Transcript of PneumoniaBy Dr. Abdelaty Shawky Assistant professor of pathology.
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- PneumoniaBy Dr. Abdelaty Shawky Assistant professor of
pathology
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- PNEUMONITIS
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- * Classification: 1. Bacterial pneumonia: lobar pneumonia &
bronchopneumonia. 2. Viral (interstitial) pneumonia: influenza,
measles, chicken pox. 3. Loefflers (parasitic) pneumonia:
Bilharziasis, ascaris & ankylostomiasis. 4. Granulomatous
pneumonia: T.B, sarcoidosis, leprosy, syphilis, actinomycosis. 5.
Lipoid pneumonia: due to aspiration of oily nasal drops. 6.
Irradiation pneumonia.
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- LOBAR PNEUMONIA
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- * Def: acute diffuse fibrinous inflammation of one or more lung
lobes. * Etiology: Age: middle age. Predisposing factors: low
resistance. Causative organism: pneumococci. Route of infection:
droplet infection.
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- * Pathogenesis: Pneumococci are inhaled to reach alveoli. They
cause acute inflammaion with excess fluid exudate. This fluid
exudate pass from one alveolus to another rapidly through the
inter- alveolar pores of cohn to involve the whole lung lobe. The
fluid exudate expel air away from the alveoli producing a firm
airless lobe leading to consolidation (hepatisation) of the
affected lobe.
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- 4. Stage of resolution 3. Stage of gray hepatization 2. Stage
of red hepatization 1. Stage of congestion 1. Duration 9th day
215th 8th day2nd 4th day1st day 2. Gross Picture: the affected lobe
is - Since there is no necrosis, healing by resolution occurs. -
Enlarghed. - Gray. - Consistency: consolidated (hepatized). - Cut
section: dry. - Pleurisy. - Enlarged hilar LNs. - Enlarged. - Red.
- Consistency: consolidated (hepatized). - Cut section: dry. -
Pleurisy. - Enlarged hilar LNs. - Size: Enlarged. - Color: Red. -
Consistency: like wet sponge. - Cut section: exudes frothy fluid. -
The covering pleura: normal - The hilar L.Ns.: normal
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- Lobar pneumonia of upper lobe
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- Lobar pneumonia of the lower lobe
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- 4. Stage of resolution 3. Stage of gray hepatization 2. Stage
of red hepatization 1. Stage of congestion 3. Microscopic Picture
a. Alveolar capillaries: Less congested b. Alveolar walls: thin. c.
Alveolar spaces: Show dead bacteria, shrinked fibrin, hemolysed
RBCs, excess polymorphs and macrophages. a. Alveolar capillaries:
Congested. b. Alveolar walls: thickened. c. Alveolar spaces: Show
bacteria, fibrin, RBCs and polymorphs. a. Alveolar capillaries:
Congested. b. Alveolar walls: thickened. c. Alveolar spaces: Show
bacteria & fluid exudate.
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- Lobar pneumonia; red hepatization
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- Lobar pneumonia; grey hepatization
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- 4. Stage of resolution 3. Stage of gray hepatization 2. Stage
of red hepatization 1. Stage of congestion 4. Clinical course -
Fever, cough, dyspnea and chest pain. - At about 9th day the
disease ends by crisis (sudden improvement), however death may
occur due to severe toxaemia.
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- 4. Stage of resolution 3. Stage of gray hepatization 2. Stage
of red hepatization 1. Stage of congestion 5. Complications 1.
Spread of infection: direct, lymphatic and blood (toxaemia,
septicaemia). 2. Lung fibrosis due to failure of resolution. 3.
Post-pneumonic lung abscess.
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- BRONCHOPNEUMONIA
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- * Def: Acute suppurative inflammation of bronchioles and
adjacent alveoli characterized by patchy lung consolidation. *
Etilogy: Age: extremes of age (young & elderly). Predisposing
factors: low resistance and bronchitis. Causative bacteria:
staphylococci, streptococci & H. influenza. Route of infection:
endogenous invaders and exogenous invaders (droplet
infection).
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- * Gross picture: Bilateral. Basal. Multiple consolidated
yellowish patches exuding pus on pressure. Several patches may
coalesce to produce confluent bronchopneuomonia. Enlarged hilar L.
nodes.
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- Bronchopneumonia
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- Bronchopneumonia
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- * Microscopic Picture: I. The broncioles show: Their lumen
shows: necrotic epithelial cells, polymorphs & pus cells. Their
lining: ulceration. Their walls: congested capillaries, neutrophils
and pus cells & exudate. II. The adjacent alveoli show: 3
successive zones: zone of alveolitis then zone of alveolar collapse
and a zone of alveolar dilatation (compensatory emphysema).
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- * Complications: 1. Spread of infection: direct, lymphatic and
blood (toxaemia, septicaemia). 2. Lung fibrosis due to failure of
resolution. 3. Post-pneumonic lung abscess. 4. Bronchiectasis.
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- Thanks