Lobar pneumonia


Lobar pneumonia is a form of pneumonia that affects a large and continuous area of the lobe of a lung1

It is one of the two anatomic classifications of pneumonia the other being bronchopneumonia

Stagesedit

Micrograph of lobar pneumonia, H&E stain

Lobar pneumonia usually has an acute progression Classically, the disease has four stages:

  • Congestion in the first 24 hours: This stage is characterized histologically by vascular engorgement, intra-alveolar fluid, small numbers of neutrophils, often numerous bacteria Grossly, the lung is heavy and hyperemic
  • Red hepatization or consolidation: Vascular congestion persists, with extravasation of red cells into alveolar spaces, along with increased numbers of neutrophils and fibrin The filling of airspaces by the exudate leads to a gross appearance of solidification, or consolidation, of the alveolar parenchyma This appearance has been likened to that of the liver, hence the term "hepatization"
  • Grey hepatization: Red cells disintegrate, with persistence of the neutrophils and fibrin The alveoli still appear consolidated, but grossly the color is paler and the cut surface is drier
  • Resolution complete recovery: The exudate is digested by enzymatic activity, and cleared by macrophages or by cough mechanism Enzymes produced by neutrophils will liquify exudates, and this will either be coughed up in sputum or be drained via lymph

Diagnosisedit

Lobar pneumonia of the middle lobe Notice sharp edges

The most common organisms which cause lobar pneumonia are Streptococcus pneumoniae, also called pneumococcus, Haemophilus influenzae and Moraxella catarrhalis Mycobacterium tuberculosis, the tubercle bacillus, may also cause lobar pneumonia if pulmonary tuberculosis is not treated promptly

Like other types of pneumonia, lobar pneumonia can present as community acquired, in immune suppressed patients or as nosocomial infection However, most causative organisms are of the community acquired type Pathological specimens to be obtained for investigations include:

  1. Sputum for culture, AAFBS and gram stain
  2. Blood for full hemogram/complete blood count, ESR and other acute phase reactants
  3. Procalcitonin test, more specific

The identification of the infectious organism or other cause is an important part of modern treatment of pneumonia The anatomical patterns of distribution can be associated with certain organisms,2 and can help in selection of an antibiotic while waiting for the pathogen to be cultured

Referencesedit

  1. ^ Cotran, Ramzi S; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L; Abbas, Abul K 2005 Robbins and Cotran pathologic basis of disease St Louis, Mo: Elsevier Saunders p 749 ISBN 0-7216-0187-1 
  2. ^ "Lobar Pneumonia" Retrieved 2008-11-16 


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