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Pneumonia
an inflammation of the lungs usually caused by infection with bacteria, viruses, fungi or other organisms. It is a serious infection or inflammation in which the air sacs fill with pus and other liquid.
Cause
Viruses, bacteria, or (in rare cases) parasites or other organisms In most cases, it is usually the bacteria Streptococcus pneumoniae. Other bacteria that may cause pneumonia include Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophila, Staphylococcus aureus, Moraxella catarrhalis, Streptococcus pyogenes, Neisseria meningitidis, or Klebsiella pneumoniae. Pneumonia caused by Mycoplasma pneumoniae is sometimes mild and called walking pneumonia. Viruses, such as influenza A (the flu virus) and respiratory syncytial virus (RSV) can cause pneumonia.
Risk Factors
being in poor health age - the very young and old (over 65) are most susceptible to pneumonia smoking heart disease having a lung disease- ex. Astha, COPD a low immunity to infection ex. AIDS, or undergoing chemotherapy
Altered bacterial lung clearance ( bacterial ability of the alveolar macrophages, extreme virulence of bacteria, susceptibility of the host) Bacterial invasion (klebsiella pneumoniae)
Hyperemic Stage:
Red Hepatization Stage:
Inflammatory reaction in the alveoli Alveoli are infiltrated with RBC, fibrin & leukocytes Bacteria are contained within segments of pulmonary lobes Engorgement of the alveolar spaces with fluid & hemorrhagic exudates Exudates coagulates, resulting in red appearance of affected lung tissue
Number of RBC in the exudates decreases & are replaced by increased numbers of Neutrophils w/c infiltrates the alveoli, causing the tissue to become solid & grayish
Resolution: or
Consolidation:
Exudates are converted to fibrous tissues Alveoli becomes functionless; Blood passing thru these unventilated areas are not properly oxygenated
Hypoxemia
Hypoxia
Ischemia
Acidosis
CNS Depression
RESPIRATORY FAILURE
Anaerobic metabolism
Resolution:
Exudates is lysed & reabsorde by the neutrophils & macrophages
ARDS
Acute Respiratory Distress Syndrome
ARDS
A fulminant lung condition in which trauma to the lungs leads to inflammation of the lungs, accumulation of fluid in the alveolar air sacs, low blood oxygen, and respiratory distress. It is not a specific disease. Instead, it is a life-threatening condition that occurs when there is severe fluid buildup in both lungs.
Reduced perfusion - Cardiogenic shock - Trauma - Major burns - Fat embolus - Hemorrhage - Severe hypovolemia
Increased Capillary Permeability - Sepsis - Pneumonia - Noxious fume or smoke inhalation - Reactions to drugs -Venoms or toxins - Immune complex diseases - Overtransfusion of crystalloids - Uremia
Direct Tissue & Capillary Insults - Aspiration of gastrointestinal contents - Rapid decompression - Near-drowning - Oxygen toxicity - Hypoxemia - Fluid overload - Starvation
ARDS
Platelet aggregation
Bacterial infection
Alveolocapillary membrane permeability Exudation of fluid, protein, RBCs into interstitium Pulmonary edema & hemorrhage with severe impairment of alveolar ventilation Right-to-left shunt, hyaline membrane formation & finally FIBROSIS
Vasoconstriction
Pneumonia
V/Q mismatching
Rapid, shallow breathing- increased RR Labored breathing retractions Respiratory alkalosis-hyperventilation Marked dyspnea Hypoxemia unresponsive to oxygen therapy (refractory hypoxemia) CXR-show progressive, patchy, bilateral infiltrates
Here is an example of diffuse alveolar damage in which the lung is diffusely firm and rubbery. Clinically, this is known as adult respiratory distress syndrome (ARDS).
References
Bullock, B. & Henze, R. (2000) Focus on Pathophysiology. Philiadelphia:Lipincott, Williams and Witkins
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