3- complications of pneumonia

Question 1

what is pneumonia?

Answer 1

form of acute respiratory infection that affect the lungs where alveoli filled with pus

Question 2

what do bronchial breath sounds suggest?

Answer 2

implies airways full of pus and pus transmitting sound from large bronchial airways to your stethoscope

Question 3

what is empyema?

Answer 3

pus in pleural space = complication of pneumonia
- needs intercostal drain

Question 4

are primary empyema iatrogenic or idiopathic?

Answer 4

can be both = often iatrogenic (doctors fault), many idiopathic (spontaneous)

Question 5

what signs mean just a simple parapneumonic effusion?

Answer 5

• Clear fluid
• pH > 7.2 (pretty benign)
• LDH < 1000
• Glucose > 2.2 (low glucose benign as no cells eating up sugar)

Question 6

what signs mean a complicated parapneumonic effusion?

Answer 6

• pH < 7.2
• LDH > 1000
• Glucose < 2.2
• Requires Chest Tube Drainage

Question 7

what signs mean empyema?

Answer 7

• Frank pus
• No other tests required
• Requires Chest Tube Drainage

Question 8

what is the most common organisms causing empyema?

Answer 8

aerobic organisms: both gram positive + gram negative

gram positive: strep pneumoniae, staph aureus, strep milleri (found in healthy people’s mouth, flu like illness encourage bacteria to travel down and cause infection for some reason)

gram negative: e.coli, pseudomonas, klebsiellae

Question 9

are empeyemas ever caused by anaerobes?

Answer 9

in 13% cases = not common = usually in severe pneumonia or poor dental hygiene

Question 10

what are you looking for in chest x-ray?

Answer 10

persisting or new effusion

Question 11

what is the preferred investigation for checking complications of pneumonia?

Answer 11

ultrasound as simple bedside test with targeted sampling

= the appearances will give clue to complexity of fluid

Question 12

what is purpose of CT scan in pneumonia complication?

Answer 12

• Differentiation between Empyema and Abscess
• Allows extent of effusion/empyema to be appreciated

Question 13

what are you looking for on chest x-ray?

Answer 13

• look for meniscus (characteristic appearance of the fluid level within the pleural space, resembling a meniscus shape indicating pleural effusion)
• D -sign or split pleural sign (concave shape that looks like a D indicating empyema)

= some are obvious, some are not - not always large

Question 14

what is antibiotics for empyema treatment?

Answer 14

IV antibiotics = amoxicillin + metronidazole or co-amoxiclav = a broad spectrum as often polymicrobial and need anaerobic cover

Oral antibiotic = usually co-amoxiclav for 5 weeks, directed towards cultured bacteria

Question 15

what other treatment can be given for empyema?

Answer 15

intrapleural fibrinolytics = attempt to break down inflammation to try and help patient get better more quickly

• if complicated effusion and dont get better with drain & antibiotic = give 2 drugs (tPA and DNA) in co,bimatoon up the drain and suddenly all the fluid comes out

Question 16

what is an intrapulmonary abscesses?

Answer 16

• A circumscribed necrotic infection within the lung parenchyma
• Can sometimes be hard to distinguish from an empyema!

Question 17

what is helpful in diagnosing intrapulmonary abscess?

Answer 17

CT important for helping

Question 18

what are the symptoms like for intrapulmonary abscesses?

Answer 18

similar to lung cancer symptoms:
- Indolent presentation (little pain)
- Weight loss common
- Lethargy, tiredness, weakness
- Cough ± sputum, often suddenly worse
- High mortality if not treated

Question 19

what are common preceding illnesses of intrapulmonary abscesses?

Answer 19

• Pneumonic infection
• Post viral
• Foreign body

Question 20

what are the different angle on CT suggest?

Answer 20

acute angle = abscess
obtuse angle = empyema

Question 21

what should you NOT drain?

Answer 21

an abscess

Question 22

what are pathogens that cause abscess?

Answer 22

• bacteria (strep, staph, e.coli, gram negative)
• funghi (aspergillus)
• septic emboli (right sided endocarditis, infected DVT, septicaemia)

Question 23

why are intravenous drug users more vulnerable to abscess?

Answer 23

• Inject into groin
• DVT
• Infection
• PE + Abscesses

Question 24

what is treatment of abscess?

Answer 24

• Prolonged courses of antibiotics – sometimes for months!
• Occasionally surgery, but drainage is much less common than for empyema, and carries risk

Question 25

what makes aspiration pneumonia more likely?

Answer 25

• Vomiting increases risk
• Lowered conscious level means higher risk of aspirating foreign material
• Pharyngeal pouch are outpouchings of mucosa and submucosa in posterior pharyngeal wall which can trap food particles & secretions
• Hypogammaglobulinemia (deficiency of immunoglobulins in blood which means increased risk of aspiration pneumonia, respiratory infections)

Question 26

what are some key images of complications of pneumonia?

Answer 26

ultrasound and CT