2. • Lung abscess - purulent melting of lung tissue
with the formation of one or more cavities of
destruction, often surrounded by inflammatory
infiltrate
• Pulmonary gangrene - necrosis, putrefactive
decay of a large area of lung tissue that has a
tendency to spread, without a tendency to limit
• Bronchiectasis - a localized chronic purulent
process (purulent endobronchitis) in irreversibly
altered (dilated, deformed) and functionally
defective bronchi with the formation of
bronchiectasis (pathologically dilated bronchi)
3. Etiology
• There are no specific pathogens of IDD of the bronchopulmonary
system
• Gram-positive flora : Staphylococcus aureus, Streptococcus pyogenes
• Gram-negative flora: Klebsiella, E. coli, Proteus, Pseudomonas
aeruginosa
• Anaerobic flora: Bacteroides melaningenicus, Bacteroides fragilis,
Fusobacterium nucleatum
4. Ways of infection penetration into the
broncho-pulmonary system
• Bronchogenic (most common);
• Lymphogenic
• Hematogenous
• Direct transition of the process from neighboring organs
(perforation of liver abscess or pleural empyema)
• From a lung injury
5. Conditions for the development of lung
destruction
Combination and interaction of the following factors:
1.Acute infectious inflammatory process in the lung parenchyma
2.Impaired blood supply and the formation of necrosis of lung tissue
3.Disorders of bronchial patency in the area of inflammation and
necrosis
Contributing factors: smoking, chronic bronchitis, bronchial asthma,
diabetes, epidemic influenza, alcoholism
6. There are the following stages of abscess:
-infiltration stage
-stage of disintegration and formation of
cavities
-break through of the abscess and its
release
-healing
In pulmonary gangrene, the decay of
lung tissue has no clearly defined
boundaries and occurs as a result of
significant suppression of the body's
defenses.
Pathomorphologically distinguish the
following bronchiectasis in
bronchiectasis:
-cylindrical
-spindle-shaped
- sac-like
- mixed
7. Clinical manifistations of lung abscess
• Before the breakthrough of the
abscess
• rise in body temperature to 39 ° C and
above
• chills
• sweating
• shortness of breath
• dry unproductive cough
• chest pain
• aggravated by deep inhalation (in the
projection of the affected area)
• tachycardia;lack of appetite, weakness
• After the breakthrough of the
abscess
• productive deep cough with a large
amount of purulent sputum (up to 1
liter)
• sputum has a sharp unpleasant odor,
often dark in color
• drop in body temperature
• general improvement of the patient's
condition
8. Clinical manifistations of pulmonary
gangrene
• The patient's condition is severe / extremely severe
• Body temperature is hectic
• Chills, sweating
• Cough with a foul-smelling sputum dirty gray in large quantities
• Chest pain on the affected side, exacerbated by cough, deep breath
• Dyspnea
• Weight loss, lack of appetite
Mortality, according to various authors, reaches 90%!
9. Clinical manifistations of
bronchiectasis
• Chronic productive cough with a significant amount of purulent
sputum - from 20 to 500 ml, which usually worsens in the
morning and is often caused by a change in body position
(especially on the healthy side with a forward tilt)
• Intoxication syndrome
• Hemoptysis in 25-30% of patients
• Expressed asthenic syndrome
• The course is, of course, long, with periodic exacerbations and
various complications: pulmonary hemorrhage, abscesses,
pleural empyema. Possible development of pulmonary heart
disease and amyloidosis.
10. Physical examination
• Nails clumbing; diffuse cyanosis
• Lag of the affected part of the chest when breathing
• Pain on palpation in the intercostal spaces above the abscess area
• Dull percussion sound (tympanic tint may appear - when gas appears
in the cavity), pain during percussion (Kiesling's symptom) over the
affected area
• At auscultation of breath over a zone of defeat there can be: weakened
vesicular / rigid / bronchial / amphora, wet rales of various calibers
can be listened
11.
12.
13. Treatment
• Patients need comprehensive intensive care, including:
• ensuring optimal drainage of decay cavities;
• antibacterial therapy;
• correction of volemic violations;
• detoxification therapy
To restore the patency of the bronchi draining the abscess, carry out
their rehabilitation, in which the leading place belongs to bronchoscopy
14. Antibiotic therapy
• Prescribe combination treatment with two or three antibiotics
simultaneously in sufficiently high doses - For example, penicillin
10-20 million IU / d. IV 4 g / d + metronidazole 1.5-2 g IV or
amikacin 500 mg 2 g / d IV; or cephalosporins 3-4 generations +
aminoglycoside → 6 weeks (abscess / gangrene)
• Endoscopic rehabilitation with intrabronchial administration of
antibiotics
• Anticandidal therapy (fluconazole, nystatin)
