PNEUMONIA - hind.cc

					PNEUMONIA
      BY
DR.SOHEIR SAAD
               Pneumonia
Pneumonia is a term which describes inflammation of the
lung parenchyma characterised by exudation and
consolidation into the alveoli.

Pneumonia can occur in any individual who is seriously ill,
both in adults and in children. It also occurs especially:
at the extremes of life - neonates, the elderly

in patients with pre-existing lung disease - chronic
bronchitis, bronchiectasis, fibrosis, carcinoma
after abdominal operations
in the compromised host, including patients with AIDS
          Pulmonary Defence
              Mechanism
pneumonia can result whenever these defense
mechanisms are impaired or whenever the
resistance of the host in general is
lowered.
Factors that affect resistance in general
include chronic diseases, immunologic
deficiency, and treatment with
immunosuppressive agents, leukopenia, and
unusually virulent infections.
     The clearing mechanisms can be interfered
          with by many factors, such as the
                                  following:
Loss or suppression of the cough reflex, as a
result of coma, anesthesia, neuromuscular
disorders, drugs, or chest pain.

Injury to the mucociliary apparatus
Interference with the phagocytic or
bactericidal action of alveolar macrophages
by alcohol, tobacco smoke, anoxia, or
oxygen intoxication

Pulmonary congestion and edema
Accumulation of secretions in conditions such
as cystic fibrosis and bronchial obstruction
     Pneumonia: types
Pneumonia is divided into six broad clinical
syndromes:
1-community acquired Acute pneumonia
2-community acquired Atypical pneumonia
3-hospital acquired pneumonia (Nosocomial)
4-aspiration pneumonia
5-Chronic pneumonia
6-Necrotizing Pneumonia and Lung Abscess
      Symptoms and signs
Common symptoms and signs of pneumonia
include:
cough
fever
pleuritic chest pain
Features which indicate the severity of the
pneumonia include:
            confusion
            respiratory distress
            cyanosis
The classical physical signs of pneumonic
lung consolidation are:
reduced percussion note
bronchial breathing
crackles
whispering pectoriloquy
pleural friction rub
Septicaemia should be suspected if the
patient is cold, clammy and hypotensive.
Sputum production may not be a feature in
the acute phase
   Community acquired
       pneumonia
-Community acquired pneumonia is a
common disease with a reducing
incidence. It usually occurs in
children or the elderly, or in people
with an underlying pathology.
-This type of pneumonia is often a
complication of viral respiratory
disease such as influenza.
It is particularly common in winter in
countries with temperate climates.
Eighty percent of community acquired
pneumonia is pneumococcal pneumonia.

Other causes of community acquired
pneumonias include haemophilus
influenzae, staphylococcal aureus,
atypical pneumonias (e.g. due to
mycoplasma pneumoniae), mycobacterium
tuberculosis, and viruses.
Lobar Pneumonia-Pathogenesis
In lobar pneumonia, four stages
of the inflammatory response
have classically been described:
1.congestion,
2.red hepatization,
3.gray hepatization, and
4 resolution.
Lobar pneumonia-gray hepatization, gross photograph.
      The lower lobe is uniformly consolidated.
A closer view of the
lobar pneumonia
demonstrates the
distinct difference
between the upper
lobe and the
consolidated lower
lobe.
This is a lobar
pneumonia in which
consolidation of the
entire left upper lobe
.has occurred
                                                         .


Patchy area of alveoli that are filled with inflammatory cells
(lobular pneumonia) is characterized by patchy areas of
.pulmonary consolidation
A bronchopneumonia is
classically a "hospital
acquired" pneumonia seen
in persons already ill
from another disease
process.
Typical bacterial
organisms include:
Staphylococcus aureus,
Klebsiella, E. coli, and
.Pseudomonas
LOBAR
OTHER TYPE OF
 PNUOMONIA
  Hospital acquired pneumonia
         (Nosocomial)
-Gram-negative rods belonging to
Enterobacteriaceae
 (Klebsiella., Serratia marcescens,
Escherichia coli) and pseudomnas

-Staphylococcus aureus
(usually penicillin-resistant)
 Aspiration pneumonia
-Anaerobic oral flora (Bacteroides,
Prevotella, Fusobacterium,
Peptostreptococcus),
admixed with aerobic bacteria like
(Streptococcus pneumoniae,
Staphylococcus aureus, Haemophilas
influenzae, and Pseudomonas
aeruginosa
Aspiration pneumonia is a lung infection
resulting from the aspiration of
organisms into the lower respiratory
tract. This contrasts with inhalation
pneumonia which refers to the
consequences of inhaling non-infected
particulate matter, fluids and irritant
gases.
The usual site for an aspiration
pneumonia is the right lung. Aspirated
material will enter the lower lobes
when the patient is standing. If the
patient is supine then the aspirated
material will enter the apical segment
of the lower lobes or the posterior
segment of the upper lobes
 There is a localized foreign body giant cell response to the aspirated
 material seen here at high magnification. Aspirated material may also
.produce inflammation from chemical irritation, as with gastric contents
    Chronic pneumonia
Nocardia
Actinomyces
Granulomatous: Mycobacterium
tuberculosis and atypical
mycobacteria,
Histoplasma capsulatum,
Coccidioides immitis,
Blastomyces dermatitidis
Necrotizing Pneumonia and
     Lung Abscess
Anaerobic bacteria (extremely
common), with or without mixed
aerobic infection
Staphylococcus aureus,
Klebsiella pneumoniae,
Streptococcus pyogenes,
and type 3 pneumococcus
(uncommon)
An abscess is a
complication of severe
pneumonia, most
typically from virulent
organisms such as
Staphylococcus aureus.
Abscesses are often
complications of
aspiration, where they
appear more frequently
in the right posterior
.lung
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1,2,3.4 for you as a histology of lung
----------------------------------------------
 Chronic Obstructive lung disease: (60, 61 .63, 67 ,68, 71, 72)
60 bronchial asthma
61 high bower of bronhial asthma with bredominanat esophilia
63 chronic & permenant dilataion of bronchi (bronchaitesis)
67 emphyzimaitis bullae ‫( فقاقيع‬emphyzima)
68                               (emphyzima)
71 pan lubelar emphyzima due to defitiensi of alpha one ……
71 spure thin distruction of alvioli wiz spure
………………………………………………………………
+ dr.sohair 59
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Restrictive lung disease (114,120,125.126,127, 133)
114 ‫جدول للناس المتمييزيين‬
120 ansrachosis 3amla fibrosis
125 lung hyper sensitivity pneumonitis
126 high power
127 Example of lung fibrosisi ‫تحت الشقر يا وهيبة‬



TB(36 39 40 41 42 43 44 )

                                 133 ‫اتأكد من 721 و‬
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TB(36 39 40 41 42 43 44 )

36 secondary tb chronic fibro pulmonary Tb
39suppelura bons focus (primary complex) wtith hilar lymph node
40 tubericlr in lung alvioli (primary without caziation)
41 graniulomtus lung show multiple tubericle
42 lung hanz gint cell og graneulomma of TB
43 zell neelssen (rood of mucrumbacterum sorrunded by
3 layer lipd protein carbohydrate)

				
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posted:3/20/2012
language:English
pages:40