Absceso Pulmonar Flashcards
Definition of lung abscess?
A circumscribed area of pus or necrotic debris in lung parenchima, which leads to a cavity, and after formation of bronchopulmonary fistula, an air-fluid level inside the cavity
Division of lung abscesses according to the duration?
Acute: < 6 weeks
Chronic: > 6 weeks
Division of lung abscesses by etiology?
- Primary: Aspiration of oropharyngeal secretions, necrotizing penumonia, immunodeficiency
- Secondary: Bronchial obstructions, haematogenic dissemination, direct spreading from mediastinal infection, from subphrenium, coexisting lung disease
Ways of spreading?
- Brochogenic: Aspiration of oropharyngeal secretions, bronchial obstruction by tumor, foreign body, enlarged lymph nodes, congenital malformation
- Haematogenic: Abdominal sepsis, infective endocarditis, septic thromboembolisms
Situations of aspiration of oropharyngeal secretions?
- Dental/pero dental infection
- Para nasal sinusitis
- Disturbance states of consciousness
- Swelling disorders
- Gastro-oesophageal reflux disease
- Frequent vomiting
- Intubated patients
- Patients with tracheostomy
- Nervous recurrent paralysis
- Alcoholism
Haematogenic dissemination?
- Abdominal sepsis
- Infective endocarditis
- Intravenous drug abuse
- Infected cannula or central venous catheter
- Septic thromboembolisms
Coexisting lung disease capable of causing lung abscesses?
- Bronchiectasis
- Cystic fibrosis
- Bullous emphysema
- Bronchial obstruction by tumor, foreign body or enlarged lymph nodes
- Congenital malformations (pulmonary sequestration, vasculitis, cystitis)
- Infected pulmonary infarcts
- Broncho-oesophageal fistula
Características radiológicas del absceso pulmonar agudo?
Circumscribed with not so well-defined surrounding to lung parechyma, fulfilled with thick necrotic detritus.
Características histológicas del absceso pulmonar agudo?
In central parts of abscess there are necrotic tissue mixed with necrotic granulocytes and bacteria. Around this area there are preserved neutrophillic granulocytes with dilated blood vessels and inflammatory oedema
Características radiográficas del absceso pulmonar crónico?
Is usually irregular star-like shape with well-defined surrounding to lung parenchyma, fulfilled with grayish line or thick detritus.
Características histológicas del absceso pulmonar crónico?
In the center of abscess is located pyogenic membrane through which white blood cells are migrating to abscess cavitation. Around pyogenic membrane lymphocytes, plasma cells and histiocytes are placed in connective tissue.
Contributing factors for lung abscess?
- Elderly
- Dental/peridental infecciones (gingivitis-with bacterial concentration > 10 11/ml)
- Alcoholism
- Drug abuse
- DM2
- Coma
- Artificial ventilation
- Convulsions
- Neuromuscular disorders with bulbar disfunctions
- Malnutrion
- Therapy with corticosteroids, cytostatics or immunosupressants
- Mental retardation
- Gastroesophageal reflux disease
- Bronchial obstruction
- Inability to cough
- Sepsis
Microbial bacteria round?
90% is poly microbial bacteria
Predominant anaerobic bacteria lung abscess?
Gram (-):
- Bacteroides Fragilis
- Fusobacterium capsulatum and necrophorum
Gram (+):
- Peptostreptococcus
- Streptococci
Aerobic bacteria predominant isolates in lung abscess?
- Staohyloccocus aureus (including methicilin resistant staphylococcus aureus)
- Streptococcus pyogenes and penumonia
- Klebsiella pneumonia
- Pseudomona aeruginosa
- Haemophilus influenza (type B)
- Acinectobacter spp
- Escherichia coli
- Legionela
