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Symptoms of respiratory system > Consolidation Syndromes > Flashcards

Consolidation Syndromes Flashcards

1
Q

PULMONARY CONSOLIDATION

SYNDROMES

A

signs and symptoms secondary to the
collapse of the lung parenchyma with disappearance of air in the involved territory
Consolidation occurs through accumulation of inflammatory cellular exudate in the alveoli

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2
Q

CLASSIFICATION

A
  1. Depending on location
     Systematized (lung, lobe, segment)- without displacement
     Not-systematized
  2. Related to the adjacent parenchyma:
    • Not-retractile- they do not restrict the adjacent parenchyma
    • Retractile - they restrict the adjacent parenchyma
  3. Related to etiology:
    • Determined by infectious / inflammatory processes
    • Pneumonia
    • Bronchopneumonia
    • Determined by tumors
    • Lung cancer
    • Vascular etiology: Pulmonary Infarction
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3
Q

PULMONARY CONSOLIDATION

SYNDROMES- characteristics

A 
PALPATION
• ↑ tactile fremitus (when bronchia is open)→not
retractile
PERCUSSION
• Dullness to percussion (fixed)
AUSCULTATION
• ↓ intensity / absence of breath sounds, replaced
by
• Tubular breath
• Possible medium, late, or pan-inspiratory
crackles
• “Crepitante”
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4
Q

PULMONARY CONSOLIDATION
SYNDROMES
•Not retractile

A

•Pneumonias
1. Bacterial
2. Interstitial (atypical)
•Bronchopneumonias

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5
Q

BACTERIAL PNEUMONIAS

A

Inflammation of the alveoli and terminal airspaces in response to invasion by an infectious agent acquired through hematogen spread or airborne transmission

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6
Q

ETIOLOGY of bacterial pneumonia

A
  1. S. pneumoniae (pneumococcus) →Typical lobar
  2. pneumonia
  3. Staphylococcus
  4. Streptococcus
  5. Haemophilus influenzae
  6. Klebsiela (Friendlander bacillus)
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7
Q

TYPICAL LOBAR PNEUMONIA

A

Etiology: Streptococcus pneumoniae = encapsulated Gram positive diplococci

Involves: 1 segment / 1 pulmonary lobe
Evolution: in 3 stages/phases

  1. Onset
  2. Evolution
  3. Resolution
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8
Q

TYPICAL LOBAR PNEUMONIA

onset phase

A

Onset phase
Symptoms/ Sygns
▪ Sudden Onset
▪ Chills: sudden, Single rigor, prolonged (Duration 15 – 30 min) ▪ Chest pain
▪ Cough - Dry, irritating, hollow cough, at first 1 – 3 day Followed by Sputum production- dark-red, adherent ▪ Superficial respiration – Tachypnea, polypnea General sign
▪ Fever: high 390 – 400, constant pyrexia, plateau ▪ Tachycardia
▪ Altered status
Physical sign
▪ Warm teguments (febrile)
▪ Redness of face
▪ ± herpes labialis (± whole face)

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9
Q

Chest pain

A
  1. Severe
  2. Sharp / knifelike
  3. Localization: submammary area / basal *
  4. Aggravated by breath / coughing
  5. Immobilize the patient on the sick side
  6. Pleuritic pain = Results from inflamed parietal pleura
    (e.g.: diaphragmatic pl. → shoulder pain
    children → abdominal pain)
    * Depend on pneumonia location (anatomical involvement)
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10
Q

TYPICAL LOBAR PNEUMONIA
Onset Phase
Respiratory system examination
inspection + palpation + precussion + auscultation

A

INSPECTION: superficial respiration - polypnea
PALPATION: tactile fremitus normally transmitted
PERCUSSION: discreet dullness

AUSCULTATION:
Initially: ↑ tonality and intensity of breath sounds
= bronchial breath sounds
± timber changes = hardening of breath sounds
= fremitus, breath and voice sounds are transmitted
as if they came directly from the larynx and trachea

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11
Q

TYPICAL LOBAR PNEUMONIA
EVOLUTION phase (the disease course)
→ After 24 – 48 hours

A

Duration → 7 – 10 days
Consolidation syndrome → full clinical presentation
Fever → sustained (plateau)
Dyspnea with inspiratory polypnea
Cyanosis ±
Chest Pain (pleuritic) sustained but of ↓ intensity
Cough with
Sputum: pinkish or adherent rusty sputum (containing fibrin and red cells)
→ yellowish
- Redness of face (plethora of the cheek of affected side)
- Jaundice ( hemolysis, impaired liver function)

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12
Q

TYPICAL LOBAR PNEUMONIA
Respiratory system examination
EVOLUTION phase

A

INSPECTION : ↓ chest expansion
restricted motion of the affected hemithorax
PALPATION : ↑ tactile fremitus
PERCUSSION : Dullness
AUSCULTATION :
bronchial breath sounds surrounded by fine crepitant rales, instead of vesicular breath sounds
(initially, fine crepitant rales dominate, being replaced by tubular or bronchial breath sounds)

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13
Q

TYPICAL LOBAR PNEUMONIA

Resolution / Recovery

A
  1. In “ crisis ”
  2. In “ lisis ”Characteristics:
     Less well defined dullness
     ↓ / tubular & breath sounds disappear
     Crepitant rales reappear with other characters:
    coarse, unequal, mucous
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14
Q

Recovery in “crisis”

A 
Sudden
Before AB / 1⁄2 pt. died “in crisis”
The patient state of health is aggravated suddenly
Rapid temperature rise at 400
± delirium -> 
Abundant sweating
↓ Fever → normal
Normal pulse
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15
Q

Recovery “in lisis”

A
  • Without particular clinical signs
  • Apparent state of health is improving
  • Body temperature begins to fall
  • Cough diminishes, then disappears
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16
Q

TYPICAL LOBAR PNEUMONIA

LABORATORY FINDINGS

A 
- Specific
SPUTUM
1. Bacteriological examination:
pneumococci
Gram’s method (smear- direct exam)
2. Culture
Cellularity: red cells, alveolar cells, leucocytes
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17
Q

TYPICAL LOBAR PNEUMONIA

Chest XRAY

A

Triangular dense opacity systematized, not retractile

  1. The base towards the pleura
  2. The tip towards the hil
  3. Subcostal intensity, homogenous
  4. May occupy an entire segment / lobe
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18
Q

TYPICAL LOBAR PNEUMONIA

PARTICULAR FORMS

A

1.INCOMPLETE FORM
– spontaneous healing without AB
2.ELDERLY PNEUMONIA
– discreet clinical picture, adverse outcome
3. CHILDREN PNEUMONIA
–abdominal pain, vomiting, meningeal signs
4. IN ALCOHOL ADDICTED
– psychiatric disorders, psychomotor agitation

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19
Q

TYPICAL LOBAR PNEUMONIA

OUTCOME

A

NATURAL (SPONTANEOUS, W/O Tretment)
- Death “in crisis”
- Complication
with TREATMENT
- Younger & Immunocompetent → healing in 5-6 days
- Elders & immunodepressed → Complications

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20
Q

TYPICAL LOBAR PNEUMONIA

COMPLICATIONS

A

Sepsis → bacteriemia: pericarditis, endocarditis, meningitis, brain abscess, nephritis, circulatory collapse

Abscess
Pleural effusion
- Early : parapneumonic = sterile serocitrine effusion
- Late: metapneumonic = usually, purulent fluid

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21
Q

STAPHYLOCOCCAL PNEUMONIA

A 
Less brutal onset
 More altered general condition
 Clinical = dominated by Dyspnea and Cyanosis
 Remittent Fever
 muco-purulent sputum with blood streaks
 Physical exam:
consolidation area
• Dull area
• High tonality breathing
• crepitants dry and wet (”subcrepitante)
Rx. = Multiple consolidation foci
 →pneumatocele → pneumothorax
= bronchopneumoniae
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22
Q

Diferentia diagnosis with
INTERSTITIAL PNEUMONIAS
(“Non bacterial”, atypical pneumonias)

A

ETIOLOGIES → different
viral
chlamydia
mycoplasmas

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23
Q

INTERSTITIAL PNEUMONIAS

CLINICAL MANIFESTIONS

A 
Onset:
 Progressive :
• Headache
• Mialgias
• Chills
• Dry cough
• Rhinitis
• Erythematous angina

Evolution
 General signs: Fever, Asthenia, nocturne Diaphoresis
 Bronchitis syndrome
 Cough (Severe, paroxysmal, not responsive to treatment) with
 Expectoration → mucous, adherent
 Dyspnea without cyanosis in children

24
Q

INTERSTITIAL PNEUMONIAS

RSPIRATORY SYSTEM EXAMINATION

A

Normal
 ± Dullness in lung base
 ± fine crackles basal & lateral
Poor correlation between clinical symptoms and signs
(↑ ↑ ↑ Symptoms and ↓ signs)
Poor correlation between clinical signs and Radiology
The pulmonary interstitial infiltrative processes
DO NOT realize
parenchymatous consolidation syndrome

25
Q

INTERSTITIAL PNEUMONIAS

DIAGNOSTIC

A

Epidemiological
• suggested by the presence of rhinitis, bronchitis
Poor clinical signs contrasting with significant xRay
changes
• X- ray (chest)

• Accentuated pattern
• Linear and reticular densities
• Hylio-basal,
• uni or bilateral
• transitory character of micro- or macronodular
densities
26
Q

Bronchopneumonias

A

Definition:

  • clinical syndrome with unpredictable evolution, poor prognosis
  • Affect extreme ages /immuno-depressed

Clasiffication: primary / secondary
PRIMARY: Children, elderly, imunocompromissed
(plurimicrobial)
SECONDARY - more frequent
- predisposing condition:
 various viral lung infections (microbial, viral), Aspiration, Inhaling toxins

27
Q

Bronchopneumonia pathology

A

 Microbial polymorphism
 Broncho-alveolitis
 Consolidation foci in both lung (different ages)

28
Q

BRONCHOPNEUMONIAS
clinical presentation
General

A 
Onset: insidious, untypical
 Symptoms: variable, nonspecific
 State of health: grave, severe
 Chills, Chest Pain may miss (Pleuritic type)
 Fever
Irregular
Gradually increase
- Increases each time a new focus appears
- Decreases at the end of the disease
29
Q

Bronchopneumonia

Respiratory physical exam

A

Cough + mucopurulent Sputum with hemorrhagic striae
 Cyanosis: Intense, Central (lips and extremities)
 Dyspnea
- on the first plane
- POLYPNEA
- Severe > 35resp/min
or permanent dyspnea with exacerbations
+ (newborn: suprasternal and intercostal retraction
and grunting)

30
Q

Bronchopneumonias
RESPIRATORY SYSTEM EXAMINATION
Physical signs

A

 Fluctuating
 Varying with time
 Changing the characters from day to day (hours)
 No relation with the gravity of general signs + dyspnea

31
Q

Bronchopneumonias precussion

A

Dull areas (multiple, in lower lobes but not only (except measles, pertussis infection)

32
Q

Bronchopneumonias auscultation

A

 Bronchial breath sounds (expression of bronchitis)
 Fine and Coarse Crackles surrounding the lobular focus
 Fine bubbling rales, coarse crepitants (ro:SUBCREPITANTE)

33
Q

Bronchopneumonia complications

A 
 Early onset *: local / general
 Late onset: bronchiectasis
* E.g.
 Septic shock with tachycardia, hypotension, collapse
 Renal failure
 Heart failure
 Hypoxemia with hypercapnia
 Children: acute cor pulmonale
34
Q

Bronchopneumonias prognosis

A

severe before antibiotics use

 improved with treatment (etiological and supportive)

35
Q

Bronchopneumonia XRAY

A 
There is no parallel between the clinical and
radiological picture
bronchopneumonic foci
= “shadows” with less extension
- multiple
- variabile intensities
- irregular shape not well delimitated
Some times there are foci much more dense
36
Q

LUNG CANCER

Classification depending on location

A
  1. Hilar
  2. Lobar
  3. Segmental
  4. Peripheral Nodule
37
Q

LUNG CANCER

ASSOCIATED SYNDROMES

A 
 Consolidation Syndr. Retractil / Rarely not-
retractil
 Pleural effusion Sdr.
 Mediastino-pulmonary Sdr.
 Cavitary Sdr.
38
Q

LUNG CANCER

CLINICAL PRESENTATION

A 
• COUGH
Vagus nerve stimulation
• CHEST PAIN
appears late in the disease course
continous, not related to the respiration
• HEMOPTIZIS
Currant Jelly Appearance Aspect
• DYSPNEEA
if the main bronchus is obstructed
39
Q

Localized bronchial obstruction syndrome

A

• PARTIAL OBSTRUCTION
• Localized wheezing
• Local Hypersonority
• Localized bronchial sounds (“Sibilante + ronflante”)
• ↓ tactile fremitus, ↓ vesicular sounds → localized
• TOTAL OBSTRUCTION = ATELECTASIS SYNDROME *
dullness, loss of tactile fremitus and vesicular sounds

40
Q

*Atelectasis

A

is a partial or complete collapse of the entire lung or a specific area, or lobe, of the lung, leading to impaired exchange of carbon dioxide and oxygen
 occurs when the alveoli (small air sacs) within the lung become deflated or fill with alveolar fluid.

41
Q

Sign and symptoms of atelectasis

A
  1. Pain on the affected side
  2. Sudden onset of dyspnea
  3. Cyanosis (bluish skin discoloration)
  4. Dullness to percussion over the involved area
  5. Diminished or absent breath sounds
  6. Reduced or absent chest excursion of the involved hemithorax
  7. Deviation of trachea and heart toward the affected side
42
Q

LUNG CANCER

OBSTRUCTION COMPLICATIONS

A

• repetitive Pneumonias with same location

- Abscesses

43
Q

LUNG CANCER
LOCAL INVASION SDR.
MEDIASTINUM INVASION

A

 Recurrent laryngeal nerve= vocal cord palsy, hoarseness
 Phrenic nerve= diaphragm palsy, pain radiated to the neck
 Esophagus = swallowing disorders
 Vagus nerve = dyspnea, constipation
 Cervical Sympathetic nerve= Claude‐Bernard‐ Horner sdr
 Trachea = stridor, dyspnea
 Superior cava vein = jugular vein distension, chest edema
 Pleural=pleural effusion sdr
 Pericardium = pericardial effusion/ cardiac tamponade
 Myocardial involvement = arrhythmias
 Superior thoracic outlet= Pancoast sdr. (lysis of the ribs1& 2)

44
Q

LUNG CANCER
METASTASIS SIGNS
• LIMPHATICS

A 
LIMPH NODES:
- hilar
- mediastinal
- supraclavicular
Carcinomatous Limphangitis
- (dyspnea, Respiratory failure)
45
Q

LUNG CANCER
METASTASIS SIGNS
HEMATOGEOUS

A
  • liver, brain, suprarenal, bone
46
Q

SYSTEMIC SYNDROMES

A
  1. ↓ G (weight loss)
  2. Fever
  3. Endocrine Sdr.
  4. Paraneoplastic nerve involvement = peripheral neuropathy
  5. Myasthenia like Sdr., polimiositis
  6. Rheumatoid Sdr.
  7. Pierre Marie Osteoarthropathy
  8. Dermatological Sdr. : dermatomiositis, achantosis nigricans
  9. Migratoy Trombhoflebitis (Trouseau)
  10. Endocarditis nonbacterial
  11. Hematological: anemia, Trombopenia, intravascular coagulation
  12. Membranous Glomerulopathy
47
Q

LUNG CANCER

DIAGNOSTIC

A

Clinical Suspicion (sygns &symptoms)
Confirmed by Rx, CT,
bronhoscopy (± sputum exam)
mediastinoscopy

48
Q

LUNG CANCER

TREATMENT

A
  • Chimiotherapy
  • Surgery
  • Radioterapy
49
Q

PULMONARY INFARCTION

A

Consolidation syndrome caused by “alveolar air

replacement with blood”

50
Q

PULMONARY INFARCTION

Patophysiology

A
  • Sudden occlusion of a part of pulmonary arterial tree
51
Q

PULMONARY INFARCTION

Predisposing factors

A
  • diseases that favor thrombosis

- deep vein thrombosis

52
Q

PULMONARY INFARCTION

CLINICAL PRESENTATION

A 
 Chest pain
- Pleuritic chest pain
- Aggravated by cough / respiration
- Ameliorated: Lateral decubitus on the healthy side
 Dyspnea
 Anxiety
 Hemoptosys after a few hours of chest pain onset
 Dry Cough with pleural character
53
Q

PULMONARY INFARCTION

Physical exam - general

A 
 Tachycardia
 Fever
 Lips cyanosis
 Conjunctival jaundice
 right heart failure signs (Sometimes)
54
Q

PULMONARY INFARCTION
RESPIRATORY SYSTEM EXAMINATION
“SMALL SIZE”

A
  • Dullness
  • ↑ tactile fremitus
  • rough breathing
  • Pleural rub
55
Q

PULMONARY INFARCTION

“LARGE size ” INFARCT

A
  • Sub dullness
  • ↑ tactile fremitus
  • Tubular breath sounds
  • Rales, fine crepitants
  • Pleural rub
  • ± Pleural effusion syndrome
56
Q

PULMONARY INFARCTION

DIAGNOSTIC

A
  1. The clinical manifestations of underlying disease
  2. Respiratory symptoms
  3. Chest X ray
    - Triangular density base towards the pleura
    ± dilated pulmonary artery
    Other: CT, ventilation / perfusion scintigraphy, echography
57
Q

PULMONARY INFARCTION

TREATMENT

A

Rx of underlying disease + ANTICOAGULANT

HEPARINS (UFH, LMWH) → ORAL ANTICOAGULANTS

Symptoms of respiratory system (8 decks)

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