pneumonia and cholecystitis

1. Pneumonia
Presented by
Amer M. Nasir
Instructor

2. Pneumonia
Pneumonia is an inflammation of the lung
parenchyma caused by various microorganisms,
including bacteria, mycobacteria, fungi, and
viruses .Bacterial pneumonia is the most common
type in adults.

3. • Pneumonias are classified as :
1.community acquired pneumonia (CAP).
2. hospital-acquired (nosocomial) pneumonia (HAP).
3. pneumonia in the immunocompromised host.
4. aspiration pneumonia.
Pathophysiology
An inflammatory reaction can occur in the
alveoli, producing an exudate that interferes
with the diffusion of oxygen and carbon dioxide;
bronchospasm may also occur if the patient has
reactive airway disease.

4. Risk factors of pneumonia
1. infants from birth to age 2 years, and individuals
ages 65 years or older
2. people who have had a stroke, have problems
swallowing, or are bedridden
3. people with weakened immune systems because
of disease or use of medications such as steroids
or certain cancer drugs
4. people who smoke, misuse certain types of illicit
drugs, or drink excessive amounts of alcohol
5. people with certain chronic medical conditions
such as asthma, cystic fibrosis, diabetes, or heart
failure

5. • Clinical Manifestations
Clinical features vary depending on the causative organism
and the patient’s disease.
1. Sudden chills and rapidly rising fever (38.5C to 40.5C
[101.F to 105.F]).
2. Pleuritic chest pain aggravated by respiration and
coughing.
3. Severely ill patient has marked tachypnea (25 to 45
breaths/min) and dyspnea; orthopnea when not
propped up.
4. Pulse rapid and bounding; may increase 10 beats/min
per degree of temperature elevation (Celsius).
5. A relative bradycardia for the amount of fever suggests
viral infection, mycoplasma infection, or infection with a
Legionella organism.

6. 6. infection, headache, low-grade fever, pleuritic pain,
myalgia, rash, and pharyngitis; after a few days, mucoid
or mucopurulent sputum is expectorated.
7. Severe pneumonia: flushed cheeks; lips and nail
beds demonstrating central cyanosis.
8. Sputum purulent, rusty, blood-tinged, viscous, or
green depending on etiologic agent.
9. Appetite is poor, and the patient is diaphoretic and
tires easily.
10 Signs and symptoms of pneumonia may also depend
on a patient’s underlying condition (eg, different signs
occur in patients with conditions such as cancer, and in
those who are undergoing treatment with
immunosuppressants, which decrease the resistance to
infection).

8. Cause of pneumonia
1. Bacteria causes of pneumonia which including
 Streptococcus pneumoniae
 Haemophilus influenzae
 Chlamydophila pneumoniae
 Mycoplasma pneumonia
 Loginella pneumophlea
2. Viruses causes of pneumonia
• Rhinoviruses
• Coronaviruses
• Influenza Virus
• Respiratory Syncytial Virus (Rsv)
• Adenovirus
• Parainfluenza.
• Herpes Simplex Virus

9. Causes of pneumonia
3- Fungi causing pneumonia
 Histoplasma Capsulatum
 Cryptococcus Neoformans
 Pneumocystis Jiroveci
 Coccidioides Immitis
4- Aspiration
When aspiration gastric contain may be lead to aspiration
pneumonia such as during surgery or G.E.R.D

10. Diagnosis test of pneumonia
• • Primarily history, physical
examination
• Blood tests. Blood tests are used
to confirm an infection and to try
to identify the type of organism
causing the infection.
• Chest X-ray. determine the extent
and location of the infection. a.
• Pulse oximetry. This measures the
oxygen level in blood. Pneumonia
can prevent lungs from moving
enough oxygen into bloodstream.

11. Diagnosis
Sputum test. A sample of fluid
from lungs (sputum) is taken
after a deep cough and analyzed
to help pinpoint the cause of the
infection.
CT scan
Pleural fluid culture. A fluid
sample is taken by putting a
needle between ribs from the
pleural area and analyzed to help
determine the type of infection.

12. Prevention of pneumonia
 Vaccination against causative
pneumonia
 Environmental Measures which
includes avoid any stimulus of the
pneumonia such as smoke, dust or
any pollution
 Appropriate Treatment of other
health problems. It is involved
antibiotics and anti-emetics, control
of the fever

13. • Medical Management
• Antibiotics are prescribed on the basis of Gram stain results
and antibiotic guidelines (resistance patterns, risk factors,
etiology must be considered). Combination therapy may also be
used.
• Supportive treatment includes hydration, antipyretics,
antitussive medications, antihistamines, or nasal decongestants.
• Bed rest is recommended until infection shows signs of
clearing.
• Oxygen therapy is given for hypoxemia.
• Respiratory support includes high inspiratory oxygen
concentrations, endotracheal intubation, and mechanical
ventilation.
• Treatment of pleural effusion, shock, respiratory failure, or
superinfection is instituted, if needed.
• For groups at high risk for CAP, pneumococcal vaccination is
advised.

14. Cholelithiasis (and Cholecystitis)
Amer M. Nasir
Master Degree in
Medical_ Surgical
Nursing

15. Cholelithiasis :calculi (gallstones) usually form in the
gallbladder from solid constituents of bile and vary greatly in
size, shape, and composition.
• There are two major types of gallstones:
1. pigment stones, which contain an excess of unconjugated
pigments in the bile.
2. cholesterol stones (the more common form), which result
from bile supersaturated with cholesterol due to increased
synthesis of cholesterol and decreased synthesis of bile acids
that dissolve cholesterol.
• Risk factors for pigment stones include:
1. cirrhosis,
2. hemolysis,
3. infections of the biliary tract.
These stones cannot be dissolved and must be removed
surgically.

16. Risk factors for cholesterol stones include:
1. gender (women are two to three times more
likely to develop cholesterol stones).
2. use of oral contraceptives.
3. estrogens, and clofibrate;
4. age (usually older than 40 years);
5. multiparous status.
6. obesity.
7. There is also an increased risk related to
diabetes, GI tract disease, T-tube fistula,and
ileal resection or bypass.

17. Cholecystitis
is refers to a painful inflammation of the gallbladder's wall.
The disorder can occur a single time (acute), or can recur
multiple times (chronic).

18. Clinical Manifestations of
Cholelithiasis (and Cholecystitis)
1. May be silent, producing no pain and only mild GI
symptoms
2. May be acute or chronic with epigastric distress (fullness,
abdominal distention, and vague upper right quadrant
pain); may follow a meal rich in fried or fatty foods.
3. If the cystic duct is obstructed, the gallbladder becomes
distended, inflamed, and eventually infected; fever and
palpable abdominal mass; biliary colic ,abdominal pain,
radiating to back or right shoulder with nausea and
vomiting several hours after a heavy meal; restlessness and
constant or colicky pain.
4. Jaundice, accompanied by marked itching, with obstruction
of the common bile duct, in a small percentage of patients
5. Very dark urine; grayish or clay-colored stool
6. Deficiencies of vitamins A, D, E, and K (fat-soluble vitamins)

19. Diagnosis of cholecystitis
Cholecystogram, cholangiogram; celiac axis
arteriography
• Laparoscopy
• Ultrasonography
• Helical CT scans and MRI; ERCP
• Serum alkaline phosphatase; gamma-glutamyl
(GGT),gamma-glutamyl transpeptidase (GGTP), LDH
• Cholesterol levels

20. Risk factors of cholecystis
The following factors may increase the risk of developing
gallstones:
1. A family history of gallstones on the mother's side of the
family
2. Crohn's disease
3. Diabetes
4. End-stage kidney disease
5. Hyperlipidemia
6. Losing weight rapidly
7. Obesity
8. Older age
9. Pregnancy

21. Complications of cholecystitis
1. Gangrene (death tissue)
2. Preformation of gallbladder
3. Pancreatitis
4. Persistent bile duct blockage
5. Inflammation of bile common duct

22. • Medical Management
•Achieve remission with rest, IV fluids,
nasogastric suction,
• analgesia, and antibiotics.
• Diet immediately after an episode is usually
low-fat liquids with high protein and
carbohydrates followed by solid soft foods as
tolerated, avoiding eggs, cream, pork.

23. Surgical Management
• Goal of surgery is to relieve persistent symptoms, to
remove the cause of biliary colic, and to treat acute
cholecystitis.
1. Laparoscopic cholecystectomy: performed through a small
incision or puncture made through the abdominal wall in the
umbilicus.
2. Cholecystectomy: Gallbladder is removed through an
abdominal incision (usually right subcostal) after ligation of
the cystic duct and artery.
3. Minicholecystectomy: Gallbladder is removed through a
small incision.
4. Choledochostomy: incision into the common duct for stone
removal.