pathology

1. PNEUMONIAPNEUMONIA
“Captain of the men of death”
– William Osler

2. History of PneumoniaHistory of Pneumonia
 Described as early as 400
BC by a Greek Physician
named Hippocrates.
 Edwin Klebs was the first to
see bacterial infection from
a person who died from
pneumonia.
 Described by Sir William
Osler over 100 years ago
linking the infection to a
bacterial cause.
 Pneumonia killed a majority
of the 50-100 million people
that died from the Spanish
flu in 1918.

3. Statistics From CDCStatistics From CDC
 Cause of death (based on the International Classification Death Percent
 Rank 1 of Diseases , Tenth Revision , 1992) Number rate 2005 2004
change
 ... All causes 2,447,910 825.9 798.8 800.8 -0.2
 1 Diseases of heart (I00–I09,I11,I13,I20–I51) 649,399 219.1 210.3 217.0
-3.1
 2 Malignant neoplasms (C00–C97) 559,300 188.7 183.8 185.8 -1.1
 3 Cerebrovascular diseases (I60–I69) 143,497 48.4 46.6 50.0
-6.8
 4 Chronic lower respiratory diseases (J40–J47) 130,957 44.2 43.2 41.1
5.1
 5 Accidents (unintentional injuries) (V01–X59,Y85–Y86) 114,876 38.8 38.1
37.7 1.1
 6 Diabetes mellitus (E10–E14) 74,817 25.2 24.5 24.5 0.0
 7 Alzheimer's disease (G30) 71,696 24.2 22.9 21.8 5.0
 8 Influenza and pneumonia (J10–J18) 62,804 21.2 20.3 19.8
2.5
 9 Nephritis, nephrotic syndrome and nephrosis (N00–N07,N17–N19,N25–N27) 43,679
14.7 14.3 14.2 0.7
 10 Septicemia (A40–A41) 34,142 11.5 11.2 11.2 0.0
 11 Intentional self-harm (suicide) (*U03,X60–X84,Y87.0) 31,769 10.7 10.6
10.9 -2.8
 12 Chronic liver disease and cirrhosis (K70,K73–K74) 27,393 9.2 8.9
9.0 -1.1
 13 Essential (primary) hypertension and hypertensive renal disease (I10,I12) 24,865
8.4 8.0 7.7 3.9
 14 Parkinson's disease (G20–G21) 19,547 6.6 6.4 6.1 4.9
 15 Assault (homicide) (*U01–*U02,X85–Y09,Y87.1) 17,694 6.0 5.9
5.9 0.0
 ... All other causes (residual) 441,475 148.9

4. What is Pneumonia?What is Pneumonia?
It is the infection of one or both of the lungs.
Occurs from bacteria, virus, or fungus that is
inhaled or gets into the blood stream.
Is an inflammatory process of the lung
parenchyma that is commonly caused by
infectious agents.
The air sacs may fill with fluid or pus, causing
cough with phlegm or pus, fever, chills and
difficulty breathing.
It is usually characterized by consolidation.It is usually characterized by consolidation.
Consolidation is a pathological process in which the alveoli areConsolidation is a pathological process in which the alveoli are
filled with a mixture of inflammatory exudate, bacteria & WBCfilled with a mixture of inflammatory exudate, bacteria & WBC

6. 5 Main Causes of5 Main Causes of
PneumoniaPneumonia
Bacteria
Viruses
Mycoplasmas
(Bacteria without a cell
wall)
Fungi including
Pneumocystis
Various Chemicals

7. • Classification .
1 : Anatomical classification.
A – lobar pneumonia .
The consolidalion involves all or part of lobe
B – Bronchopneumonia
the consolidation involves scattered lobules
C - Interstitial pneumonia .
As in viral pneumonia where inflammatory .
Infiltrate involve mainly interstitial tissue between alveli.

8. Lobar pneumoniaLobar pneumonia

9. Bronchopneumonia-Bronchopneumonia-Patchy consolidation usually inPatchy consolidation usually in
the bases of both lungs.the bases of both lungs.

10. Frequent Pathogens Age group
Group B straptococcus – E coli
streptococcus Pneumoniae – H influeza.
Neonate <1mo
Rsv . Influenza viruses para fluenza viruses – adenovirus 1-3 mo
febrile Pneu
R.S.V Influenza viruses para fluenza viruses adenovirus
S. pneumoniae
3 – 12 mo
Influenza viruses para fluenza viruses adenovirus S. pneumoniae
H . Influenza Mycoplasma pneumoniae Chlamydia pneumoniae
Group A straptococcus S . Aureus.
2 – 5 yr
Mycoplasma pneumoniae S. pneumoniae Chlamydia pneumoniae H .
Influenza Influenza viruses adenovirus
5 – 18 yr
Mycoplasma pneumoniae S. pneumoniae Chlamydia pneumoniae H .
Influenza Influenza viruses adenovirus.
> 18 yr

11. Types of PneumoniaTypes of Pneumonia
Bacterial Pneumonia
Viral Pneumonia
Fungal Pneumonia
Parasitic Pneumonia
Atypical Pneumonia
Community-Acquired Pneumonia
Hospital-Acquired Pneumonia
Healthcare-Associated Pneumonia
Ventilator-Associated Pneumonia
Aspiration Pneumonia
Eosinophilic pneumonia
Bronchiolitis obliterans organizing pneumonia

12. Bacterial PneumoniaBacterial Pneumonia
Bacterial pneumonia develops when bacteria
that normally live harmlessly in the throat
enter the lungs. This usually happens when
the body's immune system is weakened in
some way.
 This usually occurs after an upper
respiratory infection, such as influenza.
The lungs are damaged enough to allow the
bacteria to infect the area.
Bacterial pneumonia is usually caused by
bacteria called either pneumococcus or
streptococcus pneumoniae.

13. Bacterial PneumoniaBacterial Pneumonia
Infection by Bacteria
Most commonly
Streptococcus
pneumoniae
Gram Positive (Gram
Stain)
Staphylococcus
aureus
Gram negative,
Haemophilus
influenzae
Contracted through
inhalation or through
the blood stream.
Treated with
Antibiotics

14. Viral PneumoniaViral Pneumonia
 Caused by Influenza,
parainfluenza, adenovirus,
rhinovirus, herpes simplex
virus along with several
other kinds of viruses.
 Antibiotics are not
effective in treating viral
pneumonia.
 It is often treated with
antiviral medications along
with plenty of fluid and
rest
 Individuals with
suppressed immune
systems are most at risk
for acquiring this form of
pneumonia

15. X-RAYS-X-RAYS-Viral pneumonia x-rayViral pneumonia x-ray

16. Staph pneumonia x-rayStaph pneumonia x-ray

17. Parasitic PneumoniaParasitic Pneumonia
Not common in industrialized
nations.
Infection occurs by ingesting
parasite contaminated food
or other products.
A common one that occurs
primarily in children is
toxocariasis.
Infection caused by larvae of
the roundworm

18. Community-AcquiredCommunity-Acquired
PneumoniaPneumonia
Gram stain showing
Streptococcus pneumoniae
 Community Acquired means that
an individual has not been
recently hospitalized and has
acquired a lung infection
 Pneumonia which develops in an otherwisePneumonia which develops in an otherwise
healthy person outside of hospital or havehealthy person outside of hospital or have
been in hospital for less than 48hrs.been in hospital for less than 48hrs.
 Most commonly caused by
streptococcus
 Can also be caused by
Haemophilus, influenzae,
Legionella, mycoplasma,
chlamydia, and viruses.
 Occurs most commonly in the
very young and the very old
 Usually starts from an upper
respiratory tract infection
 S/S usually are that of a flu
along with a productive cough
with sputum that is rust colored
from blood.
 Leads to sepsis
 Can be treated with antibiotics
 Problem with antibiotic resistant
strains

19. Hospital-Acquired PneumoniaHospital-Acquired Pneumonia Hospital-acquired pneumonia is a bacterial infection that
occurs in people 48 hours or more after being hospitalized
for another condition. Hospital-acquired pneumonia can be
serious because the bacteria causing it may be more
resistant to antibiotics.
 People who are on a breathing machine (ventilator), often
used in intensive care units, are at higher risk of this type
of pneumonia.
 People in the hospital and care facilities tend to be more
vulnerable making them less able to fight the infection.
 Some risk factors include: Over the age of 70, Prolonged
hospital stay, and COPD patients
 Most commonly occurs in patients that require ICU care
 Caused when organisms are delivered to lower reparatory
through aspiration or contaminated respiratory machines.

20. Aspiration PneumoniaAspiration Pneumonia
 Defined as inhalation of either
oropharyngeal or gastric
content into the lower airway.
 The inhalation of
oropharyngeal content is
usually witnessed and leads
to an infection process.
 Occurs often in patients with
altered level of
consciousness, drug
intoxication, or head trauma.
 Approximately 10% of
patients hospitalized from
drug overdoses have
aspiration pneumonia
 High Risk Patients are:
Elderly; Coma; Anesthesia;
Excessive alcohol
consumption; Near Drowning
accident

21.  Mycoplasma Pneumonia
 Mycoplasmas are not viruses or bacteria, but they
have traits common to both. They are the smallest
agents of disease that affect humans.
 Mycoplasmas generally cause mild cases of
pneumonia, most often in older children and young
adults.
 Pneumonia caused by opportunistic organisms
Tuberculosis and pneumocystis
carinii pneumonia (PCP) generally affect persons with
AIDS. In fact, PCP can be one of the first signs of
illness in people with AIDS.

22. Clinical manifestationClinical manifestation
 What we will commonly see and hear in the field
 Fever
 Cough
 Cough will bring up Greenish, Yellowish Mucus and possibly
hemoptysis
 Stabbing Chest pain that worsens with deep respirations
 Fatigue
 Head Ache
 Loss of Appetite
 Shortness of Breath
 Cyanotic, Sweaty, clammy skin
 Rapid Heart Rate
 Crackles (Rales)/Wheezing Auscultated
 Diminished lung sounds in areas filled with infection

23. Based on the severity of pneumonia ;
 Very Severe pneumonia -s/s central
cyanosis,respiratiory distress(eg:head
nodding )
Not able to drink ,Nasal flaring
Severe Pneumonia -Chest indrawing or
intercostal retraction
pneumonia -cough,fast breathing & SOB.

25. Physical examinationPhysical examination
Physical finding:
Depends on the stage of pneumonia diminished
breath sound scattered crackels
and rhonchi over affected lung.

Increasing consolidation or complication.
As effusion empyema or pyopneumothorax
dullness on percussion and breath sounds

26. Physical examinationPhysical examination
Sound.
In case of sever pneumonia -Decreased breath
sounds ( bronchial breath sounds )
Diminished abdominal distension because of gastric dilation
from swallowed
air or ileus. Abdominal pain in lower lobe pneumonia
Liver may seem enlarged because downward of diaphragm
secondary to hyper
inflation of lung
Neck rigidity without meningitis in right upper lobe.

27. Diagnostic testsDiagnostic tests
Chest X-rays, to confirm the presence of
pneumonia and determine the extent and
location of the infection.
Blood tests, to confirm the presence of
infection and to try to identify the type of
organism causing the infection. Precise
identification occurs in only about half of people
with pneumonia.
Pulse oximetry, to measure the oxygen level in
your blood. Pneumonia can prevent your lungs
from moving enough oxygen into your
bloodstream.

28. Sputum test. A sample of fluid from yours lungs
(sputum) is taken after a deep cough, and
analyzed to pinpoint the type of infection.
Pleural fluid culture. A fluid sample is taken
from the pleural area and analyzed to help
determine the type of infection.
Bronchoscopy. A thin, flexible tube with a
camera is inserted down your throat and through
your airways to check whether something is
blocking the airways or whether something else
is contributing to your pneumonia.

29. TreatmentTreatment
Diagnosed on basis of physical
examination, X-Ray findings, and
laboratory cultures.
Primary Treatment are antibiotics
Supportive Treatment

30. Antibiotic doses for treatingAntibiotic doses for treating
pneumoniapneumonia

31. TreaTmentTreaTment
Treatment in case os severe
➤Admit the child to hospital.
Antibiotic therapy
➤Give ampicillin (50 mg/kg IM every 6
hours) and gentamicin (7.5 mg/kg IM
once a day) for 5 days;
 then, if child responds well, complete
treatment at home or in hospital with oral
amoxicillin (15 mg/kg three times a day) plus
IM gentamicin once daily for a further 5 days.

32.  Treatment
 ➤Admit or refer the child to hospital.
 Antibiotic therapy
 ➤Give benzylpenicillin (50 000 units/kg IM or IV every 6 hours) for at least
 3 days.
 ➤When the child improves, switch to oral amoxicillin (25 mg/kg 2 times a
 day). The total course of treatment is 5 days.
 ➤If the child does not improve within 48 hours, or deteriorates, look for
 complications and treat accordingly .If there are no apparent
 complications, switch to chloramphenicol (25 mg/kg every 8 hours IM or
 IV) until the child has improved. Then continue orally for a total course of
 10 days.
 Oxygen therapy
 ➤If readily available, give oxygen to any child with severe lower chest wall
 indrawing or a respiratory rate of ≥70/minute.

33. Treatment for special casesTreatment for special cases
. Patient less than 60 years & without
comorbidities:-
Azithromycine ( 500mg OD) *1day
( 250mg OD) *4days
Norfloxacin/Levofloxacin (400mg OD) *7days
2. Outpatient greater than 65 years:-
Norfloxacin (400mg OD) *7days or
Ceftriaxon (1-2 g/day) / Cifixim (2-4 g/day)
3rd
gen cefalosporins

34. 3. Patient is hospitalised but not severely ill:-
Combination of 3rd
gen cefalosporins + Macrolides
Ceftriaxone + Azithromycin
OR
Norfloxacin/Levofloxacin (400mg OD)
5. Patient hospitalised & severely ill:-
Combination of 3rd
gen cefalosporins + Macrolides
Ceftriaxone + Azithromycin
and newer fluroquinolones (Gatifloxacin)
We can add Vancomycin.
6. Patient with icu admission:-
3rd
gen cefalosporins + Fluroquinolones (Gatifloxacin)
+
Nutritional supplements + Saline
Vancomycin/Meropenam

36. The Pre-Hospital SettingThe Pre-Hospital Setting
 Place patient in position of
comfort
 High-flow Oxygen
 Severe Cases may require
endotracheal intubation
 IV, base fluid resuscitation
on patient’s hydration
status (Assess for
dehydration).
 Breathing Treatment
 Antipyretic agents for high
fevers
 Remember to consider
Pneumonia in patients
complaining of chest pain
especially if its
accompanied by fever

37. Duration of therapyDuration of therapy
5 -7 days – outpatients
7-10 days – inpatients, S. pneumoniae
10-14 days – Mycoplasma, Chlamydia,
Legionella
14+ dayss - chronic steroid users

38. Who Is at Risk for DevelopingWho Is at Risk for Developing
Pneumonia?Pneumonia?
 previous stroke or problems swallowing: People who
have had a stroke, have problems swallowing, or are
bedridden can easily develop pneumonia.
 age: Infants from birth to age two are at risk for
pneumonia, as are individuals age 65 or older.
 weakened immune system: This includes people who
take medications (steroid drugs and anti-cancer drugs)
that weaken the immune system and people with HIV,
AIDS, or cancer.
 drug abuse: This includes excessive alcohol consumption
and smoking.
 certain medical conditions: Asthma, cystic fibrosis,
diabetes, and heart failure raise your risks for pneumonia.

39. Pneumonia: ComplicationsPneumonia: Complications
 Bacteria in the bloodstream (bacteremia). Bacteria
that enter the bloodstream from your lungs can spread the
infection to other organs, potentially causing organ failure.
 Lung abscess. An abscess occurs if pus forms in a cavity
in the lung. An abscess is usually treated with antibiotics.
Sometimes, surgery or drainage with a long needle or tube
placed into the abscess is needed to remove the pus.
 Pneumothorax.
 Pyopneumothorax - eg following rupture of a
staphylococcal lung abscess in the pleural cavity.
 Deep vein thrombosis.
 Septicaemia, pericarditis, endocarditis, osteomyelitis,
septic arthritis, cerebral abscess, meningitis (particularly in
pneumococcal pneumonia).
 Postinfective bronchiectasis.
 Acute renal failure.

40.  Fluid accumulation
around your lungs
(pleural
effusion).Pneumonia
may cause fluid to build
up in the thin space
between layers of
tissue that line the
lungs and chest cavity
(pleura). If the fluid
becomes infected, you
may need to have it
drained through a chest
tube or removed with
surgery.

41. INTRODUCTIONINTRODUCTION
Pleurisy is caused by inflammation of the
linings around the lungs (the pleura), a
condition also known as pleuritis.
There are two layers of pleura: one covering
the lung (termed the visceral pleura) and the
other covering the inner wall of the chest
(the parietal pleura). These two layers are
lubricated by pleural fluid.
Pleurisy is frequently associated with the
accumulation of extra fluid in the space
between the two layers of pleura. This fluid is
referred to as a pleural effusion.

43.  The pain fibers of the lung are located in theThe pain fibers of the lung are located in the
pleura. When this tissue becomes inflamed, itpleura. When this tissue becomes inflamed, it
results in a sharp pain in the chest that is worseresults in a sharp pain in the chest that is worse
with breathing. Other symptoms of pleurisy canwith breathing. Other symptoms of pleurisy can
include cough, chest tenderness, and shortnessinclude cough, chest tenderness, and shortness
of breath.of breath.
 Pleurisy describes the chest pain syndromePleurisy describes the chest pain syndrome
characterized by a sharp chest pain that worsenscharacterized by a sharp chest pain that worsens
with breathing.with breathing.
 Pleurisy is caused by a variety of conditions, suchPleurisy is caused by a variety of conditions, such
as infections, TB, congestive heart failure,as infections, TB, congestive heart failure,
cancer, pulmonary embolism, and collagencancer, pulmonary embolism, and collagen
vascular diseases.vascular diseases.

44. Pleurisy is inflammation of thePleurisy is inflammation of the
pleura.pleura.
Classification:
 Dry pleurisy (pleuritis sicca)
 Pleurisy with effusion (pleuritis exudativa)
The character of the inflammatory
effusion may be different: serous,
serofibrinous, purulent, and
haemorrhagic.

46. Etiology and pathogenesisEtiology and pathogenesis
Serous and serofibrinous pleurisy
(tuberculosis in 70-90 per cent of cases,
pneumonia, certain infections, and also
rheumatism in 10-30 per cent of cases)
Purulent process (pneumococci, streptococci,
staphylococci, and other microbes)
Haemorrhagic pleurisy (tuberculosis of the
pleura, bronchogenic cancer of the lung with
involvement of the pleura, and also in
injuries to the chest)

47. How does the pleura work?How does the pleura work?
The pleura is composed of two layers of thin liningThe pleura is composed of two layers of thin lining
tissue. The layer covering the lung (visceral pleura) andtissue. The layer covering the lung (visceral pleura) and
the parietal pleura that covers the inner wall of thethe parietal pleura that covers the inner wall of the
chest are lubricated by pleural fluid.chest are lubricated by pleural fluid.
Normally, there is about 10-20 ml of clear liquid thatNormally, there is about 10-20 ml of clear liquid that
acts as a lubricant between these layers. The fluid isacts as a lubricant between these layers. The fluid is
continually absorbed and replaced, mainly through thecontinually absorbed and replaced, mainly through the
outer lining of the pleura.outer lining of the pleura.
 Pressure inside the pleura is negative (as in sucking) andPressure inside the pleura is negative (as in sucking) and
becomes even more negative during inspirationbecomes even more negative during inspiration
(breathing in).(breathing in).

48. How does the pleura work?How does the pleura work?
The pressure becomes less negative duringThe pressure becomes less negative during
exhalation (breathing out). Therefore, the spaceexhalation (breathing out). Therefore, the space
between the two layers of pleura always has abetween the two layers of pleura always has a
negative pressure.negative pressure.
The introduction of air (positive pressure) into theThe introduction of air (positive pressure) into the
space (such as from a knife wound) will result in aspace (such as from a knife wound) will result in a
collapse of the lung.collapse of the lung.

50. CausesCauses
Pleurisy occurs when
the pleura becomes
irritated and inflamed.
As a result, the two
layers of the pleural
membrane rub against
each other like two
pieces of sandpaper,
producing pain when
you inhale and exhale.
The pleuritic pain
lessens or stops when
you hold your breath.

51. The Causes of PleuritisThe Causes of Pleuritis
 Viral Infections – The infections caused by viruses are the
most common causes of pleurisy. The simple buildup of
materials could be due to inefficient removal of materials that
were left over during an internal battle with a virus. This can
leave several locations on the lining of the lungs that can be
inflamed, causing pleuritis.
 Bacterial Infections – Many people will also experience
pleuritis when they experience a bacterial infection of the
lungs. Although many of the treatments designed to battle
bacterial infections are available such as antibiotics, it often
does not repair the damages that are caused by the infection
and can lead to many instances of pleuritis. This can be
extremely difficult to deal with and treat in the long run.
 Pneumonia – Pneumonia is a type of bacterial infection that
can cause many different afflictions if the person survives the
sickness. One of the most common things that occur is
pleuritis by the inflamed lung lining and weakened breathing
of the individual who has or had the disease. It could be
caused by secondary infections caused by pneumonia as
well.

52. The Causes of PleuritisThe Causes of Pleuritis
 Tuberculosis – Tuberculosis is not as common as it used to be, but the
isolated incidents in which it has occurred, many people developed
pleuritis. This is characteristic of the damage done to the lungs during the
bout with tuberculosis as the lungs would bleed and fill with fluid that can
be seen often during the sickness of the individual.
 Autoimmune disorders – When the body mistakenly attacks its own
tissues, the lungs can be incapacitated over time and the complications of
pleuritis will take effect. It is important to look into treatments for the
autoimmune disorder if available to ensure that the patient has a chance to
recover.
 Rheumatoid Arthritis – The rheumatoid arthritis complications with fluid
buildup and increased pain in areas of the body may put the lungs in a
compromised position to develop pleuritis. Having pain in the back and
trying to avoid causing the pain can weaken and damage the lining of the
lungs and make it possible for pleuritis to occur.
 Lung cancer – lung cancer due to smoking or other reasons can cause
varying levels of pleuritis. Some types of lymphoma can also cause the
pleuritis when they develop on the lining of the lungs and is very difficult to
treat. It is possible that this cannot be treatable and the person would have
to live the rest of their lives with pleuritis.

53. Sign and Symptoms of PleurisySign and Symptoms of Pleurisy
 Chest pain that worsens when you breathe, cough or
sneeze
 Shortness of breathShortness of breath – One of the main symptoms will always be difficulty – One of the main symptoms will always be difficulty
breathing as this complication will affect the lungs. Difficulty breathing breathing as this complication will affect the lungs. Difficulty breathing
may not get enough oxygen to the blood, causing the body to feel like it is may not get enough oxygen to the blood, causing the body to feel like it is
getting colder.getting colder.
 CoughCough – Coughing is common in sufferers of pleuritis as the disease deals – Coughing is common in sufferers of pleuritis as the disease deals
with the lungs and often induces coughing episodes. The coughs will with the lungs and often induces coughing episodes. The coughs will
generally cause a great deal of pain for those who have pleuritis, as the generally cause a great deal of pain for those who have pleuritis, as the
disease will cause the inflamed lining of the lungs to rub against other disease will cause the inflamed lining of the lungs to rub against other
tissues and organs which could become rather painful.tissues and organs which could become rather painful.
 Fever and ChillsFever and Chills – Fevers and chills are very common as well in individuals – Fevers and chills are very common as well in individuals
with pleuritis, as the buildup of fluid can also be toxic and cause the body with pleuritis, as the buildup of fluid can also be toxic and cause the body
to heat up from the complications. to heat up from the complications.

54. Sign and Symptoms of PleurisySign and Symptoms of Pleurisy
Unexplained Weight LossUnexplained Weight Loss – Unexplained weight loss – Unexplained weight loss
is a very unusual indicator that pleuritis is present in is a very unusual indicator that pleuritis is present in
the body. This can be due to several different the body. This can be due to several different
reasons but it is most likely because the body does reasons but it is most likely because the body does
not know how to cope with the pleuritis. This can not know how to cope with the pleuritis. This can
also be due to the fact that it can become painful to also be due to the fact that it can become painful to
eat when the pleuritis is present and the pain does eat when the pleuritis is present and the pain does
not allow for proper digestion of food ingested.not allow for proper digestion of food ingested.

55. Sign and Symptoms of PleurisySign and Symptoms of Pleurisy
 Sore throatSore throat – A sore throat is very common and makes it – A sore throat is very common and makes it
possible to look for problems such as pleuritis when other possible to look for problems such as pleuritis when other
symptoms are present. This could be due to several reasons symptoms are present. This could be due to several reasons
including the spread of the pleuritis problem near the including the spread of the pleuritis problem near the
esophagus. This infection occurring near the trachea can usually esophagus. This infection occurring near the trachea can usually
make the throat feel very sore.make the throat feel very sore.
 Pain and Swelling of JointsPain and Swelling of Joints – Joints swelling with pain are often – Joints swelling with pain are often
caused by arthritis and arthritis is one of the underlying causes caused by arthritis and arthritis is one of the underlying causes
of pleuritis in some patientsof pleuritis in some patients

56. Pain caused by pleurisy also might affect your
shoulder or back.
In some cases of pleurisy, fluid builds up in the
small space between the two layers of tissue
(pleural space). This is called pleural effusion.
When there is a fair amount of fluid, pleuritic
pain lessens or disappears because the two
layers of pleura are no longer in contact.
 A large amount of fluid in the pleural space
can create pressure, compressing your lung to
the point that it partially or completely
collapses.
This makes breathing difficult and might cause
you to cough. The extra fluid can also become
infected. This is called an empyema. An
empyema is often accompanied by fever.

57. Characteristic Significance
Bloody Most likely an indication of malignancy in the absence
of trauma; can
also indicate pulmonary embolism, infection,
pancreatitis,
tuberculosis, mesothelioma, or spontaneous
pneumothorax
Turbid Possible increased cellular content or lipid content
Yellow or whitish,
turbid
Presence of chyle, cholesterol or empyema
Brown (similar to
chocolate sauce
or anchovy paste)
Rupture of amebic liver abscess into the pleural space
(amebiasis
with a hepatopleural fistula)
Black Aspergillus involvement of pleura

58. Physical ExaminationPhysical Examination
 Respiration is superficial (deep breathing
intensifies friction of the pleural membranes to
cause pain)
. Lying on the affected side lessens the pain.
Inspection of the patient can reveal unilateral
thoracic lagging during respiration. Percussion
fails to detect any changes except decreased
mobility of the lung border on the affected side.
 Auscultation determines pleural friction sound
over the inflamed site.

59. Diagnostics and Tests for PleuritisDiagnostics and Tests for Pleuritis
 CBC – The complete blood count screen helps to determine whether
or not the blood is being produced correctly and can help to identify
diseases and disorders like pleuritis. This test is more of an option to
check whether or not blood cell count is showing anything abnormal
in the body.
 Thoracentesis – This is when the location of fluid in the chest is
confirmed and the doctor decides to withdraw a sample of the fluid
for testing. This testing can help determine if the fluid is caused
because of pleuritis. If so, the person will be checked to see the
possible treatment options for the disease.
 Arterial Blood Tests – These blood tests are done from easy to
access artery locations such as the wrists to get a blood sample for
testing. In these tests, the blood is checked for the amount of
oxygen and carbon dioxide that is being handled in the blood. It can
call for additional testing to determine that the person has pleuritis.
 Ultrasound of the Chest – The ultrasound of the chest can reveal
fluid cavities in the lungs and lung tissues. It is helpful in locating
where the pleuritis resides and to plan for actions towards removal of
this fluid in the lung tissue.

60. CT scan of the Chest – A CT ccan is useful in
having a 3 dimensional view of the pleuritis to
ensure that it is treatable and to plan out steps to
remove the fluid and material buildup that is
there. The CT scan may be much more accurate
than an ultrasound but may not have an up to
date view of the pleuritis once procedures to
remove the fluids are ready.
X-Ray of the Chest – An x-ray is a very useful
tool that can show pockets of fluid buildup in the
lungs and can help doctors make a quick decision
whether or not to drain these fluid filled pleuritis
locations.
Biopsy – A biopsy of the pleura may be
examined when cancer or tuberculosis is
suspected. This can help determine what course
of actio

61. TREATMENTTREATMENT
Removal of pleural fluid with a needle and Removal of pleural fluid with a needle and
syringe (aspiration) is essential in diagnosing the syringe (aspiration) is essential in diagnosing the
cause of pleurisy. The fluid's color, consistency, cause of pleurisy. The fluid's color, consistency,
and clarity are analyzed in the laboratory. and clarity are analyzed in the laboratory.
The fluid analysis is defined as either an The fluid analysis is defined as either an
""exudateexudate" (high in protein, low in sugar, high in " (high in protein, low in sugar, high in
LDH enzyme, and high white cell count; LDH enzyme, and high white cell count;
characteristic of an inflammatory process) or a characteristic of an inflammatory process) or a
""transudatetransudate" (containing normal levels of these " (containing normal levels of these
body chemicals).body chemicals).

63. Treatments used in pleurisy and pleural effusion
focus primarily on the underlying cause. For
example, if bacterial pneumonia is the cause, an
antibiotic will control the infection. If the cause is
viral, pleurisy will resolve on its own.
Antibiotics (eg, for parapneumonic effusions) and
diuretics (eg, for effusions associated with CHF)
are commonly used in the initial management of
pleural effusions in the ED. The selection of drugs
in each class depends on the cause of the
effusion and its clinical presentation.

64. How is pleurisy treated?How is pleurisy treated?
In severe cases, in which there are large amounts of In severe cases, in which there are large amounts of
pus and scar tissue (adhesions), there is a need for pus and scar tissue (adhesions), there is a need for
"decortication.“"decortication.“
 This procedure involves examining the pleural space This procedure involves examining the pleural space
under general anesthesia with a special scope under general anesthesia with a special scope
(thoracoscope). Through this pipelike instrument, (thoracoscope). Through this pipelike instrument,
the scar tissue, pus, and debris can be removed.the scar tissue, pus, and debris can be removed.
 Sometimes, an open surgical procedure Sometimes, an open surgical procedure
(thoracotomy) is required for more complicated (thoracotomy) is required for more complicated
cases.cases.

65. PreventionPrevention
Early appropriate antibiotic therapy reduces
mortality and morbidity.
Influenza and pneumococcal vaccination.
Targeted risk reduction, such as smoking
cessation.
Most pleurisy is caused by infection and is
unavoidable. You can avoid severe pleuritic
chest pain by early diagnosis and treatment
with anti-inflammatory drugs
Pleurisy caused by viral infections usually
lasts about seven days and goes away.

66. Prognosis and Outlook of Patients withPrognosis and Outlook of Patients with
PleuritisPleuritis
Many people with pleuritis will be able to make a full Many people with pleuritis will be able to make a full
recovery if their underlying problems are taken care recovery if their underlying problems are taken care
of. of.
Proper treatment of the affliction makes it possible Proper treatment of the affliction makes it possible
to really come through strong. There is a possibility to really come through strong. There is a possibility
of death caused by pleuritis in very unhealthy of death caused by pleuritis in very unhealthy
individuals if they do not make the necessary individuals if they do not make the necessary
lifestyle changes needed to heal from the lifestyle changes needed to heal from the
complications of pleuritis.complications of pleuritis.