152. Pneumococcal pneumonia: pathological anatomy, complications and pathomorphosis.

Croup pneumonia is an acute infectious disease manifested by inflammation of one or more lobes of the lungs with the obligatory involvement of the lung Parenchyma pleura in the process: bronchial tree and alveoli Interstitial connective tissue.

Pathogenesis High tide stage - Duration up to 1 day In the affected lobe, serous inflammation occurs in response to the proliferation of microbes: due to increased permeability of the vascular wall of capillaries, blood plasma and erythrocytes enter the alveoli

The stage of red liver disease. On the 2nd - 3rd day, croup inflammation develops: the exudate contains erythrocytes, leukocytes, fibrin filaments. The lobe of the lung is enlarged, red and dense – airless (resembles a liver)

- "Rusty" sputum is a characteristic symptom of croup pneumonia. The rust color is due to the content of hemosiderin in the mucus, which is formed during the intraalveolar disintegration of erythrocytes, appears from the 2nd day of the disease, the stage of gray hepatica On the 4th - 6th day, leukocytes remain in the fibrinous exudate (microbes phagocytize) and fibrin lung fraction is increased in gray size, fibrinous exudate on the pleura

Resolution stage From day 7, leukocytes begin to break down fibrin and absorb the remains of microbes. Airiness is restored Fibrinous overlays on the pleura turn into adhesions

Complications - Pulmonary complications: Abscess, Gangrene, Carnification, Pleural empyema - Extrapulmonary complications: Pericarditis Endocarditis Meningitis Pyelonephritis

153. Bronchopneumonia: etiology, pathoanatomical characteristics of pneumococcal, staphylococcal, streptococcal, fungal, viral pneumonia. Features of pneumonia in children.

Features of pneumonia in children.

Bronchopneumonia is an inflammation of the lungs that develops in connection with bronchitis or bronchiolitis: it has a focal character, it can be primary (viral infections), and secondary (complication of diseases) acute pneumonia.

Etiology. Microbial agents: pneumococcus, Staphylococcus, streptococcus, enterobacteria.

Bronchopneumonia has morphological features depending on the type of infectious agent causing it. Staphylococcal, streptococcal, pneumococcal, viral and fungal focal pneumonia are of the greatest clinical importance.

Staphylococcal bronchopneumonia is usually caused by Staphylococcus aureus, it is often detected after a viral infection. It is characterized by a heavy current. Inflammation is usually localized in the IX and X segments of the lung, where foci of suppuration and necrosis are found. After emptying the pus through the bronchi, small and larger cavities are formed. Serous hemorrhagic inflammation develops in the circumference of necrosis foci.

Streptococcal bronchopneumonia is usually caused by hemolytic streptococcus, often in combination with a virus. It flows acutely. The lungs are enlarged, bloody fluid is draining from the surface. Leukocyte infiltration prevails in bronchi of different caliber, necrosis of the bronchial wall, formation of abscesses and bronchiectasis are possible.

Pneumococcal bronchopneumonia is characterized by the formation of foci closely related to bronchioles, in the exudate — neutrophils, fibrin. On the periphery of the foci of pneumonia there is a zone of edema, where many microbes are found. The lung on the section has a mottled appearance.

Fungal bronchopneumonia (pneumomycosis) can be caused by various fungi, but more often of the Candida albicans type. Foci of pneumonia of different sizes (lobular, drain), dense, grayish-pink in the section. In the center of the foci there is decay, in which the filaments of the fungus are found.

Viral bronchopneumonia is caused by RNA and DNA-containing viruses. Viruses are introduced into the epithelium of the respiratory tract. RNA-containing viruses form colonies in the cytoplasm of cells in the form of basophilic inclusions, have a cytopathic effect, cells peel off and proliferate, form cell clusters and giant cells. DNA-containing viruses are introduced into the nuclei, the cells are exfoliated, but do not regenerate. The detection of exfoliated cells with intracellular inclusions in smears taken from the mucous membrane is of diagnostic importance. Viral bronchopneumonia rarely exists in its pure form, since it breaks the epithelial barrier, which contributes to the development of a secondary bacterial infection. Viral bronchopneumonia occurs in viral respiratory infections (influenza, parainfluenza, respiratory syncytial and adenovirus infections), cytomegaly, chickenpox, measles.

Features in children: Bronchopneumonia has some features in different age periods. In newborns with pneumonia, hyaline membranes consisting of compacted fibrin often form on the surface of the alveoli. In weakened children under the age of 1-2 years, foci of inflammation are localized mainly in the posterior, adjacent to the spine and not completely straightened after birth in the lung sections (II, VI and X segment). Such pneumonia is called paravertebral pneumonia. Due to the good contractility of the lungs and the drainage function of the bronchi, the richness of the lungs with lymphatic vessels, the foci of pneumonia in children resolve relatively easily.

154. Chronic obstructive pulmonary diseases: terminology, etiology, pathogenesis, clinical and morphological characteristics, complications, causes of death.

Chronic obstructive pulmonary disease (COPD) is a disease characterized by persistent restriction of airflow, which usually progresses and is a consequence of a chronic inflammatory response of the respiratory tract and lung tissue to the effects of inhaled damaging particles or gases. Exacerbations and comorbid conditions are an integral part of the disease and make a significant contribution to the clinical picture and prognosis.

Etiology

Environmental factors: - Smoking

- Occupational hazards

- Outdoor air pollution.

Endogenous factors:

- genetic

- epigenetic

- congenital deficiency of alpha 1-antitrypsin

Consequences (complications):

Irreversible ones include: - Fibrosis and narrowing of the airway lumen;

- Loss of elastic lung traction due to alveolar destruction;

- Loss of alveolar support for the lumen of the small airways. The reversible ones include:

- Accumulation of inflammatory cells, mucus and plasma exudate in the bronchi;

- Reduction of the smooth muscles of the bronchi;

- Dynamic hyperinflation during physical activity.

Pathogenesis.

Inflammation of the respiratory tract:

It is characterized by an increase in the number of neutrophils, macrophages and T-lymphocytes in various parts of the respiratory tract and lungs. An increased number of inflammatory cells are found in the proximal and distal airways.

Complications of COPD:

Infections;

Respiratory insufficiency is a condition of the external respiratory apparatus in which either the voltage of O2 and CO2 in arterial blood is not maintained at a normal level, or it is achieved due to increased work of the external respiratory system. It is manifested mainly by shortness of breath.

Chronic pulmonary heart is an enlargement and dilation of the right parts of the heart, which occurs when blood pressure increases in the small circle of blood circulation, which, in turn, develops as a result of pulmonary diseases. The main complaint of patients is also shortness of breath.

Bronchogenic carcinoma (lung cancer) is also found.

Causes of death from COPD: pulmonary heart failure with decompensated pulmonary heart or in combination with pathology of the left ventricle of the heart (valvular defects, myocardial infarction and postinfarction cardiosclerosis), chronic respiratory failure, purulent intoxication with severe bronchopneumonia and pleurisy, lung collapse with pneumothorax.