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SUPPURATIVE LUNG DISEASES. Bronchiectasis. * Def: persistent dilatation of medium sized bronchi accompanied by suppurative inflammation of their walls. * Etio-pathogenesis: I. Weakening of the bronchial wall by; a. Chronic suppurative inflammation: due to recurrent septic bronchopneumonia.

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* Def: persistent dilatation of medium sized bronchi accompanied by suppurative inflammation of their walls.

* Etio-pathogenesis:

I. Weakening of the bronchial wall by;

a. Chronic suppurative inflammation: due to recurrent septic bronchopneumonia.

b. Congenital weakness: leads to congenital bronchiectasis.

II. Bronchial obstruction: by foreign body, bronchial secretion or tumor.


* N/E:

- Dilated bronchi:

  • Cylindrical, fusiform or saccular

  • Bilateral.

  • Basal.

  • Has patchy distribution.

  • The bronchial lumen contains pus.

  • The bronchial mucosa: ulceratd.

    - The surrounding alveoli are: fibrotic and collapsed.

    - The pleura shows: pleurisy

    - Draining hilar L. nodes:enlarged


* Complications:

  • Spread of infection: direct, lymphatic and blood.

  • Hemoptysis.

  • Lung abscess (post-bronchiectatic lung abscess).

  • 2ry amyloidosis.

  • Lung fibrosis.

  • Bronchogenic carcinoma (squamous cell carcinoma).



* Classification:

1. Bacterial pneumonia: lobar pneumonia & bronchopneumonia.

2. Viral (interstitial) pneumonia: influenza, measles, chicken pox.

3. Loeffler’s (parasitic) pneumonia: Bilharziasis, ascaris & ankylostomiasis.

4. Granulomatous pneumonia: T.B, sarcoidosis, leprosy, syphilis, actinomycosis .

5. Lipoid pneumonia: due to aspiration of oily nasal drops.

6. Irradiation pneumonia.


Lobar pneumonia
LOBAR PNEUMONIA

* Def: acute diffuse fibrinous inflammation of one or more lung lobes.

* Etiology:

  • Age: middle age.

  • Predisposing factors: low resistance.

  • Causative organism: pneumococci.

  • Route of infection: droplet infection.


Pathogenesis
* Pathogenesis:

  • Pneumococci are inhaled to reach alveoli. They cause acute inflammaion with excess fluid exudate. This fluid exudate pass from one alveolus to another rapidly through the inter- alveolar pores of cohn to involve the whole lung lobe. The fluid exudate expel air away from the alveoli producing a firm airless lobe leading to consolidation (hepatisation) of the affected lobe.


Bronchopneumonia
BRONCHOPNEUMONIA

* Def: Acute suppurative inflammation of bronchioles and adjacent alveoli characterized by patchy lung consolidation.

* Etilogy:

  • Age: extremes of age (young & elderely).

  • Predisposing factors: low resistance and bronchitis.

  • Causative bacteria: staphylococci, streptococci & H. influenza.

  • Route of infection: endogenous invaders and exogenous invaders (droplet infection).


* N/E:

  • Bilateral.

  • Basal.

  • Multiple consolidated yellowish patches exuding pus on pressure. Several patches may coalesce to produce confluent bronchopneuomonia.

  • Enlarged hilar L. nodes.


* M/P:

I. The bronchioles show:

  • Their lumen shows: necrotic epithelial cells, polymorphs & pus cells.

  • Their lining: ulceration.

  • Their walls: congested capillaries, neutrophils and pus cells & exudate.

    II. The adjacent alveoli show: 3 successive zones: zone of alveolitis then zone of alveolar collapse and a zone of alveolar dilatation (compensatory emphysema).


* Complications:

  • Spread of infection: direct, lymphatic and blood (toxaemia, septicaemia).

  • Lung fibrosis due to failure of resolution.

  • Post-pneumonic lung abscess.

  • Bronchiectasis.


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