Haemoptysis Flashcards
What can haemoptysis be confused with? (3)
• Haematemesis: brownish-red blood that is vomited from the gastrointestinal (GI) tract.
• Epistaxis (nosebleed): particularly posterior nosebleeds.
• Bleeding gums: combined with a cough, this may be confused with true
haemoptysis.
How can you check a patient presenting with haemoptysis is really haemoptysis? (6)
Ask them where they think the blood is coming from (e.g. initially from nose), colour (darker = partially digested), clots and history of N&V, gastric disease and alcoholism
How should you assess a history of alcoholism?
CAGE questions
Have you ever felt you need to Cut down on your drinking?
Have people Annoyed you by criticizing your drinking?
Have you ever felt Guilty about your drinking?
Have you ever needed an Eye-opener to steady your nerves in the morning?
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1st I causes of haemoptysis? (5)
pulmonary tuberculosis (TB), bronchitis, pneumonia, lung abscess, mycetoma
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N causes of haemoptysis? (2)
Neoplastic: primary lung cancer, metastatic lung cancer
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V causes of haemoptysis? (5)
Vascular: pulmonary infarction (embolism), left ventricular failure, bleeding diathesis, arteriovenous malformation, vascular–bronchial fistula
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2nd I causes of haemoptysis? (7)
Inflammatory: Wegener’s disease, Goodpasture’s syndrome, systemic lupus erythematosus, hereditary haemorrhagic telangiectasia (Osler–Weber–Rendu syndrome), polyarteritis nodosa, microscopic polyangiitis
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T causes of haemoptysis? (3)
Traumatic: iatrogenic (lung biopsy, post-intubation), wounds (broken rib)
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E causes of haemoptysis? (1)
Endocrine: (none)
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D causes of haemoptysis?
Degenerative: bronchiectasis
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M causes of haemoptysis? (1)
Metabolic: (none)
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D causes of haemoptysis? (2)
Drugs: warfarin (bleeding diathesis), crack cocaine use
Mnemonic for causes of haemoptysis
Infective Neoplastic Vascular Inflammatory Traumatic Endocrine (none) Degenerative Metabolic (none) Drugs
Most common causes of haemoptysis
Infection and exacerbations of COPD
What is the must exclude diagnosis of haemoptysis
Lung cancer
What questions should you ask initially about haemoptysis once confirmed that it is haemoptysis? (3)
What is he coughing up? (Frank blood blood, blood streaked sputum, pink frothy sputum)
How much is he coughing up? Quantify (teaspoon, tablespoon, eggcup…)
How suddenly did it start and has it got worse progressively?
What does frank blood haemoptysis suggest? (6)
Frank blood: this is suggestive of a vascular problem such as a ruptured
blood vessel (invasive cancer, bronchiectasis, TB, mycetoma), a ruptured
arteriovenous malformation, or a vascular–bronchial fistula.
What does blood-streaked sputum haemoptysis suggest? (2)
any infection of the lungs can cause this; however, in the context of chronic production of large volumes of sputum this
would suggest bronchiectasis.
What does pink frothy sputum haemoptysis suggest? (1 and due to 3 examples)
This suggests pulmonary oedema (secondary to, for
example, left ventricular failure, CHF or severe mitral stenosis).
What can the volume of haemoptysis suggest?
Massive haemoptysis can be caused by erosion of a pulmonary blood vessel.
What can the speed of onset and progression of haemoptysis suggest? (Sudden and gradual 2)
Sudden onset is consistent with pulmonary embolism (PE) or erosion of a cancer into a large pulmonary blood vessel. Gradual onset argues for a progressive condition such as lung cancer or bronchiectasis.
What other (sets of) symptoms should you ask someone presenting with haemoptysis about? (6)
Cough productive of sputum? - Lower RTI, bronchiectasis, lung cancer
Fever - Lower RTI, TB, Carcinoma
Weight loss - lung cancer TB
Pleuritic chest pain - PE, pneumonia
SOB - PE, CHF
Haematuria/oliguria - Goodpastures, vasculitides, SLE
What questions about someones past history should you ask with haemoptysis? (11)
Smoking history
Exposure to asbestos/other inhaled industrial substances
Prior lung disease
Did he grow up abroad or travel abroad recently?
Anticoagulant meds/bleeding tendency?
Change to voice?
RF for DVT/PE: Prolonged best rest/long haul flight? Blood vessel damage from trauma or surgery? Malignancy? FHx of vascular disease? Painful swollen limb/leg?
What does haemoptysis with a cough productive of sputum suggest? (5)
Lower RTI (pneumonia, bronchitis, TB…)
Bronchiectasis
Lung cancer
What does haemoptysis with a fever suggest? (5)
Lower RTI (pneumonia, bronchitis, TB…)
TB
Carcinoma
What does haemoptysis with night sweats suggest? (2)
TB or carcinoma
What does haemoptysis with pleuritic chest pain suggest? (2)
PE
Pneumonia that has spread to the chest
What does haemoptysis with SOB suggest? (2)
PE with sudden onset
CHF with gradual onset