13 Pneumonia

Lobar

• 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

.

• splotches everywhere instead of 1 lobe
• staph aureus, H. influenza, pseudomonas, moraxella, legionella

Legionella

• atypical

Interstitial Pneumonia

• 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

• nonspecific symptoms
• damage mucociliary escalator

Mycoplasma

CMV

• clearing around dark material

RSV

• wheezing: infect and narrow the bronchioles

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

PCP

• dark black

Other Causes

Age

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

Community vs Hospital

• clinically, don't isolate bug, treat based on symptoms
• VAP: get while on ventilator

• uncomplicated

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

Aspiration

• anaerobic bacteria normally present in oral cavity

Symptoms

• chest pain on inhalation from stretching of pleura

• lavage: liquid solution, collect cells in lungs

ARDS

• 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

• aspirate anaerobes and cause abscess

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