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PLEURAL EFFUSION SECONDARY TO COMMUNITY ACQUIRED PNEUMONIA PATHOPHYSIOLOGY

PLEURAL EFFUSION SECONDARY TO COMMUNITY ACQUIRED PNEUMONIA PATHOPHYSIOLOGY

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Published by Iris Caberte

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Published by: Iris Caberte on Sep 06, 2011
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07/24/2013

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VII.
 
PATHOPHYSIOLOGYPLEURAL EFFUSION SECONDARY TO COMMUNITY ACQUIRED PNEUMONIATheoretically Based
Modifiable Factors:
 
Lifestyle:
 
 
Smoking and Alcohol abuse
 
Improper diet causing malnutrition
 
Environmental:
 
Exposure to Pathogens:
S. Pneumoniae, H. Influenza, Lagionella, P. Aureginosa, other gram (-) rods and viruses
 
Exposure and inhalation of Secondhand smoke and other chemical pollutants
 
 
Genetics:
 
The immunocompromised or immunosuppressed patients with low neutrophil count
 
 
Underlying Diseases:
 
HIV/AIDS
 
 
Diabetes Mellitus
 
 
Cardiovascular Diseases
 
 
Respiratory Diseases: Pulmonary tuberculosis and Chronic Obstructive Pulmonary Disease
 
 
Medication:
 
Drugs that may cause Respiratory Depression:
General Anesthetics, Opioids, Sedatives
 
Drugs that may cause Immunosuppresion:
Corticosteroids, Chemotherapeutic Drugs
 
Self-medicating with antibiotics that may cause bacterial/viral resistance:
Penicillin, Cephalosporins
 
Others:
 
Depressed Cough Reflex
 
Non-Modifiable Factors:
 
Extremes of Age:
 
 
The Very Young
 
The Elderly (60 and Above)
 
Race or Ethnicity:
 
Native Americans
 
Native Alaskans
 
 
Gender:
 
Male
 
 
Environmental:
 
 
Inhalation of foreign materials into the lungs
Legend:
 Modifiable and Non-Modifiable Risk Factors
 Clinical Manifestations/Signs and Symptoms 
Susceptibility tobacterial invasion
 
Improperdietcausing
malnutrition
 Drugs that maycauseRespiratoryDepression andImmuno-suppression:
General  Anesthetics,Opioids, Sedatives,Corticosteroids,chemotherapeuticdrugs
HIV/ADIS, DM, CVD,COPD, PTB
Excessivealcoholintake andsmoking
LIFESTYLE UNDERLYING DISEASES MEDICATIONGENETICSENVIRONMENTAL
OTHERS
GENDERAGERACE
Possibledepressedcough andglotic reflex
More mensmokethanwomen
Exposure to2
nd
handsmoke andotherchemicalollutantsExposure topathogens:
S. Pneumoniae, H.Influenza,Lagionella, P. Aureginosa, other gram (-) rods and viruses
Self-medicatingwithantibioticsthat maycausepathogenicresistance
 
Theimmuno-compro-mised orimmuno-suppressedpatientswith lowneutrophilMaleNativeAmericansand NativeAlaskans
Impairment of host’s
immune defensesHighestmorbidityandmortalityrateAlterationsin normalfloraInhalation of foreign materials
Decreased Immune response orimmunesuppressionDecreased/Disruption of mucocilliaryand macrophage activity
Decreased coughreflex
 
 
Bacterial invasion into the lungs and lower respiratory tract(trachea > bronchus > bronchioles > alveoli)
 
↑ WBC
 
Inflammatory responseAspiration of bacteria in lower respiratory tractImmune response triggeredFeverVasodilation and
capillarypermeabilityStimulate release of prostaglandinRelease of chemical mediators(Histamine, Bradykinin, etc.)Lymphocytes produce cyto
ki 
nesRelease of killer T-Cells,macrophages, phagocytes andanti-bodiesChillsFluid shifting and edemaMigration to alveoli
Alveolar O2 tensionAltered ventilation and diffusionExudate/Fluid accumulation in alveoliPurulent exudate formationKiller T-Cells, macrophages,phagocytes and anti-bodies takeeffect to pathogensCracklesCough with purulentyellowish secretionsDyspneaFilling of WBC in alveoli and the normally air containing spaceChest painPartial occlusion of bronchi and alveoliDecrease oxygen level of blood that passes on the lungs
 
 
Venous blood entering pulmonary circulation passesunventilated areaVentilation and Perfusion mismatchPoorly oxygenated blood travels to the left side of the heart
Circulating O2HypoxiaArterial hypoxemia
Oxygen demandAltered Tissue PerfusionCerebral hypoxiaHeadache, dizziness,fatigue, lethargy,restlessness, confusion,irritability, loss of appetite,mood swingsCyanosisCNS AlterationsPallor
↑ Respiratory Rate
 Hyperventilation
↑ RBC
 Difficulty of breathing andshortness of breathUse of accessory muscles
↑ Heart
Rate
 HemoptysisPulmonary consolidationAlveolar collapseAlveolar damageFurther damage to other lungparenchyma near the affected partAtelectasisContinuous exudates/fluidaccumulationHypoventilationPulmonary neutrophiliaApoptosis of other phagocytesSecondary necrosis of other phagocytes
↑ Permeability of pleural capillary
membrane
Inflammation

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