SUPPURATIVE LUNG SUPPURATIVE LUNG DISEASESDISEASES

BronchiectaBronchiectasissis

* Def:* Def: persistent dilatation of medium sized persistent dilatation of medium sized bronchi accompanied by suppurative bronchi accompanied by suppurative inflammation of their walls.inflammation of their walls.

* Etio-pathogenesis:* Etio-pathogenesis:

I. Weakening of the bronchial wall by;I. Weakening of the bronchial wall by;

a. Chronic suppurative inflammation:a. Chronic suppurative inflammation: due due to recurrent septic bronchopneumonia.to recurrent septic bronchopneumonia.

b. Congenital weakness:b. Congenital weakness: leads to congenital leads to congenital bronchiectasis.bronchiectasis.

II. Bronchial obstruction:II. Bronchial obstruction: by by foreign bodyforeign body, , bronchial secretionbronchial secretion or or tumortumor..

* N/E:* N/E:

- Dilated bronchi:- Dilated bronchi: Cylindrical, fusiform or saccular Cylindrical, fusiform or saccular Bilateral. Bilateral. Basal. Basal. Has patchy distribution.Has patchy distribution.The bronchial lumen contains pus.The bronchial lumen contains pus.The bronchial mucosa: ulceratd.The bronchial mucosa: ulceratd.

- The surrounding alveoli- The surrounding alveoli are: are: fibrotic and collapsed.fibrotic and collapsed.

- The pleura shows:- The pleura shows: pleurisy pleurisy

- Draining hilar L. nodes:- Draining hilar L. nodes: enlargedenlarged

* Complications:* Complications:1.1. Spread of infection: direct, lymphatic and Spread of infection: direct, lymphatic and

blood.blood.

2.2. Hemoptysis.Hemoptysis.

3.3. Lung abscess (post-bronchiectatic lung Lung abscess (post-bronchiectatic lung abscess).abscess).

4.4. 2ry amyloidosis.2ry amyloidosis.

5.5. Lung fibrosis.Lung fibrosis.

6.6. Bronchogenic carcinoma (squamous cell Bronchogenic carcinoma (squamous cell carcinoma).carcinoma).

PNEUMONITISPNEUMONITIS

* Classification:* Classification:1. Bacterial pneumonia:1. Bacterial pneumonia: lobar pneumonia & lobar pneumonia &

bronchopneumonia.bronchopneumonia.

2. Viral (interstitial) pneumonia:2. Viral (interstitial) pneumonia: influenza, influenza, measles, chicken pox.measles, chicken pox.

3. Loeffler3. Loeffler’’s (parasitic) pneumonia:s (parasitic) pneumonia: Bilharziasis, Bilharziasis, ascaris & ankylostomiasis.ascaris & ankylostomiasis.

4. Granulomatous pneumonia:4. Granulomatous pneumonia: T.B, sarcoidosis, T.B, sarcoidosis, leprosy, syphilis, actinomycosis .leprosy, syphilis, actinomycosis .

5. Lipoid pneumonia:5. Lipoid pneumonia: due to aspiration of oily due to aspiration of oily nasal drops.nasal drops.

6. Irradiation pneumonia.6. Irradiation pneumonia.

LOBAR PNEUMONIALOBAR PNEUMONIA

* Def:* Def: acute diffuse fibrinous inflammation acute diffuse fibrinous inflammation of one or more lung lobes.of one or more lung lobes.

* Etiology:* Etiology: Age:Age: middle age. middle age. Predisposing factors:Predisposing factors: low resistance. low resistance. Causative organism:Causative organism: pneumococci. pneumococci. Route of infection: Route of infection: droplet infection.droplet infection.

* Pathogenesis:* Pathogenesis:

Pneumococci are inhaled to reach Pneumococci are inhaled to reach alveoli. They cause acute inflammaion alveoli. They cause acute inflammaion with excess fluid exudate. This fluid with excess fluid exudate. This fluid exudate pass from one alveolus to exudate pass from one alveolus to another rapidly through the inter- another rapidly through the inter- alveolar pores of cohn to involve the alveolar pores of cohn to involve the whole lung lobe. The fluid exudate expel whole lung lobe. The fluid exudate expel air away from the alveoli producing a air away from the alveoli producing a firm airless lobe leading to consolidation firm airless lobe leading to consolidation (hepatisation) of the affected lobe. (hepatisation) of the affected lobe.

11 . .Stage of Stage of congestioncongestion

22 . .Stage of Stage of red red

hepatizationhepatization

33 . .Stage of Stage of gray gray

hepatizationhepatization

44 . .Stage of Stage of resolutionresolution

1. Duration 1. Duration 1st day1st day 2nd 2nd –– 4th day 4th day 5th 5th –– 8th day 8th day 9th 9th –– day 21 day 21

2. Gross findings: the affected lobe is: 2. Gross findings: the affected lobe is: - Size:- Size: Enlarged. Enlarged.

- Color:- Color: Red. Red.

- Consistency:- Consistency: like like wet sponge.wet sponge.

- Cut section:- Cut section: exudes frothy exudes frothy

fluidfluid..- The covering - The covering pleura:pleura: normal normal

- The hilar L.Ns.:- The hilar L.Ns.:

normalnormal

- Enlarged.- Enlarged.

- Red.- Red.

- - Consistency: Consistency: consolidated consolidated (hepatized).(hepatized).

- Cut section: - Cut section: dry.dry.

- Pleurisy.- Pleurisy.

- Enlarged - Enlarged hilar LNs. hilar LNs.

- Enlarghed.- Enlarghed.

- Gray.- Gray.

- - Consistency: Consistency: consolidated consolidated (hepatized).(hepatized).

- Cut - Cut section: dry.section: dry.

- Pleurisy.- Pleurisy.

- Enlarged - Enlarged

hilar LNs.hilar LNs.

- Since there - Since there is no is no necrosis, necrosis, healing by healing by resolution resolution occurs.occurs.

11 . .Stage of Stage of congestioncongestion

22 . .Stage of Stage of red red

hepatizationhepatization

33 . .Stage of Stage of gray gray

hepatizationhepatization

44 . .Stage of Stage of resolutionresolution

3. M/P 3. M/P a. Alveolar a. Alveolar capillariers:capillariers:

Congested.Congested.

b. Alveolar b. Alveolar walls:walls: thickened.thickened.

c. Alveolar c. Alveolar spaces:spaces:

Show bacteria Show bacteria & fluid & fluid exudate.exudate.

a. Alveolar a. Alveolar capillarierscapillariers::

CongestedCongested..

b. Alveolar b. Alveolar walls:walls: thickenedthickened..

c. Alveolar c. Alveolar spacesspaces::

Show Show bacteria, bacteria, fibrin, RBCs fibrin, RBCs and and

polymorphspolymorphs..

a. Alveolar a. Alveolar capillariers:capillariers:

Less congestedLess congested

b. Alveolar b. Alveolar walls:walls: thin. thin.

c. Alveolar c. Alveolar spaces:spaces:

Show dead Show dead bacteria, shrinked bacteria, shrinked fibrin, hemolysed fibrin, hemolysed RBCs, excess RBCs, excess polymorphs and polymorphs and macrophages.macrophages.

11 . .Stage of Stage of congestioncongestion

22 . .Stage of Stage of red red

hepatizationhepatization

33 . .Stage of Stage of gray gray

hepatizationhepatization

44 . .Stage of Stage of resolutionresolution

4. Clinical course4. Clinical course - Fever, cough, dyspnea and chest pain.- Fever, cough, dyspnea and chest pain.

- At about 9th day the disease ends by - At about 9th day the disease ends by crisiscrisis (sudden (sudden improvement), however death may occur due to severe improvement), however death may occur due to severe

toxaemia.toxaemia.

11 . .Stage of Stage of congestioncongestion

22 . .Stage of Stage of red red

hepatizationhepatization

33 . .Stage of Stage of gray gray

hepatizationhepatization

44 . .Stage of Stage of resolutionresolution

5. Complications5. Complications 1.1. Spread of infection: direct, lymphatic and blood Spread of infection: direct, lymphatic and blood

(toxaemia, septicaemia).(toxaemia, septicaemia).

2.2. Lung fibrosis due to failure of resolution.Lung fibrosis due to failure of resolution.

3.3. Post-pneumonic lung abscess. Post-pneumonic lung abscess.

BRONCHOPNEUMONIABRONCHOPNEUMONIA

* Def:* Def: Acute suppurative inflammation of Acute suppurative inflammation of bronchioles and adjacent alveoli bronchioles and adjacent alveoli characterized by patchy lung consolidation.characterized by patchy lung consolidation.

* Etilogy:* Etilogy: Age:Age: extremes of age (young & elderely). extremes of age (young & elderely). Predisposing factors:Predisposing factors: low resistance and low resistance and

bronchitis.bronchitis. Causative bacteria:Causative bacteria: staphylococci, streptococci staphylococci, streptococci

& H. influenza.& H. influenza. Route of infection: Route of infection: endogenous invaders and endogenous invaders and

exogenous invaders (droplet infection). exogenous invaders (droplet infection).

* N/E: * N/E: Bilateral.Bilateral. Basal.Basal. Multiple consolidated yellowish Multiple consolidated yellowish

patches exuding pus on pressure. patches exuding pus on pressure. Several patches may coalesce to Several patches may coalesce to produce confluent produce confluent bronchopneuomonia.bronchopneuomonia.

Enlarged hilar L. nodes.Enlarged hilar L. nodes.

* M/P:* M/P:I. The bronchioles show:I. The bronchioles show:

Their lumen shows:Their lumen shows: necrotic epithelial cells, necrotic epithelial cells, polymorphs & pus cells.polymorphs & pus cells.

Their lining:Their lining: ulceration. ulceration. Their walls: Their walls: congested capillaries, congested capillaries,

neutrophils and pus cells & exudate.neutrophils and pus cells & exudate.

II. The adjacent alveoli show:II. The adjacent alveoli show: 3 successive 3 successive zones: zone of alveolitis then zone of alveolar zones: zone of alveolitis then zone of alveolar collapse and a zone of alveolar dilatation collapse and a zone of alveolar dilatation (compensatory emphysema).(compensatory emphysema).

* Complications:* Complications:

1.1. Spread of infection: direct, Spread of infection: direct, lymphatic and blood (toxaemia, lymphatic and blood (toxaemia, septicaemia).septicaemia).

2.2. Lung fibrosis due to failure of Lung fibrosis due to failure of resolution.resolution.

3.3. Post-pneumonic lung abscess.Post-pneumonic lung abscess.

4.4. Bronchiectasis.Bronchiectasis.