02_pneumonias. pleural syndrome

8/10/2019 02_Pneumonias. Pleural Syndrome

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Pneumonias. Pleural syndrome.

Ethiology. Clinical pattern. Daignostics.

Complications. Principles of treatment

Ass-prof. N. Bilkevych


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Acute inflammation of lung

parenchyma with obvious

involvement of alveoli.Usually is caused by bacteria or

viruses

Pneumonia(pneumonia)


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Alveoli and lung cells that produce

surfactant


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Ethio logy:

Not specific pathogenic

or obligate-pathogenicmicrobes


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Pathogenesis:

Infection spread into theorganism through respiratory

airways. Microbes appears and

multiple on bronchial mucosa of

upper airways and than spread

down to bronchi and lung tissue


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Classification

Community-acquiredpneumonia.

Nosocomia l(intrahospital) pneumonia acute

infection of lower airways confirmed with X-ray, has being developed in 48 hrs after

appearance of the patient in hospotal

environment.

Aspi rat ionpneumonia.

Pneumoniain immunocomprom izwd pat ients


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Croupous pneumonia Acu te inf lammat ion of lungs, which in

mos t cases sp reads on all pulmonary

lobe. That is why it is cal led lobar

pneumonia (pneumonia lobar is) , but

can be l imited to the affect ion of

segment or a few segments.

Synonims fibrinous pneumonia,

pleuropneumonia


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Pneumococc i


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Pneumococci are typically

asociated with pneumonia


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Clin ical s tages:

initial

clinical manifestation

(corresponds to red and greyhepatisation

resolution


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Lobar pneumonia: stage of

onset Morphology. Congestion stage extensive serous

exudation, vascular engorgement, rapid bacterial pro-liferation.

Inspection. An increased respiratory rate is usuallyevident. Pain is a frequent accompaniment, and with itthe involved side shows a lag of respiratory motion.

Palpation. Palpation confirms the findings on inspection.Tactile fremitus is normal or even slightly decreased, anda pleural friction rub may be present.

Percussion. Impaired resonance may be elicited withlight percussion. This finding is extremely important.

Auscultation. Although the breath sounds may bediminished, expiration is prolonged and crepitation(crepitus indux) is heard. With pleural involvement, apleural friction sound is determined.


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consolidation

Morphology. Red hepatization stage airspaces are filledwith PMN cells, vascular congestion, extravasation of

RBC. Grey hepatization stage

accumulation of fibrin,inflammatory WBCs and RBCs in various stages ofdisintegration, alveolar spaces filled with inflammatoryexudate.

Complaints. Coughing may be associated with i sharp painin the affected side. Mucoid sputum be comes rusty brown(prune juice color).


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General inspection. Cyanosis of the lips and fin gers.When the fever is high, the face may be flushed The

patient's nostrils dilate on inspiration, and expi ration isoften grunting.

Inspection. Dyspnea is invariably present. Respi ratorymovements are generally decreased on the af fectedside.

Palpation. Diminished respiratory excursions, i pleuralfriction rub may be felt. Tactile fremitus is in creased.

Percussion. Dullness.

Auscultation. Bronchial breathing, bronchophony,

pectoriloquy and whispered bronchophony are evidentwith consolidation provided the bronchus to the in volvedarea is open. Rales are less numerous and dis tinct thanin the stages of engorgement or resolution,


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Forced position


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resolution

Morphology. Resolution stage resorption of theexudate.

Inspection. The patient looks more comfortable and thecyanosis disappears. The dyspnea disappears and the

affected lung begins to expand again. Palpation. The previously increased tactile fremitus

becomes less marked and gradually findings becomenormal.


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Percussion. The dullness gradually

disappears and normal resonance returns.

Auscultation. The bronchial breathing is

gradually replaced by bronchovesicular

breathing and later by normal vesicular

breathing. Crepitation reappears (crepitus

redux). Small and large moist rales areheard in increasing numbers.


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Complications

Lung abscess or gangroene

Pleurisy

Toxic shock

Myocarditis Acute respiratory insufficiency

Pneumosclerosis

Atelectasis

Sepsis

Meningitis, encefalitis


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Pleurisy


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Pleurisy with effusion: 1

Damoiseau's curve; 2

Garland's triangle;

3Rauchfuss-Grocco triangle.


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Lung abscess


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Lung abscess


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Focal pneumonia


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Focal pneumonia

Focal pneumonia


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Focal pneumonia

The feature of these pneumon ias is

an invo lvement o f separate lobules

or g roups of lobules in the

inf lammatory process . Therefore i t is

named also lobu lar (pneumon ialobular is)

Synonim: bronchopneumonia


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Principles of treatment

Antibiotics

Expectorants

Desintoxication

Oxygen

Antigistamine agents

Symptomatic therapy


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orrec t reg imen

Bed mode

Care of pat ients :

proper lighting and ventilation(fresh air improve patientssleep and

bronchial clearance)

Care of oral cavity

Diet


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Diet

about 2,5-3 litres of loquid per day(water with lemon juice, mineral or

boiled water

Fruit juices

chicken clear soups

food should be easly assimilable

in some days diet 10 or 15.

Diet enr iched w ith vi tam ins


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Diet enr iched w ith vi tam ins

Climatotherapy


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pymild dry warmclimat


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Symptomat ic means

antitussives antipyretics

Pain killers

antiinflammmatory(nonsteroidal in pleural pain)

cardiotonics


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02_pneumonias. pleural syndrome

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