performed once a day, usually at the same time.
ATTENTION!!!
For research, it is better to take feces after an independent act of defecation in the form in which it is excreted.
bacteriologically
macroscopically
Kal explore microscopically
chemically
Macroscopically determined:
A) color, density (consistency)
B) shape, smell, impurities
Color–fine
with mixed food - yellowish-brown, brown;
with meat - dark brown;
with milk - yellow or light yellow;
the newborn is greenish-yellow.
REMEMBER!!! The color of feces can change:
Fruits, berries (blueberries, currants, cherries, poppies, etc.) - in a dark color.
Vegetables (beets, carrots, etc.) - in a dark color.
Medicinal substances (salts of bismuth, iron, iodine) - in black.
The presence of blood gives the feces a black color.
Consistency(density) feces are soft.
In various pathological conditions, feces can be:
semi-liquid
Putty (clay), often gray in color and depends on a significant admixture of undigested fat.
mushy
moderately dense
The shape of the feces- Normally cylindrical or sausage-shaped.
With spasms of the intestines, feces can be ribbon-like or in the form of dense balls (sheep feces).
Smell of feces depends on the composition of the food and the intensity of the processes of fermentation and decay. Meat food gives a pungent odor. Dairy - sour.
Pathological secretions of the respiratory organs are called, which are thrown out when coughing. When conducting laboratory studies of sputum, it becomes possible to characterize the pathological process in the respiratory system, in some cases it becomes possible to determine its etiology. To do this, carry out the following actions:
- sputum is collected for general clinical analysis;
- sputum is collected to detect tuberculosis in the respiratory organs;
- sputum is collected to look for abnormal cells;
- sputum is collected to determine sensitivity to antibiotics.
The area of the pleura of a healthy person contains a certain amount of fluid, which facilitates the sliding of the pleura during breathing and is very close in composition to the lymph. In cases of violation of the circulation of blood and lymph in the cavity of the lungs, an increase in the volume of pleural fluid is possible. This can occur both during inflammatory changes in the pleura (exudate), and during processes that occur in the absence of inflammation. Primary clinical infection of the pleura may contribute to the manifestation of exudate, or it may accompany some general infections and in the case of certain diseases of the lungs and mediastinum, such as rheumatism, heart attack, tuberculosis and lung cancer, lymphogranulomatosis. The pleural fluid is examined for the following purposes: determination of its nature; study of the cellular composition of the fluid, containing information about the properties of the pathological process, and in some cases (with tumors) and about the diagnosis; with lesions of an infectious nature, the identification of the pathogen and the determination of its sensitivity to antibiotics. The analysis of the pleural fluid includes the conduct of physicochemical, microscopic, and in some cases microbiological and biological studies.
Methods for the study of sputum
For the study of sputum in the respiratory organs, radiography, fluoroscopy, bronchography and lung tomography are used.
Fluoroscopy is the most common research method that allows you to visually determine how the transparency of the lung tissue changes, detect places of compaction or cavities in its structure, determine the presence of air in the pleural cavity and other pathologies.
Radiography is carried out in order to record and document changes in the respiratory system detected during fluoroscopy, which appear on x-ray film. Pathological processes that occur in the lungs can lead to a loss of airiness, followed by compaction of the lung tissue (lung infarction, pneumonia, tuberculosis). In this case, healthy lung tissue on the negative film will be darker than the corresponding areas of the lungs. The cavity of the lung, which contains air, surrounded by an inflammatory ridge, will look like an oval dark spot in the pale shadow of the lung tissue. The fluid contained in the pleural plane transmits a smaller amount of X-rays compared to lung tissue, leaves a shadow on the X-ray negative film that has a darker shade compared to the lung tissue shadow. Carrying out radiography makes it possible to determine the amount of fluid in the pleural cavity and its nature. In the event that there is an inflammatory fluid or exudate in the pleural cavity, its level of contact with the lungs has the form of an oblique line directed upwards from the line of the middle clavicle. If there is an accumulation of non-inflammatory fluid or transudate in the pleural cavity, its level is located more horizontally.
Bronchography is performed to study the bronchi. After preliminary anesthesia of the respiratory tract has been carried out, a contrast agent is injected into the lumen of the bronchi, which delays x-rays. After that, an x-ray of the lungs is taken in order to obtain a clear image of the bronchial tree on the x-ray. This method makes it possible to diagnose the expansion of the bronchi, as well as their narrowing as a result of a tumor or a foreign body entering the lumen of the bronchi.
Lung tomography is a special type of radiography, which makes it possible to carry out a layered X-ray examination of the lungs. It is carried out to determine the presence of tumors in the bronchi and lungs, cavities and cavities located in the lungs at different depths.
Collection of sputum for research
It is best to collect sputum for research in the morning, since it accumulates at night, and before eating. Preliminary brushing of the teeth and rinsing the mouth with boiled water ensure the reliability of sputum analysis. All this makes it possible to significantly reduce the contamination of bacteria in the oral cavity.
To collect sputum, a special one-time sealed bottle is used, made of a material with sufficient impact resistance and a tightly closed lid or a cap that is tightly screwed on. It is necessary that the bottle has a capacity of 25-50 ml and a wide opening. This is required in order for the patient to be able to spit sputum into the vial. In order to be able to assess the quality and quantity of the sample that has been collected, the material from which the vial is made must be completely transparent.
In the event that the collected sputum needs to be transported to another institution, the vials with the collected material should be stored in the refrigerator for no more than three days until it is sent. If it is necessary to store for a longer period, a preservative should be used. During transportation, sputum must be protected from exposure to wind and direct sunlight.
Sputum examination for general analysis
A sputum examination for a general analysis usually begins with an examination of its appearance. At the same time, some general rules are observed: transparent mucus means standard external sputum, the inflammatory process is characterized by the presence of cloudy sputum. Serous sputum has no color, it is distinguished by a liquid consistency and the presence of foam. Its release occurs with pulmonary edema.
Putrid sputum is characterized by the presence of pus. Its color is green and yellow. Most often, putrefactive sputum is observed when a lung abscess breaks into the bronchus, in most cases it is in the form of a mixture of pus and mucus.
Green sputum is present in the pathology associated with slowing down the outflow. It can be sinusitis, bronchiectasis, disorders after tuberculosis. In the event that green sputum appears in adolescent children, chronic bronchitis should not be assumed, and ENT pathology can also be excluded.
An allergic reaction and eosinophilia are identified by the appearance of amber-orange sputum.
Pulmonary bleeding is characterized by the appearance of bloody sputum, or mixed, in particular mucopurulent with blood streaks. When blood is retained in the respiratory tract, hemoglobin is converted to hemosiderin, followed by the acquisition of a rusty hue by sputum. The presence of blood in the sputum is an alarming factor that requires special investigation.
Pearly sputum is distinguished by rounded opalescent inclusions, consisting of detritus and atypical cells. Seen in squamous cell lung cancer.
Bacteriological examination of sputum
Conducting a bacteriological examination of sputum allows you to establish the presence of pathogens of pulmonary diseases. A purulent lump of sputum with blood is rubbed between two glasses. The hardened smears are subject to fire fixation, after which one of them is stained in accordance with the Gram staining method, and the other with the Ziehl-Neelsen staining method. The first staining method allows detecting gram-positive microbes, the second - tuberculosis bacteria. A piece of filter paper should be applied to the smear, equal in area to the smear itself, pour Tsilya fuchsin on it and heat it on a low flame until vapors appear. After the paper is discarded, the smear should be dipped in a solution of sulfuric acid, a concentration of 5-10% or a solution of hydrochloric acid, a concentration of 3% to discolor it, after which it should be washed well with water. Then, for half a minute, it should be repainted with a solution of blue methylene, a concentration of 0.5%, after which it is again washed with water. On the blue background of the drug, red mycobacteria are well displayed. In the event that mycobacterium tuberculosis is not found in the smear, the method of their accumulation - flotation is used. 15-25 ml of sputum are placed in a container with a volume of a quarter of a liter, a double volume of caustic sodium solution, a concentration of 0.5%, is added to it, after which the resulting mixture is shaken until the effect of complete dissolution of sputum is obtained. 100 ml of distilled water is added with 2 ml of toluene, the mixture is shaken for fifteen minutes, after which it is topped up with water from the neck of the bottle and kept for two hours. A layer is formed on top, resembling cream in its consistency, it is sucked off with a pipette with a spray can and drops are applied to a heated glass, each time on the previous dried drop. Then the drug is fixed and applied according to the Ziehl-Neelsen principle. If the result is negative, one should resort to bacteriological sputum culture or inoculation to an animal (biological study). In order to determine how sensitive the sputum flora is to antibiotics, they resort to its crops.
Microscopic examination of sputum
Microscopic examination of sputum consists of the study of stained and native (raw, natural) preparations. For the latter, purulent, crumbly, bloody lumps are selected, they are placed on a glass slide in such a volume that, when covered with a cover glass, a thin translucent preparation is formed. If the magnification of the microscope is low, Kirschman's spirals can be detected, which look like stretch marks of mucus of various thicknesses. They include a central axial line, which is wrapped in a spiral mantle interspersed with leukocytes. Such spirals appear in sputum with bronchospasm. Using a high magnification, one can detect leukocytes, alveolar macrophages, erythrocytes, cell formations characteristic of heart defects, flat and cylindrical epithelium, all kinds of fungi, cancer cells, eosinophils in the native preparation. Leukocytes are round granular cells. Erythrocytes are called yellowish homogeneous discs of small size, the appearance of which is characteristic of sputum with pneumonia, pulmonary infarction and destruction of lung tissue. Alveolar macrophages are cells three times larger than erythrocytes, with large, abundant granularity in the cytoplasm. The cylindrical epithelium of the respiratory tract is determined by the goblet or wedge-shaped cells. In large quantities, it appears in catarrh of the respiratory tract and acute bronchitis. Squamous epithelium is a large cellular formation with many angles, having no diagnostic value and originating from the oral cavity. Cancer cells are determined by large nuclei, for the recognition of the nature of which, significant experience of the researcher is required. These cells are large in size and have an irregular shape.
Macroscopic examination of sputum
When conducting a macroscopic examination of sputum, attention is drawn to its quantity and nature, smell, color, consistency, the presence of various inclusions and mucous.
The composition of sputum determines its character.
Mucous sputum includes mucus - a product of the activity of the mucous glands of the respiratory system. Its release occurs in acute bronchitis, resolution of attacks of bronchial asthma, catarrh of the respiratory tract.
Mucopurulent sputum is a mixture of pus and mucus, with a predominance of mucus and the inclusion of pus in the form of small lumps and veins. Its appearance occurs with purulent inflammation, bronchopneumonia, acute bronchitis.
Purulent-mucous sputum consists of pus and mucus with a predominance of pus, while mucus is presented in the form of strands. Its appearance is characteristic of chronic bronchitis, abscess pneumonia, bronchiectasis.
