om verma msc lecturer medical surgical nursing

1. MR .OM VERMA

2.  Localized suppurative inflammation of the
lung.
 Necrosis of the pulmonary tissue & formation of
cavities containing necrotic debris or fluid caused
by microbial infection.
 A localized area of destruction of lung parenchyma in
which infection by pyogenic organisms results in tissue
necrosis & suppuration .
 It manifests radio graphically as a cavity with an air –
fluid levels.

3.  Lung Abscess is a localized necrotic lesion of
the lung parenchyma containing purulent
material that collapses and forms a cavity. It is
generally caused by aspiration of anaerobic
bacteria.

4. Lung abscess
Inhalation
lung abscess
Pneumonic
abscess
Embolic
abscesses

5. Location:
 Dependent areas (posterior segments of upper & lower lobes).
Stages:
 Pneumonic stage: patch of consolidation.
 Rupture: central necrosis, communication with a bronchus & expec-
toration of the liquid centre.
 Acute cavitations: irregular thick wall, shaggy ( khurdura) inner margin &
surrounding consolidation (collection).
 Chronic cavitation: thin wall, smooth inner margin & subsidence of
surrounding inflammatory reaction.

6. Complication of pneumonia:
 Staph pneumonia.
 Klebsiella pneumonia.
 T.B.

7. Lung abscess
with bulging
fissure ( a long
narrow
opening or line
of breakage )
sign.

8. EMBOLIC
ABSCESSES
 an abscess arising distal to the point of arrest of a
septic embolus.
 A septic embolism is a type of embolism that is
infected with bacteria, resulting in the formation of
pus. a clot or other plug, usually part or all of a
THROMBUS

10.  Infected catheters.
 Infected pacemakers.
 Tricuspid endocarditic ( IV drug abusers).

11.  ETOLOGY

12.  Hematogenous ( originating in the blood. 2.
producing blood or components of blood. 3.
distributed orspread by way of the bloodstream, as
in metastases of tumors or in infections; blood-borne.
spread from a distal site)
• UTI
• Abdominal sepsis
• Pelvic sepsis
• Infective endocarditic
• IV drug abuse
• Infected IV cannulae
• Septic thrombophlebitis = venous thrombosis,
inflammation, and bacteremia.

13. • Bronchiectasis
• Cystic fibrosis
• Bronchial obstruction : tumour, foreign body,
cong.abn
 Infected pulmonary infarct
 Trauma
 Immunodeficiency = immunodeficiency disease
characterized by eczema, recurrent staphylococcal
skin abscesses, recurrent lung infections,
eosinophilia (a high number of eosinophils in the
blood) and high serum levels of IgE.

14.  Lung Abscess pyogenic lung
infection/pneumonia, necrotizing pneumonia. ...
The most frequent cause is aspiration of
anaerobic organisms from the mouth in those
predisposed to ... Penetrating
pulmonary trauma - eg, a stab wound.

15.  Tuberculosis & non tuberculous mycobacterial infection
– fluid filled cavities – upper lobes / apical segments of
lower lobes
 Fungal infection – Histoplasma capsulatum
Blastomyces dermatitidis
Coccidiodes immitis
Aspergillus
Cryptococcus neoformans
Candida

16.  Aspiration of oropharyngeal or gastric secretion.
 2) Septic emboli.
 Necrotizing pneumonia
 Necrotizing tumors
 Gram negative organisms. (klebsiella)
 Anaerobic bacilli (Bacterorides
 Carcinoma of the lung
 Parasitic and fungal diseases of the lung.
 TB

17.  Lung abscess starts as an area of pneumonia
 Small zones of necrosis
 Coalesce together to from one or more large
cavities of 1-2 c.m
 Progressive and enlargement to from the abscess
cavity
 The abscess cavity well erode( increase) a
bronchus

18.  Expec-toration of purulent sputum with air fluid
formation in the cavity
 Fate
 1. infection of the other lung
 2. Open into pleura –pyopneumothorax
 3. Hematogenous spread

19.  The presenting features of lung abscess vary
considerably .
1. Symptoms progress over weeks to
months
2. Fever, cough, and sputum production
3. Night sweats, weight loss & anemia
4. Hemoptysis, is the coughing up of blood or
blood-stained mucus from the bronchi, larynx,
trachea, or lungs.

20.  Digital clubbing – develop within a few weeks if
treatment is inadequate.
 Dullness to percussion
 Diminished breath sounds if abscess is too large
and situated near the surface of lung.
 Amphoric / cavernous breath sounds
 Cough with foul smelling purulent sputum.
 Fever with shivering
 Night sweats
 Chest pain
 Shortness of breath
 Lethargy
 ) Finger clubbing

21.  Leukocytosis refers to an increase in the total number
of WBCs
 Anorexia
 Weight loss
 Weakness
 Dyspnea

22. Lung abscess
Acute
< 6 weeks.
Chronic
> 6 weeks

23.  CT SCAN = thick-walled, usually round cavity
with irregular margins forming an acute angle with
chest wall, no signs of compression of surrounding
lung .
 Bronchoscopy
 proximal airway obstruction by a tumour or foreign
body
 LUNGS XRY
 Chest x-rays nearly Identifying the lung
abscess as a cavity filled with fluid and air.

24.  Sputum Gram Stain:
May occasionally be helpful if there is a large
number of white blood cells and bacteria
consistent with oropharyngeal flora.
-
X RY
Irregularly sharp cavity with an air-fluid level inside
Chest physiotherapy and postural
drainage
and postural drainage may improve clearance of
the purulent and necrotic abscess contents

25. 
 Arterial Blood Gas Test
 The arterial blood gas
 test is a test used to check the level of
oxygen and carbon dioxide in your blood. A
doctor or nurse will take blood from the
artery in your wrist. Then, they will send the
blood to a lab for testing. The results of this
test indicate the amount of oxygen and
carbon dioxide in your blood.

26.  Pulse Oximetry Test
 The doctor will measure your oxygen level using a
small sensor that’s placed on the tip of your finger
to see if you are getting enough oxygen. This is
called the pulse oximetry test
 Physical Examination
 During a physical exam, your doctor will listen
for abnormal sounds in your lungs and heart using
a stethoscope.

27. 1 Amoxicillin x orally
1. Metronidazole 400mg TDS –Anaerobes
2. Cry.penicillin & clindamycin +/- metronidazole
IV – in hospitalised pts.
3. Can change – according to sensitivity

28.  COMPLICATION

29.  Caused by spread of infection into the pleural
space or by contamination of the pleural cavity
after percutaneous drainage.
 Amyloidosis
 is a group of diseases in which abnormal protein,
known as amyloid fibrils, builds up in tissue.
 Hemoptysis is the coughing up of blood or
blood-stained mucus from the bronchi, larynx,
trachea, or lungs.