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LUNG ABSCESS. SIFO ABRAHAM. OUTLINE. DEFINITION CLASSIFICATIONS PATHOPHYSIOLOGY SYMPTOMS PHYSICAL FINDINGS FACTORS CONTRIBUTING TO LUNG ABSCESS DIFFERENTIAL DIAGNOSIS WORKUP TREATMENT. DEFINITION. - PowerPoint PPT Presentation
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LUNG ABSCESS
SIFO ABRAHAM
OUTLINE DEFINITION
CLASSIFICATIONS
PATHOPHYSIOLOGY
SYMPTOMS
PHYSICAL FINDINGS
FACTORS CONTRIBUTING TO LUNG ABSCESS
DIFFERENTIAL DIAGNOSIS
WORKUP
TREATMENT
DEFINITION Necrosis of pulmonary tissues and
formation of necrotic debris containing necrotic debris caused by microbial infection.
The formation of multiple small abscesses <2cm is occasionally referred to as necrotizing pneumonia or lung gangrene.
CLASSIFICATION Lung abscess is classified based on its
duration or etiology.
Acute abscess occuring less than 4-6weeks
Chronic abscess longer duration
Primary abscess caused by aspiration or pneumonia
Secondary abscess caused by obstruction, bronchietasis, immuno-compromised state
pathophysiology Lung abscess is a
complication of aspiration pneumonia caused by mouth anaerobes.
Also caused by septic emboli to the lungs caused by
1.Bacteremia
2.Tricuspid valve endocarditis
Anaerobes causing lung abscess
Peptostreptococcus spp.
Bacteroides spp.
Fusobacterium spp.
Microaerophilic streptococci
symptoms The usual symptoms include fever
cough with sputum production
anorexia
weight loss
night sweats.
Hemoptysis and pleurisy
Physical findings Patients presents with low-grade fever in
anaerobic infections & temperature greater than 38.5C in other infections.
Evidence of gingival disease.
Clinical findings of consolidations:{decreased breath sounds, dullness to percussion, bronchial breath sound, course inspiratory crackles
Factors Oral cavity disease
Periodontal disease
Gingivitis
Inability to protect airways
Alcoholism
Coma
Drug abuse
Immunocompromised
Steroid chemotherapy
Malnutrition
Multiple trauma
Esophageal disease
Achalasia
Reflux disease
Esophageal obstruction
Bronchial obstruction
Tumor
Foreign bdy
stricture
DIFFERENTIAL DIAGNOSIS
Alcoholism
Empyema, Pleuropulmonary
Hydatid Cysts
Infective Endocarditis
Lung Cancer, Non-Small Cell
Lung Cancer, Oat Cell (Small Cell)
Pneumonia, Bacterial
Pneumonia, Fungal
Pulmonary Embolism
Sarcoidosis
Thrombophlebitis, Septic
Tuberculosis
Wegener Granulomatosis
WORKUPlab studies
CBC
Obtain sputum for gram stain, culture and sensitivity
Blood culture
Sputum for ova and parasite
Imaging studies CXR
A typical chest radiographic appearance of a lung abscess is an irregularly shaped cavity with an air-fluid level inside. Lung abscesses as a result of aspiration most frequently occur in the posterior segments of the upper lobes or the superior segments of the lower lobes.
Pneumococcal pneumonia complicated by lung necrosis and abscess formation.
CT scan CT scanning of the lungs may help visualize
the anatomy better than chest radiography. CT scanning is very useful in the identification of concomitant empyema or lung infarction.
TREATMENTantibiotic therapy
Clindamycin: an effective drug over penicillin because several drugs produce beta lactamase thereby showing drug resistance
Metronidazole: an effective drug with a failure rate of 50%
SURGICAL CARE Surgery is very rarely required for patients
with uncomplicated lung abscesses. The usual indications for surgery are failure to respond to medical management, suspected neoplasm, or congenital lung malformation. The surgical procedure performed is either lobectomy or pneumonectomy.
REFERENCES http://emedicine.medscape.com/article/2994
25-
http://www.healthline.com/health/lung-abscess#Overview
http://www.patient.co.uk/doctor/lung-abscess
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