The breath exhaled by a person has no special odor. Abnormal breath often comes from food, smokers, alcohol consumption, etc. If the breath exhaled is foul-smelling or has a particular odor, it is of great importance when it is seen clinically in oral, respiratory, gastrointestinal and some visceral diseases. So, what is the differential diagnosis of breath abnormalities? The following is the differential diagnosis of breath abnormalities.
I. Respiratory system diseases
1, chronic hypertrophic and chronic atrophic rhinitis when the breath has a bad smell, chronic hypertrophic rhinitis nasal lining hypertrophy, hyperplasia performance nasal obstruction, snot, chronic atrophic rhinitis nasal tissue atrophy, nasal cavity expansion with smelly nasal crust, mostly seen in young women. Sinusitis with fever, nasal congestion, headache, pus nasal discharge with odor, rhinoscopy, sinus puncture and X-ray radiographs help to confirm the diagnosis.
2, foreign body: foreign body obstruction in the larynx, nose, nasopharynx, bronchus (such as peanut rice, beans, fruit kernels, melon seeds, etc.) after corruption emits foul odor, direct speculation, laryngoscopy, rhinoscopy, bronchoscopy and radiographs can confirm the diagnosis.
3, purulent bronchitis: there is cough, fever, large amount of foul sputum or blood sputum exhalation with foul odor, X-ray examination can be seen with increased lung texture, or shadow of bronchopneumonia.
4, bronchiectasis and anaerobic bacterial infection: sputum and smelly, repeated hemoptysis, long-term cough; the affected side of the lower dorsal can be heard wet gong sound, pestle finger (toe). x-ray chest film can be seen curly hair-like shadow, bronchial iodine oil imaging can be seen in the agent filling the bronchial manifest red expansion of the cystic, columnar or cystic columnar shadow, is the most important basis for the diagnosis of bronchiectasis.
5, lung abscess: anaerobic bacterial infection, sputum with foul odor, rapid onset, chills, high fever, cough, history of foreign body inhalation, repeated hemoptysis, anemia, emaciation, physical examination of the affected side of the percussion and lung entity signs, pestle finger (toe). x-ray chest film shows dense shadow of mass, abscess and liquid flat, pus cavity is mostly round, smooth inner wall, fiberoptic bronchoscopy can directly spy on the presence of foreign body obstruction, drainage bronchus, blood Leukocytosis, neutrophil elevation, sputum culture including the culture of anaerobic bacteria can be found pathogenic bacteria.
6, pulmonary gangrene: is a consequence of the development of pulmonary suppuration, bronchiectasis or pulmonary infarction, the patient fever, emaciation, weakness, anemia, poor general condition, due to necrosis of lung tissue, breath and sputum have a foul smell such as rotten eggs, pus sputum is green or brown.
7, tuberculosis cavity secondary infection: sputum has a foul odor, the patient has symptoms of tuberculosis poisoning such as afternoon low fever, noon night sweats, lassitude, depression, weight loss, lack of appetite, hemoptysis, etc., signs are often negative, the upper lung tuberculosis can be heard fine wet rales. x-ray infiltrative lesions are soft cloudy flocculent or small pieces, fuzzy shadows around the edges or see the cavity surrounded by inflammation, there are fluid planes within, in other lung fields there is tuberculosis dissemination Foci of tuberculosis in other lung fields. Tuberculosis is found by sputum tuberculosis examination, and common sputum culture reveals pathogenic bacteria. Serology is strongly positive for anti-tuberculosis antibodies. OT test is positive. Fibreoptic bronchoscopy for sputum bacteriology, pathology for definitive diagnosis.
8.Pulmonary cyst secondary infection: patient has fever, cough, coughing pus sputum or repeated hemoptysis, chest pain. x-ray manifestation of monocystic co-infection with annular shadow with fluid level, sometimes difficult to distinguish from lung abscess, but the surrounding inflammatory infiltrate is not good for extensive lung abscess, when the inflammation is absorbed, the true nature of the cyst can be revealed. Multicystic lesions manifest as annular, cellular shadows with or liquid flat, bronchography can show the cyst catch and site and morphology.
9, purulent pleurisy (abscess chest): with bronchopleural fistula, coughing history, sputum with pus or mixed with blood, X-ray can be seen pleural effusion or encapsulated effusion, bronchopleural fistula can be seen in the liquid plane or see pneumothorax falcon wear pus examination can confirm the diagnosis.
Second, digestive system diseases
1, esophageal strictures, tumors, diverticula, can make the food stagnation, corruption with foul smell breath. Clinical, manifesting as progressive dysphagia, painful pharynx, food reflux, severe cases can be obvious chronic dehydration, malnutrition, wasting or cachexia. Barium swallowing followed by dual contrast esophageal x-ray gas-barium imaging. It is useful to observe the morphology of esophageal mucosa. Esophagoscopy can directly observe the stricture, tumor, diverticulum or perform brush examination or biopsy for pathological examination, which can be diagnosed.
2.There is often foul-smelling breath when your door cancer with ulcer formation. Clinical manifestations are progressive dysphagia, nausea, vomiting, malnutrition, emaciation and cachexia. Barium meal X-ray examination and gastroscopy combined with mucosal biopsy are the most reliable diagnostic means at present.
3, gastritis indigestion, constipation can be putrid breath of the digestive tract by the warm air. Chronic gastritis disease and prolonged, clinical manifestations of epigastric fullness and discomfort especially after meals, irregular upper fishy vague pain, warmth, acidity, vomiting, etc., gastroscopy and gastric mucosal biopsy can determine the diagnosis.
4, cirrhotic coma patients is a special musty breath odor, hepatic encephalopathy seen in portal cirrhosis, viral often negative, upper pulmonary tuberculosis can be heard fine wet rales. x-ray examination infiltrative lesions are soft type cloud flocculent or small pieces, fuzzy shadows around the edges or cavities with inflammation, fluid planes within, in other lung fields with foci of tuberculosis dissemination, sputum tuberculosis bacilli examination to find tuberculosis bacteria. Serological examination is strongly positive for anti-tuberculosis bodies, with increased sedimentation. positive OT test. Fiberoptic bronchoscopy for sputum bacteriology, pathology to clarify the diagnosis.
5.Pulmonary cyst secondary infection: patients have fever, cough, coughing pus sputum or repeated hemoptysis, chest pain,. x-ray performance monocystic co-infection when annular shadow bone liquid flat, sometimes difficult to distinguish from pulmonary swelling, but surrounding fire infiltration is not good lung abscess extensive, when inflammation absorption, can reveal the true nature of the cyst, multi-cystic lesions manifested as annular, cellular shadow or with liquid flat, bronchography can show the site of the cyst and shape.
6, purulent pleurisy (abscess chest): with bronchopleural fistula, coughing history, sputum with pus or mixed with blood, X-ray can be seen pleural effusion or encapsulated effusion, bronchopleural fistula can be seen in the liquid plane or see pus pneumothorax, chest aspiration examination can confirm the diagnosis.
Third, urinary system diseases
In uremia, the urea content in the blood increases, and the breath has the breath of ammonia or urine. Uremia is a variety of chronic kidney diseases such as glomerulonephritis, chronic pyelonephritis, tubulointerstitial nephropathy, polycystic kidney, etc.; renal lesions secondary to systemic diseases such as systemic lupus erythematosus (SLE) nephropathy, diabetic nephropathy, hypertensive renal small artery sclerosis, nodular polyarteritis nephropathy, multiple spinal cord nephropathy, etc.; urinary tract obstructive nephropathy such as urinary tract stones, prostatic hypertrophy, neurogenic bladder and urethral Stenosis, etc. The clinical manifestations are complex while the gastrointestinal symptoms are the earliest and most common symptoms: lack of appetite, odor of urine in the upper oral cavity and gastrointestinal bleeding, etc. Other symptoms such as anemia, bleeding, tendency, hypertension, heart failure, pericardial effusion, arteriosclerosis, uremic lung, pruritus, osteoporosis, infection, acidosis, etc., increased BUN in blood, decreased CO2 binding capacity, and severe impairment of renal function contribute to the diagnosis.
IV. Diabetic ketoacidosis
It is the main disease that produces acetone breath, early manifestation of thirst, excessive drinking, polyuria, polyphagia, weakness, followed by lack of appetite, nausea, vomiting, often accompanied by headache, drowsiness, irritability, deep and fast breathing, rotten apple smell (acetone) in the exhaled breath, severe water loss, reduced urine volume, decreased blood pressure, late various neurological reflexes are dull or disappear, drowsiness and even coma, laboratory tests: urine sugar, urine ketone body strong positive, blood glucose, blood ketone body elevated difficulty, carbon dioxide binding capacity decreased, PH < 7.35, alkali remaining negative value increased, etc.