Dr.dusky Siren ug

8/9/2019 Dr.dusky Siren ug

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Pneumonia

Clinical Features: A) Depending on Route of Infection:-

By Inhalation Initially respiratorycomplaints followed by ConstitutionalSymptoms. Cough,Expectoration:initially mucoid then purulent &mucopurulent, sometimes bloodtinged.


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By Hematogenous Route: --Initially constitutional follwed by repiratorysymptoms.

Fever , Arthralgia , MyalgiaAbdominal Pain, Vomiting ,Loose-motion.

Pneumonia


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Pneumonia

B)Depending upon Type Of Pneumonia:-

1) Typical Community Acquired P. :--

Short History,Cough with Expectoration,Pleuritic Chest Pain(over affected lobe),Hemoptysis,

Fever usually High grade withChills & Rigors.


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Pneumonia

2) Atypical Pneumonia :Subacute presentation-indolent course.Dry Cough,

if Productive cough- sputum is scanty &mucoid,Low grade fever,Loss of appetite,

Malaise,Signs of Anaemia.


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Pneumonia

3)Aspiration Pneumonia :-History of Aspiration,Chronic Cough,

Low grade fever,Breathlessness,Sputum is Foul Smelling,Anorexia,

Weight Loss.


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Pneumonia Clinical Findings:

Patient: presents withSweating,Dehydration,

Ill Look,Fever,Tachypnoea,Tachycardia,

Breathing- shallow,Rapid


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Pneumonia Systemic Exam :-Over Affected Area

Respiratory Movements Decrease. No Mediastinal Displacement,

Tactile Vocal Fremitus Increases, PERCUSSION:

Mild Tenderness,Impaired note,

Flat note- if Synpneumonic Effusion .


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Pneumonia

AUSCULTATION:Initially -- vesicular sounds decrease inintensity, Early inspiratory crackles.Later -- High pitched Bronchial breathing,

coarse crepitations,aegophony,whisperingpectoriloquy,increased vocal resonance,pleural rub,other signs of complications ifpresent.

Pulm.Function: mild restrictive effect,decrease in VC , FEV.


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Investigations Pneumonia:

Sputum Microscopy: Gram stain & otherspecific stains. Sputum Culture: Limitations contamination

by oropharyngeal flora.

Blood Culture: +ve in 20-30 percent cases Counter-immuno-electrophoresis (C.I.E)

on blood,urine,sputum to detect pneumo-coccal antigen,

Serological Tests- for specific organisms-mycoplasma, legionella.


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Pleural Fluid- to exclude empyema.Biochemical,microbiological,cytological ex-amination.

Bronchoscopy,TTNA,Trans-bronchial lung

biopsy -- more invasive when other testsNON-CONCLUSIVE.

Chest-X-ray: Homogenous/Nonhomogenousopacity,Air-bronchogram.

Localisation: Silhoutte sign,Lateral chest x ray.


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Inv: CXR Radiographic response to Treatment :

Usually lags behind clinical response. Various Patterns -Confluent lobar : Strep.pneumoniae.Cavitation; Necritizing pneumonia -

stap. ,gram neg. organisms.Bulging Fissures: Klebsiella,PTB. Etc.Miliary pattern- MTB, Viral, H.capsulatumPneumatoceles: S.aureus,S.pyogenes,

Kleb.pneumoniae.Cavities:M.TB,Anaerobes,Fungal pneum.


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Investigations Pneumonia :

Blood Gas Analysis (A.B.G): Hypoxaemia. Routine H'gram- PMNs Leukocytosis, if

severe sepsis- Leukopenia.

Cold Agglutinins Mycoplasma. Gas Liquid Chromatography- Anaerobic

organisms.


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Complications of Pneumonia Pleural Effusion- Exudate,small-self limited Empyema. Pericarditis-Persistent fever,chest pain,

pericardial rub, cxr: cardiomegaly. Septicaemia. Meningitis. Infective Endocarditis. Jaundice -- Hepatocellular injury or

hemolysis in G-6PD Deficiency. Pumonary Oedema or A.R.D.S. S.I.A.D.H,Rhabdomyolysis, Pneumothorax


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