pneumonia.pptx

Pneumonia Definition: Acute inflammatory condition of the lungs usually caused by bacteria, viruses or rarely fungi and Chest X Ray will show consolidation. Causes •bacteria as (Streptococci,Staph aureus, Haemophilus influenza) •Atypical organism eg mycoplasma, legionella • Gram –ve organisms •...

Pneumonia Definition: Acute inflammatory condition of the lungs usually caused by bacteria, viruses or rarely fungi and Chest X Ray will show consolidation. Causes •bacteria as (Streptococci,Staph aureus, Haemophilus influenza) •Atypical organism eg mycoplasma, legionella • Gram –ve organisms • Viruses Types of pneumonia: •Community acquired pneumonia • Hospital acquired pneumonia (in patients previously admitted or currently admitted to hospital) • Aspiration pneumonia. anatomical classification: lobar pneumonia, broncho pneumonia lobar pneumonia, lobar pneumonia, broncho pneumonia broncho pneumonia broncho pneumonia Clinical examinations: Signs of consolidation (dullness.) Bronchial breathing, (by auscultation ) Crepitation : unilateral or bilateral, Clinical picture: •Systemic features of infection : fever, shivering, sometimes vomiting • Cough , sometimes productive • Dyspnea • Chest pain increase with breathing. Investigations: •Full blood count • Blood urea , serum creatinine, liver enzymes • Chest XRay • Blood and sputum cultures • Arterial blood gases Signs of severe pneumonia: Confusion High urea Resp rate >30 SBP <90, DBP <60 Age >65 PO2 less than 60 in spite of Oxygen, multilobes involvement, Underlying diseases. Treatment: Mild and moderate cases can be managed at home but sever cases should be hospitalized Oxygen in severe cases (PO2 less than 60 ) IV fluids for preventing dehydration in severe cases and in extreme ages antibiotics:  penicillin + macrolide (erythromycin or clarithromycin)  3rd generation cephalosporins +/- macrolide  Flouroquilones (penicillin allergy)  IV antibiotics for 48 hour in severe cases then continue by oral antibiotics  Duration of antibiotics 7-10 days  Follow up chest x ray. Aspiration pneumonia:  It occurs due to aspiration of oropharyngeal content or vomitus  Can occur in decrease level of consciousness,  Common organisms induce aspiration pneumonia are anaerobes.  Can involve any part of the lung, common at right lower lobe due to relative straight right bronchus. •Treatment: metronidazole + 3rd generation cephalosporines. Complications of the pneumonia: acute respiratory failure and may require ventilation. pleural effusion associated with pneumonia or follow the pneumonia. empyema (infected effusion) lung abscess Lung Abscess: •It is Circumscribed suppurative inflammation of lung parenchyma followed by central necrosis. Clinical picture: • Productive cough (may be blood tinged) positional (increase with leaning down) • High fever, Chills, sweating • tachypnoea Signs of consolidation:  Area of dullness  Bronchial breathing  Whispering pectroliquy  Crepitations • May be chronic if not properly treated Treatment IV antibiotics usually prolonged courses Start empirical eg 3rdgeneration cephalosporin and macrolide Then antibiotics guided by culture Percutaneous drainage in complicated cases. • Bronchoscopy may be needed ( drainage, removal of foreign body , diagnosis of tumour) •Surgical resection in chronic abscess. PLEURAL EFFUSION • It is a Pathological collection of fluid in the pleural cavity It is of 2 main types: transudate or exudate. •How to differentiate between both types: Protein content Specific gravity color cells LDH Pleural protein/serum protein ratio Pleural LDH/serum LDH ration Transud ate <3 g/dl Exudate <1016 >1016 Clear, faint yellow few Cloudy, dark yellow >3g/ dl <200 <0.5 Leucocytes, erythrocytes >200 >0.5 <0.6 >0.6 Causes of Transudate: Cardiovascular • 1. Congestive heart failure • 2. Constrictive pericarditis • 3. SVC obstruction Hypoalbuminaemia: • 1. Liver cirrhosis • 2. Nephrotic syndrome • 3. Malnutrition Causes of exudate: 1. 2. 3. 4. 5. 6. Malignancy ( Bronchial carcinoma , )Metastasis Pulmonary embolism Infection eg TB, empyema, lung abscess Inflammatory eg rheumatoid arthritis trauma: haemothorax, chylothorax Subdiaphragmatic eg subphrenic abscess Pulmonary oedema excessive liquid accumulation in the tissue and air spaces (usually alveoli) of the lungs. It leads to impaired gas exchange and may cause hypoxemia and respiratory failure. Types • Cardiogenic • Non-cardiogenic Cardiogenic Pulmonary oedema • due to left ventricular failure • arrhythmias, • fluid overload, (e.g. from kidney failure or intravenous therapy). • Hypertensive crisis Non Cardiogenic Pulmonary oedema • Neurogenic causes (seizures,electrocusion ) • Pulmonary embolism • Aspiration • Inhalation of hot or toxic gases • immersion pulmonary edema