Incoming and Outgoing Shipments in 1 STEP Using Odoo 17
pneumoniapptbymukhtaralam-151230141723.pdf
1. DIRECTED BY:
DIRECTED BY: COMPLETEDBY:
COMPLETEDBY:
DR.B.S.SHARMA MUKHTAR ALAM
DR.B.S.SHARMA MUKHTAR ALAM
DR.ARTIMAL BAMS FINAL PROF.
DR.ARTIMAL BAMS FINAL PROF.
ROLL.NO.74411
ROLL.NO.74411
2014-2015
2014-2015
.
.
Project on:
Pneumonia
2. Pneumonia
Pneumonia
Pneumonia is an inflammatory process which involves the lung
Pneumonia is an inflammatory process which involves the lung
parenchyma.
parenchyma.
Pathogenesis:
Pathogenesis:
1.Anatomical defense mechanism
1.Anatomical defense mechanism
Length of airways include nose,trachea,pharynx
Length of airways include nose,trachea,pharynx
2.Mechanical defense mechanism
2.Mechanical defense mechanism
Cough,sneezing
Cough,sneezing
3.Chemical defense mechanism
-Alfa 1 antitrypsin
-Lactoferron
-Lysozymes
-Interferon
3. 4.Immunological defense mechanism
Phagocytosis,Cell mediated and humoral
Entry of microorganism
Entry of microorganism
Vasodilation
Vasodilation
Leads to outpouring of exudates or fluids
Leads to outpouring of exudates or fluids
Inflammation
Inflammation
(proliferation of bacteria .toxins released which cause inflammation )
(proliferation of bacteria .toxins released which cause inflammation )
Phagocytosis
Phagocytosis
Macrophages
Macrophages
Clearance of bacteria debris
Clearance of bacteria debris
4. Four stages
Four stages:
:
1.Stage of congestion
1.Stage of congestion
Entry of bacteria
Entry of bacteria
Vasodilation
Vasodilation
Outpouring
Outpouring
Proliferation
Proliferation
1-2 days upto onset
1-2 days upto onset
2.Stage of Red hepatisation
2.Stage of Red hepatisation
Infilteration of polymorph,RBC,fibrin
Infilteration of polymorph,RBC,fibrin
2-4 days after onset
2-4 days after onset
3.Stage of Grey hepatisation
3.Stage of Grey hepatisation
Consolidation stage
Consolidation stage
Active phagocytosis
Active phagocytosis
4-8 days
4-8 days
5. 4.Stage of resolution
4.Stage of resolution
Activation of macrophages
Activation of macrophages
Inflammation subside
Inflammation subside
Bacterial debris wash out
Bacterial debris wash out
Estabilishing normal parenchyma of lung
Estabilishing normal parenchyma of lung
8-9 days
8-9 days
Pneumonia results from-
Pneumonia results from-
1.
1. Aspiration
Aspiration
2.
2. Contiguous spread of virulent agents from upper airways.
Contiguous spread of virulent agents from upper airways.
3.
3. Secondary infection when there is disruption of protective
Secondary infection when there is disruption of protective
mechanism.
mechanism.
4.
4. Haematogenous spread
Haematogenous spread
6. Classification
Classification
A. Anatomical
A. Anatomical
1. Lobar or lobular pneumonia-
1. Lobar or lobular pneumonia- Characterized by replacement
Characterized by replacement
of alveolar air with cellular exudates.
of alveolar air with cellular exudates.
2. Interstitial pneumonia-
2. Interstitial pneumonia- Characterized by massive proliferation
Characterized by massive proliferation and
and
desquamation of alveolar cells.
desquamation of alveolar cells.
3. Bronchopneumonia-
3. Bronchopneumonia- Characterized by spreading inflammation of
Characterized by spreading inflammation of
the terminal bronchioles.
the terminal bronchioles.
4. Multi lobar Pneumonia
4. Multi lobar Pneumonia
B. Based on duration of symptoms
B. Based on duration of symptoms
1. Persistent pneumonia-
1. Persistent pneumonia- persistence of symptoms and
persistence of symptoms and x
x-
-
abnormalities for more than 4 weeks.
abnormalities for more than 4 weeks.
2. Recurrent pneumonia-
2. Recurrent pneumonia- two episodes of pneumonia in 1 year or
two episodes of pneumonia in 1 year or
more than three episodes at any time with
more than three episodes at any time with x
x-ray clearance between two
-ray clearance between two
episodes of illness.
episodes of illness.
C. Based f Etiological factors
C. Based f Etiological factors
1.
1. Infective-
Infective- Pneumonia occurs as a result of invasion of lungs due to
Pneumonia occurs as a result of invasion of lungs due to
micro-organisms such as bacteria and ruses.
micro-organisms such as bacteria and ruses.
2.
2. Non-infective-
Non-infective- Chemical
Chemical
7. Causative Agents in Pneumonia
Causative Agents in Pneumonia
Infective Pneumonia
Bacterial
Atypical Pneumonia
Viral Pneumonia
Etiological Agents
Streptococcus pneumonia
H. influenza
Staphylococcus aureus
M. Tuberculosis
Chlamydia
Mycoplasma
Legionella
Respiratory syncytial virus
Para influenza virus
Influenza virus
Rhinovirus
Adenovirus
8. Difference between viral and bacterial pneumonia
Features Bacterial Pneumonia Viral Pneumonia
Onset Abrupt Gradual
Epidemic Not Seen Common
Associated Conditions Infectionate other sites, Associated with URI, coryza
septicemia
Fever High grade May be absent
Toxemia Common Absent
Respiratory Distress Common Common in infants
Lung signs Crackles ++ Wheeze ++
Chest x-ray Confluent infiltrates Diffuse in Peripheral areas
Pleural involvement May be seen Not common
Prognosis Complications such as Self-limiting, usually resolve in
empyema, pneumatoidal about a week. Hyperinflation
septicemia may be seen seen in RSV infection.
9. D.
D. Based of Immunity
Based of Immunity
1. Primary Pneumonia-
1. Primary Pneumonia- It is caused by organisms of high purulent and
It is caused by organisms of high purulent and
as such, it even affects those with good immunity.
as such, it even affects those with good immunity.
2. Secondary Pneumonia-
2. Secondary Pneumonia- this occurs with organisms of low
this occurs with organisms of low
virulence. Either the immunity of host is diminished or some
virulence. Either the immunity of host is diminished or some
predisposing factor is present such as aspiration.
predisposing factor is present such as aspiration.
E.
E. Based on Source of Infection
Based on Source of Infection
1.
1. Community acquired pneumonia-
Community acquired pneumonia- is caused by organisms present
is caused by organisms present
in the community in children who have not been hospitalized in the
in the community in children who have not been hospitalized in the
recent past.
recent past.
2.
2. Hospital acquired pneumonia-
Hospital acquired pneumonia- is caused by organisms present in
is caused by organisms present in
hospital. It occurs after at least 48-72 hours of being admitted in the
hospital. It occurs after at least 48-72 hours of being admitted in the
hospital.
hospital.
3.
3. Opportunistic pneumonia-
Opportunistic pneumonia- is seen in children with decreased
is seen in children with decreased
immunity and is caused by organisms which usually do not cause
immunity and is caused by organisms which usually do not cause
pneumonia.
pneumonia.
10. Types of Pneumonia Causative Agent
Community Acquired
- Typical
Atypical
S. Pneumoniae
H. Infleunzae
S. Aureus
Mycoplasma
Chlamydia
Legionella
Hospital Acquired E. coli
Proteins
Klebsiella
S. aureus
Pseudomonas
Opportunistic P. Carinii
Cytomegalouirus (CMV)
Varicella Zoster
11. Organisms Neonates 1 month to 5years Above 5 years
Bacteria Group B
Streptococci
E. Coli
Listeria
S. Aureus
S. pneumoniae
S. aureus
H. influenza
Group A
Streptococus
Klebsiella
Pseudomonas
M. Tuberculosis
S. Pneumonia
S. Aureus
H. Influenzae
M. Tuberculosis
Viruses CMV
Herpes
CMV
RSV
Influenza virus
Adenovirus
Influenza Virus
Varicella
Atypical Organisms Chlamydia Mycoplasma Mycoplasma
Legionella
Chlamydia
12. AETIOLOGY
AETIOLOGY
The causative organism depends on the following factors-
The causative organism depends on the following factors-
1. Age
1. Age
2. Congenital anomalies
2. Congenital anomalies such as cleft palate and tracheo-
such as cleft palate and tracheo-
oesophageal fistula predispose to aspiration pneumonia by organisms
oesophageal fistula predispose to aspiration pneumonia by organisms
present in oral cavity.
present in oral cavity.
3. Immunity status-
3. Immunity status- Klabsiella infection is common is
Klabsiella infection is common is
immunocompromised children.
immunocompromised children.
4. Underlying lung disease-
4. Underlying lung disease- S. auceus, H. influenzae and P.
S. auceus, H. influenzae and P.
aeruginosa are the three most common organisms causing lung
aeruginosa are the three most common organisms causing lung
infections in cystic fibrosis patients.
infections in cystic fibrosis patients.
5. H/o exposure to infection-
5. H/o exposure to infection- When one of the family member is
When one of the family member is
infected with an organism, the possibility of the same infection in other
infected with an organism, the possibility of the same infection in other
child become more.
child become more.
13. Common Organisms causing Pneumonia in Immuno
Common Organisms causing Pneumonia in Immuno
compromised Children.
compromised Children.
Protozoa Bacteria Viral Fungal
P. Carinii Gram + ve
- S.
Pneumoniae
- S. Aureus
Gram – Ve
- Klebsiella
- Pseudomonas
- H. influenza
- Legionella
CMV
Varicella zoster
Measles giant
cell pneumonia
RSV
Hespes simplex
HIV
Candidiasis
Aspergillus
14. Pre-Disposing Factors
Pre-Disposing Factors
1.
1. Age-below 6 months
Age-below 6 months
2.
2. Neonatal factors – preterm, low birth weight babies.
Neonatal factors – preterm, low birth weight babies.
3.
3. Congenital defects (may predispose to aspiration)- cleft palate, to
Congenital defects (may predispose to aspiration)- cleft palate, to
Fistula, ciliary dyskinesia.
Fistula, ciliary dyskinesia.
4.
4. Bad child hearing practices- bottles feeding, lack of breast-feeding.
Bad child hearing practices- bottles feeding, lack of breast-feeding.
5.
5. Nutritional factors- protein energy malnutrition vit. A deficiency (severe),
Nutritional factors- protein energy malnutrition vit. A deficiency (severe),
iron deficiency anemia, zinc deficiency and so on.
iron deficiency anemia, zinc deficiency and so on.
Systemic factors
Systemic factors
Cardiovascular causes- congenital heart diseases, left to right shunts.
Chronic lung diseases- asthma, cystic fibrosis
Others- measles, diarrhoea, sinusitis, otitis media
7. Immunological status- immunosuppressed states
8. Malignancy
9. Iatrogenic – anesthesia
10. Trauma
15. Environmental Factors
Environmental Factors
1.
1. Overcrowding
Overcrowding
2.
2. Number of siblings (order of birth)
Number of siblings (order of birth)
3.
3. Indoor air pollution
Indoor air pollution
4.
4. Sanitation
Sanitation
5.
5. Passive smoking
Passive smoking
6.
6. Educational status
Educational status
Clinical Features
Clinical Features
Symptoms
Symptoms
1.
1. Fever with chills
Fever with chills
2.
2. Fast and difficult breathing
Fast and difficult breathing
3.
3. Cough
Cough
4.
4. Chest pain
Chest pain
5.
5. Abdominal pain
Abdominal pain
6.
6. Poor feeding
Poor feeding
7.
7. Irritability
Irritability
8.
8. Excessive sleepiness
Excessive sleepiness
16. Signs
Signs
1.
1. Tachypnoea
Tachypnoea
2.
2. Chest retraction
Chest retraction
3.
3. Grunting and stridor
Grunting and stridor
4.
4. Nasal flaring
Nasal flaring
5.
5. Cyanosis
Cyanosis
6.
6. Dullness on percussion
Dullness on percussion
7.
7. Diminished breath sounds, wheeze and crackles on
Diminished breath sounds, wheeze and crackles on
auscultation
auscultation
8.
8. May be associated with meningismus, paralytic ileus.
May be associated with meningismus, paralytic ileus.
9.
9. Right lower lobe pneumonia causes diaphragmatic irritation
Right lower lobe pneumonia causes diaphragmatic irritation
which may present as hiccoughs
which may present as hiccoughs
17. Investigations
Investigations
1.Chest radiography- PA and lateral view
1.Chest radiography- PA and lateral view
2.Total and differential blood count, haemoglobin
2.Total and differential blood count, haemoglobin
3.
3. Tests to identify organisms
Tests to identify organisms
(a)
(a) Microscopic examination – g
Microscopic examination – g
ram staining and AFB staining
ram staining and AFB staining
(b)
(b) Serological tests for bacteria and viruses
Serological tests for bacteria and viruses
(c)
(c) Urinary antigen tests for bacterial and viral antigens
Urinary antigen tests for bacterial and viral antigens
(d)
(d) Rapid antigen detection tests such as direct fluorescent antibody test
Rapid antigen detection tests such as direct fluorescent antibody test
(e)
(e) Polymerase chain reaction for mycobacterium
Polymerase chain reaction for mycobacterium
(f)
(f) Culture studies in sputum and blood.
Culture studies in sputum and blood.
Specimens to identify the organisms are taken from nasopharyngeal
Specimens to identify the organisms are taken from nasopharyngeal
aspirate, the oat swab, bronchoalveolar lavage and lung aspirates.
aspirate, the oat swab, bronchoalveolar lavage and lung aspirates.
18. Indications for Admission
Indications for Admission
1.
1. Severe malnutrition
Severe malnutrition
2.
2. Immunodeficiency
Immunodeficiency
3.
3. Severe anaemia
Severe anaemia
4.
4. disseminated infection, septicemia and shock
disseminated infection, septicemia and shock
5.
5. Drowsiness and altered senosorium
Drowsiness and altered senosorium
6.
6. Decreased O
Decreased O2
2 saturation
saturation
7.
7. Leucopenia or leucocytosis
Leucopenia or leucocytosis
8.
8. Culture and sensitivity tests- result growth of staphylococcus
Culture and sensitivity tests- result growth of staphylococcus
aureus
aureus
19. Supportive Treatment
Supportive Treatment
In mild cases it should be given
In mild cases it should be given
Antihistaminic
Antihistaminic
Antipyretic
Antipyretic
Anti allergic
Anti allergic
There is no role in antibiotic in viral
There is no role in antibiotic in viral
1.
1. Oxygen
Oxygen
2.
2. Intra venous fluid
Intra venous fluid
3.
3. Good nutrition
Good nutrition
4.
4. If fever is present then tepid sponging should be given Paracetamol
If fever is present then tepid sponging should be given Paracetamol
will also be helpful
will also be helpful
5.
5. Predisposing factors should be avoided
Predisposing factors should be avoided
6.
6. Physiotherapy
Physiotherapy
20. Management:
Management:
1.Severe pneumonia
1.Severe pneumonia
O2 inhalation ,Maintain good hydration, good nutrition with antibiotic
O2 inhalation ,Maintain good hydration, good nutrition with antibiotic
therapy
therapy
2.Viral pneumonia
2.Viral pneumonia
-vomiting (no antiemetics)
-vomiting (no antiemetics)
-loose motion (no intervention)
-loose motion (no intervention)
lathouh-
lathouh- in case of fever
in case of fever
Anand bherav rasa
Anand bherav rasa-in
-in cace of loose motion
cace of loose motion
Laxmivilas rasa
Laxmivilas rasa –
–acute corhyza
acute corhyza
Kafketu rasa
Kafketu rasa-
-productive corhyza
productive corhyza
Routinely
Routinely
1.Laxmivilas rasa ,Kafketu rasa
1.Laxmivilas rasa ,Kafketu rasa
2.Vishan bhasm and shring bhasm –in
2.Vishan bhasm and shring bhasm –in parshv shool
parshv shool
3.Kwath
3.Kwath-Gojihvvadi,Panchkoiladi,Laookqe Sapista
-Gojihvvadi,Panchkoiladi,Laookqe Sapista
4.Nasal decongestant
4.Nasal decongestant-Ajvain fumes inhalation
-Ajvain fumes inhalation
5
5.
.Talishadi churna
Talishadi churna
21. General Protocol:
General Protocol:
1.Luke warm water-shunthi/aadrak sidhh
1.Luke warm water-shunthi/aadrak sidhh
2.Haldi,aadrak,tulsi ptra,kalimirch-tea/kwath
2.Haldi,aadrak,tulsi ptra,kalimirch-tea/kwath
3.Pind khajoor,adrak,pipli-chhir paka
3.Pind khajoor,adrak,pipli-chhir paka
4.Local fomentation
4.Local fomentation
3.Bacterial pneumonia
3.Bacterial pneumonia
1.Makardhavaj/Rasasindoor
1.Makardhavaj/Rasasindoor
2.Trilokya chintamani swaras not used in shirap awastha
2.Trilokya chintamani swaras not used in shirap awastha
3.vrihat kasturi bherav rasa
3.vrihat kasturi bherav rasa
4.bramhmi vati
4.bramhmi vati
4.Severe stage convulsions
4.Severe stage convulsions
Mukta pishti,godanti-protect vital parts
Mukta pishti,godanti-protect vital parts
Sitopladi churna-brinhan hetu
Sitopladi churna-brinhan hetu
Balchaturbhadra churna-if diarrhea
Balchaturbhadra churna-if diarrhea
Kshir pak-
Kshir pak-
Munakka
Munakka
Anjir,Kesar ,Shunthi,pipali
Anjir,Kesar ,Shunthi,pipali
22. Prevention
Prevention
1.Immunization
1.Immunization
2.Health education to mother
2.Health education to mother
3.Proper implementation of ART Control programme
3.Proper implementation of ART Control programme
4.High risk factors should be avoided
4.High risk factors should be avoided
Recurrent and Persistent Pneumonia
Recurrent and Persistent Pneumonia
Etiology of recurrent and persistent Pneumonia
Etiology of recurrent and persistent Pneumonia
Causes Conditions
Congenital
Infections
CMV
Non-infections Cleft palate
To fistula
Gastro-oesophageal reflux
Sickle cell anaemia
Acquired Infections Otitis media, sinusitis, bronchietasis,
CMV infection
Non-infections Recurrent aspiration foreign body
aspiration Asthma
23. Typical Pneumonia
Typical Pneumonia
It is also known as 'walking pneumonia'. The children with these
It is also known as 'walking pneumonia'. The children with these
infections present with atypical symptoms.
infections present with atypical symptoms.
Features Typical pneumonia A typical pneumonia
Causative organisms S. Pneumoniae
S. dureus
H. influenza
M. Pneumonae
Chlmyadia Pneumoniae
Legionella
Onset Sudden Gradual
Age Any age Usually > 5 years, except
chlamyetia which
commonly occurs without
first 6 months.
Fever common may be present
cough productive dry
symptoms pulmonary systemic
x-ray chest findings localised diffuse
24. Radiological findings in various types of pneumonia
Radiological findings in various types of pneumonia
Radiological Changes Type of Pneumonia
1. Lobar involvement Pneumococcal pneumonia
2. Right middle lobe
pneumonia
Aspiration pneumonia
3. Upper lobe pneumonia,
cavitations, bronchopneumonia
with hilar lymphadenopathy
Tuberculosis pneumonia
4. Lower lobe pneumonia Chemical pneumonia
5. Multiple abscesses staphylococcal / klebsiella
pneumonia
6. Bilateral interstitial
pneumonia
Viral pneumonia
7. B/L interstitial pneumonia Pneumocystic carinric
25. Classification of Pneumonia according WHO
Classification of Pneumonia according WHO
Classification Clinical Features
No proumonia Cough & No fast breathing
No chest indrawing & Feeding well
Pneumonia Cough & No chest in drawing & Able to
drink Fast breathing
Severe pneumonia Lower chest in drawing present & Able to
drink
Fast breathing & Other signs may be
present – nasal flaring, grunting, cyanosis
Very severe pneumonia Not able to drink & Cyanosis
Striders in calm child
severe respiratory distress or grunting
lethargy, excessive drowsiness
convulsions
26. Complications
Complications
System Complications
1. Respiratory
Pulmonary Suppurative lung diseases & Collapse
Bronchiectasis
Pleural Parapneumonic effusion & empyema
Pneum othorax & Pyopneumothorax
2. Cardiovascular Acute circulatory failure due to
bacteraemia
Pericarditis & Endocarditis
Miscellaneous Meningism & Shock due to bacteriaemia
Multiorgan failure
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^fu% lkj;sTtykSdkHkh jDra p tBjkÙknk*
1 f'k'kq ds mnj esa tykSdk yxkdj jDreks{k.k djsaA
1 f'k'kq ds mnj esa tykSdk yxkdj jDreks{k.k djsaA
2 ckyd ds mnj ij vfXu ls Losnu djsaA
2 ckyd ds mnj ij vfXu ls Losnu djsaA (hast sweda upto 6
(hast sweda upto 6
months)
months)
ekrk dh fpfdRlk
ekrk dh fpfdRlk
1
1 LrU; 'kks/ku
LrU; 'kks/ku
ddksZV] 'kq.Bh] eqLrk] dadksy ,oa vfrfo"kk leHkkx ysdj
ddksZV] 'kq.Bh] eqLrk] dadksy ,oa vfrfo"kk leHkkx ysdj
pw.kZ dj nw/k ds vuqiku ls ekrk ;k ?kk=h dks fiykdj nw/k
pw.kZ dj nw/k ds vuqiku ls ekrk ;k ?kk=h dks fiykdj nw/k
dks 'kq) dj nsaA
dks 'kq) dj nsaA
vfXuuk Losn;s}k
vfXuuk Losn;s}kv
vfi nkg;sPp 'kykd;kA
fi nkg;sPp 'kykd;kA
tBsj fcUnqdkdkja i`"BHkkxs ;Fkk /qzoea~AA
tBsj fcUnqdkdkja i`"BHkkxs ;Fkk /qzoea~AA
2 ckyd ds mnj ij vfXu ls Losnu djsa ;k mnj ij vkSj ihB ij
2 ckyd ds mnj ij vfXu ls Losnu djsa ;k mnj ij vkSj ihB ij
'kykdk dj fcUnq ds vkdkj dk nkg djsaA
'kykdk dj fcUnq ds vkdkj dk nkg djsaA
31. BIBLIOGRAPHY
BIBLIOGRAPHY
1.Kaumarbhritya –Prof.Devendranath Mishra
1.Kaumarbhritya –Prof.Devendranath Mishra
Chowkhamba publication
Chowkhamba publication
2.Bailey and Love – A short text book of Surgery
2.Bailey and Love – A short text book of Surgery
3.Human Anatomy – B.D.Chaurasia
3.Human Anatomy – B.D.Chaurasia
4.Human Physiology – Prof.A.K.Jain
4.Human Physiology – Prof.A.K.Jain
5.Hutchison’s Clinical Methods
5.Hutchison’s Clinical Methods
6.A Text Book Of pathology – William Boyd
6.A Text Book Of pathology – William Boyd
7.WWW.GOOGLE.COM
7.WWW.GOOGLE.COM
8.Meharban Singh paediatrics
8.Meharban Singh paediatrics
9. OP Ghai Textbook of pediatrics
9. OP Ghai Textbook of pediatrics
10.Medsape
10.Medsape
11.
11. ¼;ks-j-ck-jks-fp-i`- 456½
¼;ks-j-ck-jks-fp-i`- 456½
12.
12. ¼p-fp- 3@53&54½
¼p-fp- 3@53&54½
