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Supuratii pulmonare

Supuratii pulmonare

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Published by Vali

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Categories:Types, School Work
Published by: Vali on Mar 14, 2009
Copyright:Attribution Non-commercial

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06/02/2013

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Pneumonii cu fungi si actinomicete
-etiologie:
1.
infectii cu fungi patogeni (primare)->sursa exogena,cale de patrundere bronhogena-histoplasmoza,coccidioidomicoza,blastomicoza,sporotricoza
2.
infectii cu fungi conditionat patogeni (oportuniste)->sursa endogena,rar exogena-candidoza,aspergiloza pulmonara3.infectii cu actinomicete
Candidoza
-reprezinta infectia cu Candida albicans-frecvent sursa de contaminare este endogena-clinic:bronhopneumonie;apare pe teren imunodeprimat-diagnostic etiologic:sputa,secretie bronsica,biopsie pulmonara-tratament:miconazol,ketoconazol(Nizoral)->p.o.sau i.v. -mycostatin-diflucan->i.v.
Aspergiloza
-reprezinta infectia cu Aspergillus funigatus-sursa exogena sau endogena (saprofit in caile respiratorii superioare);are tendinta de grefare pe cavitatile preexistente-clinic:-manifestari alergice->astm bronsic,pneumopatie eozinofilica,bronsiectazii proximale-manifestari infectioase->pneumonie cu tendinta la abcedare->formatiuni pseudotumorale(aspergiloame)-diagnostic:Rx,examen de sputa-tratament:amfotericina Bsau5-fluorocitozina -corticosteroizi->formele alergice-interventie chirurgicala->aspergilomPneumonia cu Actinomicete-reprezinta infectia cu Actinomyces israeli care este o bacterie G(+)-sursa->saprofita in caile respiratorii superioare,prezenta in carii,placi dentare,infectii gingivale-clinic:aspect asemanator TBC,nu respecta planurile anatomice-diagnostic:examen de sputa,lichid pleural,lichid de fistulizare-tratament: penicilina8-10 milioane U/zi i.m. 2 saptamani apoi per os 6-18 luni-lincomicina->in caz de alergie la penicilina
Supuratii bronhopulmonare
1.supuratii pulmonarea)acute
circumscrise ->abcesul pulmonar 
1
 
difuze ->gangrena pulmonara b)cronice
circumscrise ->abces pulmonar cronic (abces ce nu se vindeca dupa 3 luni)
difuze ->pioscleroza2.supuratii bronsicea)congenitale b)dobandite
Abcesul pulmonar
-poate fi primar sau secundar (se dezvolta pe alta leziune pulmonara de ex.cancer pulmonar)-etiologie:-bacterii anaerobe (50%)->bacteroides,chlostrydium-bacterii anaerobe + bacterii aerobe (30-40%) esp.G(-):pseudomonas,E-coli-bacterii aerobe (10%)->stafilococ,streptococ,klebsiella,pseudomonas-fungi (aspergillus,candida),paraziti (pneumocystis)-sursa de infectie:cel mai frecvent caile respiratorii superioare dar si flora saprofita din colon-cale de patrundere:bronhogena,hematogena,contiguitate (de la abcese hepatice,plagi toracice infectate)-morfopatologie:-inabcesul acutapar inflamatii supurative ale plamanilor->colectie purulenta delimitata de un perete(puroi, fibrina,zone de tesut de granulatie,zone de scleroza),inconjurata de tesut pulmonar condensat detipul hepatizatiei;vasele vecine sunt trombozate;bronsii edematiate cu leziuni de scleroza-dupa evacuare->cavitate cu continut hidroaeric-inabcesul cronicapare fibrozarea membranei piogene cu efect retractil asupra parenchimului din jur->focare de atelectazie,bronsiectazii-clinic:
1.
faza de constituire->dureaza 5-10 zile-debut insidios,aspect pseudogripal->bolnav palid,inert,astenic-expectoratie abundenta,fetida-sdr.de condensare
2.
faza de supuratie deschisa->vomica fractionata;ameliorarea fenomenelor generale si functionale-sputa abundenta (100-300 ml/zi) ce poate consta din puroi galben-verzui,poate fi pluristratificata sau poate fi purulenta si hemoptoica;sputa contine fibre elastice si are o fetiditate pronuntata-submatitate,diminuarea respiratiei,raluri buloase,subcrepitante si crepitante-paraclinic:
Rx toracic-faza de formare->imagine omogena de tip pneumonic,cu bronhograma aeriana,localizata esp.inlobii superiori din plamanul drept-faza de evacuare->imagine hidroaerica intrapulmonara,usu.unica,cu peretele gros-opacitate (cicatrice) sau cavitate evacuata-diagnostic diferential:caverna tuberculoasa,neoplasm bronsic periferic evacuat,chiste,tumori benigne supurate
 bronhoscopie
date de laborator ->
VSH,leucocitoza-examen de sputa->PMN,fibre elastice,flora bacteriana
2
 
-evolutie:
favorabila->
expectoratia,
febra
retentie bronsica->
expectoratia,
febra-complicatii->bronsiectazie,empiem pleural,focare septice,amiloidoza (infectii cronice)-tratament:1.drenaj postural2.tratament medical
antibiotice cu spectru anaerob timp de 3-4 saptamani- penicilina G10-20 milioane U/zi +metronidazol3*500 mg/zi i.v. -clindamicina-cloramfenicol3-4 g/zi
abcese cu germeni aerobi->cefalosporine+aminoglicozide
situatii severe-> penicilina+metronidazol+aminoglicozide -carbenicilina,imipenem
3.
tratament chirurgical->dupa 3-6 luni de tratament medicamentos ineficace-rezectii lobare sau segmentare
Bronsiectaziile
-reprezinta dilatatia ireversibila a bronsiilor de calibru mediu,insotita de distructia elementelor profunde desustinere a peretelui bronsic (fibre elastice si musculare,cartilaj) la care se asociaza obliterarearamificatiilor distale in raport cu regiunea dilatata (in “fund de sac”)-etiologie:1.congenitalea)primare b)secundare
defecte anatomice->traheobronhomegalie,bronhomalacie
defecte ultrastructurale->sdr.Kartagener,sdr.Young
defecte metabolice->mucoviscidoza,deficit de
α
1
-antitripsina
sdr.de imunodeficienta->hipo- sau a-gamaglobulinemie2.dobandite
infectii in copilarie->rujeola,tuse convulsiva,pneumonie,TBC
obstructie bronsica localizata->corpi straini,tumori,compresiune
 boli autoimune->ciroza biliara primitiva,artrita reumatoida,LES
SIDA
aspergiloza pulmonara-morfopatologie:
macroscopic->dilatatiile pot fi cilindrice (tubulare),moniliforme (varicoase),saculare (ampulare),chistice;sunt frecvent localizate in lobii inferiori,uni-sau bilateral-se produce distructie parietala->atrofie/ingrosare fibroasa->dilatare prin tractiune (efectcentrifug) favorizata de
deformabilitatii + / - secretie bronsica
microscopic->epiteliu bronsic cu zone de metaplazie,ulcerare sau denudare-corion si submucoasa edematiate si cu infiltratie granulomatoasa-glande bronsice dilatate,abcedate sau atrofiate-distrugerea sistemului elastic si muscular si inlocuirea cu tesut fibros
3

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