Internal illnesses. Pneumonia (etiology, pathogenesis, classification, clinical picture) (most important)

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Internal illnesses. Pneumonia (etiology, pathogenesis, classification, clinical picture) (most important)

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26. PNEUMONIA (ETIOLOGY, PATHOGENESIS, CLASSIFICATION, CLINIC)

An acute infectious and inflammatory process in the lungs involving all the structural elements of the lung tissue and obligatory damage to the alveoli of the lungs.

Etiology. In all cases they are caused by gram-positive or gram-negative microflora. In immunodeficiency pneumonia, Pneumocystis carinii, Cytomegalovirus, Herpes simplex, and fungi are found. With aspiration pneumonia, anaerobic microorganisms are detected.

Pathogenesis. In community-acquired pneumonia, damage to the endothelium of the tracheobronchial tree occurs with disruption of mucociliary clearance and the mucociliary barrier. The functioning of macrophages and the secretion of lysozyme and interferon are disrupted.

With nosocomial pneumonia, the cough reflex is suppressed, the mucous membrane of the tracheobronchial tree is damaged during surgery and artificial ventilation, and there is also a sharp decrease in general and local immune defense against the background of immunosuppressive therapy.

Classification. They are divided into community-acquired, or home, outpatient, nosocomial, or hospital, nosocomial, aspiration, in persons with severe immunity defects.

The severity is:

1) mild: mild intoxication (consciousness is clear, fever up to 38 ° C, tachycardia up to 90 beats per minute, blood pressure is normal), shortness of breath is slight on exertion, not at rest, on the x-ray - the lesion is small;

2) moderate: moderately severe intoxication (clear consciousness, mild euphoria, sweating, weakness, fever up to 39 ° C, tachycardia up to 100 beats per minute, moderate decrease in blood pressure), shortness of breath at rest (number of breaths up to 30 per minute), on an x-ray - pronounced infiltration of lung tissue;

3) severe degree: severe intoxication (temperature up to 39-40 °C, adynamia, blackout, delirium, tachycardia more than 100 beats per minute, collapse), shortness of breath at rest (30-40 respiratory movements per minute), cyanosis, extensive infiltration on x-ray, complications of pneumonia are common.

According to the prevalence of pneumonia, there are lobar, segmental, right-sided, left-sided.

Clinic. Hot flash stage: acute onset: chills, headache, chest pain when breathing, fever, dry cough, later “rusty” sputum appears. Herpes labialis (nasalis), hyperemia of the cheek on the affected side, and swelling of the wings of the nose may appear. When breathing, the affected half of the chest lags behind the healthy one. Percussion - pulmonary sound with a tympanic tint. Auscultation - weakening of vesicular breathing, gentle initial crepitation - "indux" crepitation, pleural friction noise.

In the thickening stage, a cough with purulent sputum, constant fever, shortness of breath, chest pain when breathing and coughing, mental agitation, Herpes, flushing of the cheeks, icterus of the skin and sclera appear. Voice tremors and bronchophony increase. A dull sound is detected by percussion. On auscultation, bronchial breathing and pleural friction noise are heard.

In the resolution stage, a productive cough appears, a large amount of sputum, body temperature drops. Percussion is determined by dullness with a tympanic shade. Harsh breathing, rough crepitus - "redux" crepitus, sonorous moist rales are auscultated.

Author: Myshkina A.K.

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