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What is pneumonia?

inflammation of the lung parenchyma caused by a lower RTI after a upper RTI as epithelial cells have been damaged


What are the signs and symptoms of pneumonia?

fever, confusion, chills, rigor, tachycardia, tachyponea, productive cough, vomiting, diarrhoea, dyspnea, pleuritic chest pain, punilent sputum, dull percussion, cyanosis, resp failure, speticaemia


Risk factors for pneumonia?

>65, smokers, malnourished, underlying lung disease, medications, recent RTI, infants, COPD, immunocompromised, nursing home residents, impaired swallowing, alcoholics, drug users


How do the lungs prevent against infection?

mucus lining the bronchiole, sterile lower resp tract, alveolar macrophages, mucociliary escalator, cough, IgA antibody, microflora, node hairs (mouth acidity)


What is the epithelium of the bronchi?

ciliated columnar epithelium


What does the epithelium of the bronchi secrete for immunoprotection?

mucus and IgA to eliminate microorganisms


What are the causative pneumonia agents?

bacteria: streptococcus pneumonia, haemopholus influenza, legionella pneumonia, staph aureus, mycoplasma
virus: influenze, RSV
fungi: (not common - most likely in immunocompromised)


What kind of impaired pulmonary defenses can cause pneumonia?

loss of cough reflex, injured mucocillary apparatus, decreased alveolar macro-phages, pulmonary congestion, odemea, accumulation of secretions


How does bacteria cause pneumonia?

bacteria enter alveoli causing immune response, leading to vasodilation and increasing vascular permeability so fluid shifts from vascular space into alveoli causing congestion


How do viruses cause pneumonia?

infect the respiratory cell, and release its genetic material and uses the respiratory cell proteins to replicate and make new viral particle, so the respiratory cells lysis causing immune response in the alveoli


How does fungi cause pneumonia?

the spores are inhaled and it grows into a fungal ball (seen in imaging), this can then spread to vasculature, causing systemic effects


What makes up a fungal ball?

fungus, mucus, cellular debris


What is seen in an alevoli in pneumonia?

fluid filled alveoli (congestion/consolidation), constriction, increase in mucus secretion


What is consolidation?

When the alveoli are fluid filled, causing a backflow of fluid into other alveolis, until the whole lobe is full of fluid, pus, blood and cells, resulting in lobar diffuse opacity


What is lobar pneumonia?

When there is consolidation in a lobe, starts distally and spreads throughout


What is broncho pneumonia?

when there are patches of consolidation throughout both lungs, starts proximally and moves distally towards the alveoli


What are the signs of pneumonia?

fever, raised HR, raised RR, low BP, signs of consolidation, decrease in chest expansion on affected side, bronchal breath sounds, vocal resonance, caitation, pleural effusion


What are the four stages of lobar pneumonia?

congestion, red hepatization, grey hepatization, resolution


When to hospitalise a pneumonia patient?

use CURB-65 severity criteria, if >2, needs to be hospitalised


What does CURB-65 stand for in pneumonia severity?

confusion, urea >7mmol/L, RR >30/min, BP 65years (1 point for each)


how many points match each stage in CURB-65 pneumonia?

mild = 0-1
moderate = 2
severe = 3 or more


What is the transmission of pneumonia?

inhalation, aspiration of organisms that colonise the oropharnyx, aspiration of stomach contents, hematological spread, direct innoculation


What mainly causes a community acquired pneumonia?

bacterial or viral normally from an upper RTI infection of a viral origin, main organisms are strep pneumonia, H.influenza, Morexaella cateralis, influenza, RSV


What is hospital acquired pneumonia?

pneumonia that is not incubating at time of admission and develops in a patient who is hospitalized for more than 48 hours


What organisms mainly cause hospital acquired pneumonia?

enterobacterzae, pseudomonas species and staphylococcus aureus and MRSA, aerobic gram negative bacilli


What is aspiration pneumonia?

occurs in hospitals, in markedly debilitated patients during unconsciousness or vomiting as it can aspirate the stomach with bacteria and can lead to abscess formation in the lungs (normally right lung)


What are lung abscess complications?

extension into plural cavity, meningitis, hemorrhage, brain abscess, secondary amyloidosis.


What microorganisms usually cause aspiration pneumonia?

streptococcus and staph aureus, gram negative


What is chronic pneumonia caused by?

usually by fungus, in immunocompromised eg. histoplasmosis, tuberculosis, aspergillus, nocardia


What are the complications of pneumonia?

abscess formation that can cause tissue destruction, emphyema, bacteriaic dissemination which causes bacterimia and sepsis