Lung Abscess

Lung Abscess, Lung Abscess and Treatment of Disease

Etiology

The vast majority of lung abscesses existing upper respiratory tract infection occurs by inhalation of the material. Sinüsitis respiratory tract, oral infections (pyorea, dental caries), surgical procedures (tonsillectomy, tooth extraction), infection of the larynx and bronchial tumors, chronic bronchitis and bronchiectasis, lung abscess affecting the occurrence of sources of infection. Poor nutrition, alcoholism, smoking, chronic lung disease, diabetes mellitus, immunosuppressive drugs such as corticosteroids and immunosuppressive debilitan diseases, foreign body aspiration, epilepsy, anesthesia, facilitates the occurrence of neurological problems and surgery of lung abscess. More rarely, the lung abscess penetrating the diaphragm causes subdiyafragmatik abscesses. Aerobic or anaerobic streptococci, staphylococci, Klebsiella, pneumococci, fusiform bacilli and spirochaete main factors of lung abscesses.

Pathology

Lung abscess abscess in any part of the body is like. Tuberculosis, fungal infections, infected cysts and tumors, although it fits the definition of necrosis, abscess kavernlerinde histopathological changes related to these diseases are called lesions. The size of abscess infectious agent type, quantity and virülansına the patient's resistance is localized and vary by location. After a time, localized tissue and fibrosis developed around the granülöz parenkimasında progress will prevent lung abscess. Small abscesses may heal without leaving any residue in place. Abscess drainage is not better or untreated growing in other parts of the lungs and to focus new causes suppuration and abscess.

Clinical symptoms

Facilitate the removal of dental abscesses the occurrence of the majority of cases, surgical intervention, poisoning (such as toxic doses of drugs for suicide to be taken), alcoholism, epilepsy, determined as a result. First, shivering with fever rises, this weakness, cough, pleural pain, followed by type. Starting as pneumonia and antibiotic treatment is started many times with this diagnosis. Untreated cases, and easily extracted from the increasing sputum, dyspnea, syanoz develops. Nature of 10-500 per day or more pus is removed from sputum. Sputum many times, such as sewage or rotten eggs, cabbage, pickled or corrupted bad smell. The smell next to the patient or the doctor who examined the hit and hear. The anaerobic bacteria that cause bad breath abscess. Hemoptysis is a frequent complication. In some cases the abscess begins suddenly, in some cases, there are insidious and progressive development. Pleural cavity pleural abscess proceed serious pain, dyspnea, empyema and pneumothorax causes.

Upon examination, abscess in the dullness, decreased breath sounds, sometimes it is frotmanı crepitan Railer and pleura. Comag fingers drum cases consist of a progressive deformity.

Laboratory findings

Leukocyte 20000-30000 to exit. Leukocyte formula in particular has increased neutrophils. Bacteriological examination of sputum and the sensitivity to drugs (antibiotic) should be examined. Abscess should be suspected when the culture of both aerobic bacteria aneorob hemde. Tuberculosis bacilli directly, culture and drug sensitivity study should not be neglected. Lung abscess and the mixed flora of bacteria in mixed flora can be found in Koch's bacillus. Bronchoscopy are used in the diagnosis and treatment of lung abscess. With this method, for example, whether a foreign body or tumor are taken and the material is made ​​aneorob culture.

Radiological findings

Initially, there is a concentration pneumonia-like round. A few days after the abscess necrotic material in the liquid-air level of a typical partial discharge occurs with a cavitary appearance. Intracavernous wall is thicker and usually has a concentration around the rather homogeneous nature pneumonic. Kavernleri abscess of the right lung and lower lobes are seen more.

Differential diagnosis

Especially at the beginning of the disease is difficult to distinguish pneumonia lung abscess. However, clear signs of infectious regains abscess progresses. Tuberculosis, fungal infections and complications of bronchial cancer may develop abscesses abscess-like look and feel. The patient's background and previous films with new ones drawn by comparing the diagnosis of lung helps. Hydatid cysts and bronchogenic cysts can also abseleşme. Süpürasyonu lung abscess in trauma and is an expected complication. Intracavernous and abseleşme pneumococcal-yosis'de rarely occur. Hiatus hernia and abscess kavernlerine intrato-rasim sometimes resemble other hernias. Diafragmadaki no signs of abnormalities in the respiratory system caused by the intrathoracic these hernias, the main symptoms of the disease retrostemal pain, gastrointestinal symptoms and radiological appearance of the gastrointestinal tract unchanged and baryumla diagnosed with radiographic examination are placed.

Treatment

Abesisi a serious lung disease. Should be treated in hospital. Lung infections tend to abseleşmeye. So seriously, checking the course of antibiotic treatment should be implemented and the disease. Tonsillectomy, tooth withdrawal and prophylactic penicillin treatment of lung aspiration must be the case.

The most effective antibiotic penicillin in the treatment of abscess. The daily dose is 10-20 million units or more. In some cases, the disease can be treated with penicillin alone. In addition to clindamycin, penicillin, metronizasol also be used. Changing bacterial flora in sputum bacterial culture and antibiotic that is often examined and appropriate antibiotic therapy should be combined.

Appropriate for the study of antibiotic susceptibility of gram-negative bacteria sefope-Razon (1 gm X 3/gün, IV or IM), ampicillin (500 mg X 4/gün, oral), the snow-benisilin (12-20 gm / day, and IV), gentamicin (80 mg X 2/gün, IM), cephalothin (2-4 gm / day, and IV) are used. Complete bed rest, postural drainage, in cases of hypoxia, oxygen therapy, bronchodilator drugs, diagnostics and treatment, bronchoscopy helps to ensure drainage.

6-8 weeks despite intensive treatment unhealed or hemoptysis, and chest wall of the fistula, a complication of bronkostenoz who need surgical intervention in cases without delay. If there is a complication of drainage of pleural empyema.

Delay the effective treatment of lung abscesses and 90% will recover without significant complications. Abscess in cases of chronic anemia, malnutrition, cachexia, fluid and electrolyte imbalance, particularly in elderly heart failure and amyloidosis develops in some cases. Whether these complications should be treated carefully examined.