Internal illnesses. Lung gangrene (lecture notes)

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Internal illnesses. Lung gangrene (lecture notes)

Lecture notes, cheat sheets

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LECTURE No. 26. Gangrene of the lung

Gangrene of the lung is a progressive necrosis and hypochorous (putrefactive) decay of the lung tissue, not prone to limitation.

Etiology. The causative agents of the disease are non-clostridial anaerobes.

Pathogenesis. Anaerobic bacteria penetrate into the lung tissue, activation of bacterial exotoxins and their direct effect on lung tissue, progressive lung tissue necrosis, vascular thrombosis in the affected area, impaired formation of granulation tissue.

Clinic. The main manifestations of the disease are cough with fetid sputum and fragments of lung tissue, hectic nature of fever, chest pain, shortness of breath, expanding dullness is determined by percussion at the onset of the disease; during the peak - the appearance of areas of tympanitis due to the formation of cavities. On palpation, pain over the affected area (Kissling's symptom) and percussion (Sauerbruch's syndrome) (involvement in the pleura process) is determined, palpation - first, increased voice trembling, then weakening. Auscultatory listening first bronchial breathing, then a sharp weakening of breathing.

Additional diagnostic study. A general blood test is performed, where neutrophilic leukocytosis is determined with a sharp shift to the left, increased ESR. A study of sputum is also carried out (during macro-examination, sputum forms 3 layers: the upper one is foamy, liquid; the middle one is serous; the lower one is fragments of decaying lung tissue; micro-examination is the study of flora, cytology), X-ray examination (massive infiltration without clear boundaries with the presence of multiple confluent cavities irregular shape).

Differential diagnostics. Should be carried out with tuberculosis, lung cancer.

Flow. The course of the disease is severe and progressive.

Treatment. Antibacterial therapy is carried out (parenterally, intravenously), it is possible to introduce into the pulmonary artery. Combine several types of antibacterial drugs. Carry out detoxification therapy (rheopolyglucin, hemodez, hemosorption, ultraviolet autologous blood), bronchospasmolytic therapy, endoscopic bronchial sanitation followed by the introduction of antibiotics, enzymes, antiseptics, blood transfusion (with the development of anemia), heparin is used (to prevent DIC).

Prevention. Preventive measures include adequate treatment of acute pneumonia, adequate bronchial drainage, rehabilitation of chronic infection foci, smoking cessation.

Author: Myshkina A.A.

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