1 / 43

PNEUMONIA & other patterns of acute lung injury

PNEUMONIA & other patterns of acute lung injury. PNEUMONIA DIFFUSE ALVEOLAR DAMAGE. PNEUMONIA. Inflammatory consolidation of the lung parenchyma NORMAL DEFENCES MECHANISMS Nasal clearance Tracheobronchial clearance Alveolar clearance. Local Factors Loss / impairment of cough reflex

zena-smith
Download Presentation

PNEUMONIA & other patterns of acute lung injury

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. PNEUMONIA& other patterns of acute lung injury PNEUMONIA DIFFUSE ALVEOLAR DAMAGE

  2. PNEUMONIA Inflammatory consolidation of the lung parenchyma NORMAL DEFENCES MECHANISMS • Nasal clearance • Tracheobronchial clearance • Alveolar clearance

  3. Local Factors Loss / impairment of cough reflex Impaired mucociliary elevator Impaired function of alveolar macrophages Accumulated / stagnant secretions Impaired Host Resistance Chronic Disease Malignancy Immune Defficiency Iatrogenic – immunosuppressive Rx PNEUMONIA – why?

  4. PNEUMONIA Classification Anatomic Distribution Aetiology Nature of host inflammatory reaction

  5. PNEUMONIA- Anatomic Distribution Lobar vs. Bronchopneumonia • Lobar(less frequent) - widespread fibrinosuppurative consolidation of a large portion of a lobe or an entire lobe • Bronchopneumonia - patchy consolidation, usually extension of pre-existing bronchitis / bronchiolitis

  6. PNEUMONIA - Aetiology • INFECTIOUS Acute Bacterial Pneumonia NB Streptococcus pneumoniae = pneumococcus The others: Staphyllococcus aureus Streptococcus pyogenes Haemophilius Influenza Klebsiella pneumoniae Legionella pneumoniae Viral, Mycobacterial, Fungal, Parasitic (NB in an immunocompromised population) • ASPIRATION • LIPID – endogenous vs. exogenous

  7. PNEUMONIA - Nature of Host Response • Acute fibrinous • Granulomatous • Organizing • Interstitial • Eosinophilic

  8. LOBAR PNEUMONIA • Abrupt onset • Pleuritic chest pain, rusty sputum • High fever, rapid & shallow resps, • Leucocytosis • Healing “by crisis”

  9. LOBAR PNEUMONIA • Structural Changes: uniform • 4 Stages: Congestion Red Hepatization Grey Hepatization Resolution

  10. BRONCHOPNEUMONIA • Successive infection of conductive airways • Infants, debilitated young children, elderly, post-operative • Insidious onset • Peripheral hypoxia • Slow healing, resolution “by lysis”

  11. BRONCHOPNEUMONIA • Widespread patchy areas of inflammation spreading from bronchitis and bronchiolitis • Lower lobes – larger and more numerous foci • Pale areas raised above the surface of the surrounding lung parenchyma • Recovery – liquefaction – but also by fibrosis

  12. Acute Pneumonia Alveolar Spaces filled by acute inflammatory cells (neutrophils)

  13. Acute Pneumonia Acute Inflammatory cells within alveolar spaces

  14. PNEUMONIA - Complications • Abscess Formation • Organization • Empyema – suppurative pericarditis • Bronchiectasis • Bacteraemic dissemination to other organs (metastatic abscesses) – endocarditis meningitis peritonitis suppurative arthritis

  15. LUNG ABSCESS • Localized focus of suppuration consisting of a collection of pus that is walled off by chronic inflammatory / granulation tissue and fibrous tissue • Formation of an abscess entails necrosis and destruction of lung tissue • Causes – preceding pneumonia, bronchial obstruction – tumour, foreign body, aspiration, septic embolism

  16. BRONCHIECTASIS • Permanent dilatation of the bronchi accompanied by inflammatory changes in their walls and surrounding parenchyma • Recurrent inflammation of bronchial walls & fibrosis in the surrounding parenchyma – traction on bronchi – dilatation • Divided into post-inflammatory, post-obstructive, and congenital / hereditary conditions • Cough, fever, foul sputum

  17. BRONCHIECTASIS • Localized vs. widespread • Basal segments of LLs, RML & lingula • Gross: dilated bronchi exending to pleural surface, surrounding scarring • Microscopy: mucosal ulceration, submucosal CI & granulation tissue, adjacent OP • Complications: Cor pulmonale Brain abscess Amyloid

  18. DIFFUSE ALVEOLAR DAMAGE (DAD) • Pathologic manifestation of Adult Respiratory Distress Syndrome (ARDS) • Sequence of events that follows acute lung injury caused by a variety of toxic insults • Diffuse = damage to all parts of the alveolus: epithelium, endothelium and interstitium

  19. DAD - Clinical Syndrome • Acute onset of dyspnoea • Diffuse pulmonary infiltrates • Rapid development of respiratory failure • High mortality ~ 50%

  20. DAD - Pathology Two Discrete but Overlapping Stages: Early and Late Acute and Organizing Exudative and proliferative

  21. DAD Early / Acute / Exudative Phase: Day 1: Interstitial / alveolar haemorrhage & fibrin Day 3-7: Hyaline membranes Type II pneumocyte hyperplasia Week 1: Interstitial inflammation Late / Organizing / Proliferative Phase: 1-2 weeks: Fibroblast proliferation Organization & fibrosis

  22. DAD has many Aetiolgies • Infection • Inhalants • Ingestants • Drugs • Shock • Sepsis • Radiation • Misc. • Idiopathic

More Related