13 Pneumonia

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Lobar

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• involves one or more lobes of lungs, ultimately entire lung

• currant jelly sputum

• currant jelly stool different (intussusception)

• 2: lung becomes to look like the liver, red

• exudates give lung red color

• gray: everything is dying

• 4: return to normal, regen, little scarring

Bronchopneumonia

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• splotches everywhere instead of 1 lobe

• staph aureus, H. influenza, pseudomonas, moraxella, legionella

Legionella

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• atypical

Interstitial Pneumonia

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• streaky white lines in both lung fields

• more benign

• pts not as sick

• atypical because not strep pneumoniae

• RSV: most common atypical in infants

• CMV: atypical with post transplant immunosuppression

• Influenza: elderly

• Coxiella: Q fever

• PCP: HIV

Influenza

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• nonspecific symptoms

• damage mucociliary escalator

Mycoplasma

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CMV

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• clearing around dark material

RSV

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• wheezing: infect and narrow the bronchioles

• CHD: can have life threatening disease if infected with RSV

PCP

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• dark black

Other Causes

Age

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• neonates: same bug that causes meningitis, come from mother and passed to baby

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Community vs Hospital

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• clinically, don't isolate bug, treat based on symptoms

• VAP: get while on ventilator

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• uncomplicated

• levo usually just given because can treat all kinds of pneumonia

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Aspiration

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• anaerobic bacteria normally present in oral cavity

Symptoms

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• chest pain on inhalation from stretching of pleura

• lavage: liquid solution, collect cells in lungs

ARDS

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• same problem as pulmonary edema in HF but leaky vasculature instead of hydrostatic pressure

• looks just white

• set low TV and higher RR to compensate: less injury to lungs

Lung Abscesses

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• aspirate anaerobes and cause abscess

• walled off area on imaging with fluid at bottom (pus)