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Pneumonia - Coggle Diagram

- - - - Infection
        
        Sepsis
        
        Pulmonary infections
        
        Gastric aspiration
      - Physical Injury (Extra pulmonary)
        
        Trauma
        
        Pulmonary contusions
        
        Near-drowing
        
        Fractures with fat embolism
        
        Burns
        
        Ionising radiation
      - Inhalation injury
        
        Oxygen toxicity
        
        Smoke
        
        Irritant gases / chemicals
      - Chemical injury
        
        Heroin or methdone overdose
        
        Paraquat
      - Haematological conditions
        
        Mutliple transfusions
        
        Disseminated intravascular coagulation
      - Pancreatitis
      - Uraemia
      - Cardiopulmonary bypass
    - - Early / Acute / Exudative
        
        Timescale
        
        Day 1
        
        Interstitial / alveolar haemorrhage and fibrin
        
        Day 3-7
        
        Hyaline membranes
        
        Type II pneumocyte hyperplasia
        
        Week 1
        
        Interstitial inflammation
        
        Alveolar wall damage due to injury to type I alveolar cells and capillary endothelium
        
        Consequences
        
        Cytoplasmic blebbing :large_blue_circle:
        
        Necrosis :skull_and_crossbones:
        
        Denudation of alveolar walls
        
        Escape of fibin-rich exudates into alveoli and interstitium
        
        Loss of surfactant lining - leading to alveolar collapse :umbrella_with_rain_drops:
      - Late / Organising / Proliferative
        
        Healing
        
        Resolution
        
        Fibrinolysis allowing lung recovery
        
        Fibrosis
        
        Fibrolbalst deposit collagen causing interstitial fibrosis - realted to mortality
        
        Regeneration
        
        Proliferation of epithelial cells
        
        Proliferation of type II alveolar cells and myofibroblasts in interstitum
        
        Timescale
        
        1-2 weeks
        
        Fibroblast proliferation
        
        Organisation and fibrosis
      - Fibrosis and Injury
        
        Fibrogenicity Factors
        
        Mechanism of tissue injury
        
        Severity
        
        Duration
        
        Anatomical Location
        
        Host factors
        
        Usually irreversible
        Therapy aims at prevention further injury
  - - - Alveolar insult
      - Release of pro-inflammaotry cytokines
      - Neutrophil recruitment, activation and release of toxic mediations (ROS, Proteases)
      - CApillary endothelial damage and increased vessel permeability
      - Leakage of protein rich flui into alveoli
      - Formation of intra-alveolar hyaline membranes and noncradiogenenic pulmonary oedema
      - Loss of surfactant
      - Alveolar collapse
    - - Sepsis
      - Aspiration
      - Pneumonia
      - Trauma
      - Pancreatitis
    - - A - Abnormal CXR - bilateral lung opacities
      - R - Respiratory failure within 1/52 of alveolar insult
      - D - Decreased PaO2 / FiO2 (ratio<300, hypoxemia)
      - S - Symptoms of resp failure not due to HF / fluid overload
    - - Impaured gas exchange - rapid development of resp failure with refractory hypoxemia
      - Decreased lung compliance (hyaline)
      - Pulmonary hypertention
    - - Treat underlying cause
      - Mechanical ventilation with low tidal volume and high PPEP
  - - - Hypoxia affects organs
      - Inflammatory mediators released into circulation
- - - - Antecedent pneumonia
      - Distal to an obstructing tumour / foreign body
      - Septic embolism
  - - - Recurrent inflammation of bronchial walls
      - Fibosis in lung parenchyma leads to scar tissue traction on bronchi leadin to dilation
    - - Post- inflammatory
        Complication of pneumonia
      - Post-obstructive
        Distal to tumour
      - Congenital / hereditary conditions
        Systic fibrosis
    - - Cough
      - Fever
      - Foul sputum
    - - Local or widespread
      - Affects basal segments of lower lobes, right middle molbe and lingual
    - - Dilated bronchi extending to pleural surface
      - Surrounding scarring
    - - Mucosal ulceration
      - Submucosal chronic inflammation and granulation tissue
      - Adjacent pneumonia
    - - Cor pulmonale
      - Amyloid
- - - - Endogenous
      - Exogenous
  - - - Less frequent
      - Widespread fibrinosuppurative consolidation of a large portion of a lobe or an entire lobe
      - Clinical Features
        
        Abrupt onst
        
        Pleuritic chest pain
        
        Rusty sputum
        
        High fever
        
        Tachypnoea
        
        Leukocytosis
      - Stages
        
        Congestion
        
        Less than 24h
        Vascular engorgement
        Intra alveolar fluid
        Numerous bacteria
        
        Red Hepatization (Liver Like)
        
        24-48h
        Red cells neutrophils and fibrins
        
        Grey Hepatization
        
        2-3 days
        RBCs disintegrate
        Fibrinosuppurative exudate persists
        
        Resolution
        
        Enzymatic digestion
        Ingestion by macrophages
        Coughed up
    - - Patchy consolidation, usually extension of pre-existing bronchitis / bronchiolitis
      - Insidious onset
        
        Infacts, debilitated, elderly, pot-op
        
        Lower lobes- larger and more numerous foci
        
        Gross appearrance of lung : Pale area raised above the surface surrounding the lung
        
        Recovery - liquifaction or by fibrosis
  - - - Associated with bacterial infx
      - Alveolar spaces filled with neutrophils
    - - Granulation tissue in bronchioles and alveoli
    - - Idiopathic
      - Drugs
      - Infection
      - Inhalational
    - - Exogenous lipid
      - Post obstructive
      - Foamy macrophages
- - - - Streptococcus pneumoniae (“Pneumococcus”)
      - Staphylococcus aureus
      - Streptococcus pyogenes
      - Haemophilus influenzae
      - Klebsiella pneumoniae
      - Legionella pneumophila
    - - Pneumococcus
      - H. Influenzae
      - Legionella
    - - Mycoplasma pneumoniae
      - Chlamydia
    - - Gram negative rods
        Kelbsiella spp
        E. Coli
    - - Staph aureus
      - Klebsiella pneumoniae
      - Strep. Pyogenes
    - - SMV
      - Pneumocystic
      - Mycobacterium avium intracellulare
  - - - Loss of conciousness
      - Suppressino of cough reflex
      - Dysphagia
      - Neurological disorders / tumours
    - - Apical segment of lower lobes
      - Basal segments of upper lobes
- - - - Loss / impairement of cough reflex
        
        Coma
        Anaethesia
        Neuromuscular disorders
        Drugs
      - Impaired mucocilirary elevator
        
        Cigerette smoke
        Viral diseases
        Genetics defects
      - Impaired function of alveolar macrophages
        
        C2H5OH
        Cigarette smoke
      - Accumlated / stagnant secretions
        
        Cystic fibrosis
        Bronchial obstruction
      - Pulmonary oedema
    - - Chronic disease
      - Malignancy
      - Immune deficiency
      - Iatrogenic - immunosuppressive therapy