pneumonia pathology Flashcards
(18 cards)
ANATOMICAL APPROACH TO LUNG PATHOLOGY:
* Airways
–> — , — , — , —
* Lung —
* — vascular system
* — and muscles of the —
* — spaces
larynx , trachea ,bronchi m bronchioles
lung intersitium
pulmonary
diaphragm
chest wall
pleaural space
pneumonia:
* Inflammatory — of the —
caused by formation of intra-alveolar — resulting from —
consolidation
lung parnechuma
inflammatory exudate
infection
pulmonary defences:
* Nasal –
* — of respiratory tract – the lung Microbiome
* — reflex
* — Escalator
* — secretion
* Alveolar –
* – Antibodies
hair
microflora
cough reflex
mucociliary escalator
mucus secretion
alveolar macrophages
IgA
loss of defences:
* Loss of cough reflex
* e.g. – ; —
* Injured mucociliary Escalator
– e.g. —
* Decrease in alveolar macrophages
* e.g. – , —
* Pulmonary congestion / oedema
* Accumulation of secretions [ as — secretions in Cystic Fibrosis ]
* Obstruction
coma , anaesthesia
smoking
alchohol , smoking
sticky secretions
who gets pneumonia:
* Personal risk factors
▪ – > – years
▪ —
▪ —
▪ Immunocompromised
▪ Recurrent RTI’s - ask why is there a recurrence ?
▪ Medications
* Environmental risk factors
▪ Seasonal; more common in –
* Organism virulence
organisms:
Bacteria
* — pneumoniae (60% of CAP)
* Haemophilus influenzae
* Staphylococcus aureus
* Mycoplasma pneumoniae ( —)
* Legionella pneumophilia (—)
Viral
* Influenza pneumoniae
* Respiratory syncytial virus
* SARS-CoV-2 (COVID-19)
Fungal
* Rare; immunocompromised
* Pneumocystis Jiroveci (PCP)
elderly > 65
smokers
malnutrishenedx
winter
streptococcus
atypical
atypical
evolution of signs and symptoms of pneumonia:
* Organisms in alveoli —
* – cells attack
* — of white blood cells, protein, fluid, red cells
* Release of —
* Release of — increase vascular — causing —
* Alveoli filled with fluid & Cells = —
* Hampers O2 flow –> —
* — and increase in — secretion stimulates Cough reflex
* Pain receptor on alveoli –> —
* Cytokine release -> —
muitlpy
immune
influx
cytokines
vasodilators
permeability
congestion
consolidation
shortness of breath
bronchoconstection and musus secretion
chest pain
pyrexia
classification of pneumonia is — and —
1- lobar pneumonia:
* Affects a — of a lobe
* Starts — and spreads to involve —
stages of lobar pneumonia:
1- —- :
lung is heavy and red due to vascular — and intra alveolar — w few neutrophils
2- red hepatization:
massive confluent exudation w red cells neutrophils and fibrin into alveolar spaces , lobes are distinctly red firm and airless w — like consistency
3- grey hepatization:
follows w progressive disintegration of red cells and presence of — resulting in greyish dry appearance
4- resolution or scaring:
- resolution due to clearance of — and enzymatic digest of — which can be reabsorbed , ingested by — cleared via —
- scarring due to organisation of — , infiltration of — and deposition of –
- important info:
95% of cases of Lobar pneumonia are due to — Pneumoniae
Background – > – ; 3:1; — people; —
source of organism and anatomical
sections
distally
entire lobe
congestion
engorgment
fluid
liver
fibrino-suppurative exudate
infection
exudate
macrophages
muco ciliary escalator
exudate
fibroblast
collagen
streptococcus
m > f
neglected ppl and alcoholics
bornchopenumonia:
* Starts — in the —
* — infiltrate, often throughout — lungs
* Generally affects the extremes of age: elderly and very young
– Elderly: risk factors include — , — , —
– Young: —
* — consolidation
* Clinical
– —- cough, pyrexia,
chest pain, dyspnoea, — on auscultation
* Complications include — formation
* — pneumonia
* — influenza
proximally
bronchioles
patchy
both lungs
copd stroke and immunocompromised
immature immune system
patchy
productive cough
crackles
micro abscess
streptococcus
haemophilus
atypical pneumonia ( bugs or appearance ) :
* “Walking well”
* Also called —
* CXR: — pattern; — — opacities in lung
* Infiltrate is — / around the — i.e. NO —-
* — lymphocytic
inflammatory infiltrate
* Symptoms tend to be — and — onset; “— like” symptoms
interstitial penumonia
reticulondular
linear threadlike
outside
alveoli
no consolidation
patchy interstitial lymphocytic
milder
gradul
flu like
atypical pneumonia:
* Cough is — / –
* – grade pyrexia
* Breath sound: —
* WCC: — or slightly —
* Other extra pulmonary symptoms
– sore throat, myalgia, fatigue, diarrhoea
* Atypical pneumonia caused by
—- that do not stain with — or —
* Causative organisms:
▪ Mycoplasma pneumoniae
▪ Chlamydia pneumoniae
▪ Legionella pneumoniae
▪ Mycobacteria
▪ Viruses e.g. Influenza,
respiratory syncytial virus,
adenovirus, SARS-CoV-2
non productive / dry
low
rales
normal or raised
atypical bacteria
gram stian or viruses
aspiration pneumonia:
Risk factors:
* Impaired — (e.g. Coma – Stroke - Neurologic
disorders – Intoxication through drugs or alcohol)
* — stenosis
* — obstruction
* —
* Aspirate — oro-pharyngeal or — contents
* Pneumonia – Widespread —
* Can cause — -> further weaken immune system
- pneumonia in immunocomrpised host:
* Post organ transplant
* Chemotherapy
* AIDS
* Organisms:
– Pneumocystis —
– Cytomegalovirus ( – )
– Unusual —
– –
cough reflux
pyloric stenosis
osephgal obstruction
hiatus hernia
non sterile or gastic
bronchiopenumonia
chemical penumotitis
jirovecic
CMV
mycobacteria
toxoplasma
klebsiella penumoiea ( friendlanders pneumonia ) :
* Gram — , — of mouth, skin and intestines
* Often — acquired [— ]
* Individuals with weak immune system, injuries, alcohol at
risk
* 30-50% → — cavitation
– Most common bacterial causes of lung cavities are — , —,
– less commonly staphylococcus, E.coli and Legionella.
– TB and tumours may also cavitate
-ve
normal flora
hospital
nosocomial
lung cavitation
steptoccus , klbesilla
complications of pneumonia:
* Loculated Infection
– — +/- —
– —
* Adult Respiratory Distress
Syndrome (ARDS) / Acute lung
injury (ALI)
* Respiratory failure
* Spread of organisms to other
sites
– e.g. bacterial endocarditis, otitis,
meningitis, arthritis
* Acute confusional state /
delirium
* Septicaemia septic shock /
multiorgan failure → —
effusion / empemia
abcess
death
complications of pneumonia:
1- * Empyema
– Collection of — within the —
* Investigations:
* CXR
* Aspirate pleural fluid for cytology &
microbiology
* Exudate containing abundant
neutrophils.
* Management:
– Antibiotics, +/- chest drain +/- surgical — if complex
2- * Lung Abscess
– — area of — within the —
parenchyma, leading to formation of one or more —
* “ — pneumonia”
* —- are present
in almost all lung abscesses
* Management
– —
– Surgical — if necessary
pus
pleural cavity
decortication
localised
suppurative necoriss
pulmonary
cavities
necrotising
Anaerobic bacteria
antibiotic
surgical drainage
lung abccess aetiology:
– — of infected material e.g. — contents
– Complication of —
pneumonia
– — obstruction e.g. —
– Septic —
– — spread of
bacteria
lung access appearance:
– Vary in size; mm to large cavities
– Site depends on mode of
— i.e. aspiration more
common on — side (more — airways), in — segment of — lobe
– As the focus of suppuration
enlarges, ruptures into airways and
may partially drain giving an “— ” level on CXR
aspiration
gastric
bacterial
bronchial as tumor
septic embolus
haemotgenous
mode of development
right
vertical airways
posterior
upper lobes
air-fluid
more of lung access appearance:
– May rupture into — ->
bronchopleural – or — or —
– May embolize septic material to brain -> — or brain —
* Clinical course:
– Manifestations include cough, copious amounts of — smelling sputum
– — fevers, malaise
– Clubbing, weight loss, anaemia
– Secondary — in chronic
cases
– — mortality rate
pleural space
fistula
pneumothorax or empyema
meningitis or brain abscess
foul
spiking fever
amyloidosis
10%
so basically microorganism is in from airborne/asirpriated and it will be in through heamotgeous or inculate —> failure of – mechanisms –> – is filled w infected fluid — > hampers movement of — of lungs —> —
summary:
LOBAR PNEUMONIA
* — Stages
* — appearance
* – > – — : – ; — people; —
* 95% of cases of Lobar pneumonia are due to — Pneumoniae
defence
alveoli
02 and c02
pneumonia
4
pathological
m > f 3:1
neglected , alcoholics
streptococcus
lobar pneumonia symptoms and signs:
* Shortness of breath
* Cough
* Chest pain
* Pyrexia
* — chest expansion
* – to percussion
* Tactile fremitus
* Bronchial breathing, —
* Vocal resonance
decreased
dull
crackles
