2. Case 1 :
A 54-year-old woman presented with chronic cough with thick
greenish sputum that has worsened over a period of 6–12
months. Over the course of the day, she estimates that she
produces as much as 100 ml of sputum daily. Bilateral coarse
crackles are heard in the lower lung zones. Pulmonary function
tests demonstrate FEV1/FVC ratio of 56%. A chest radiograph is
unremarkable. What would you recommend as the next step in
the evaluation and management of this patient?
3. Case 2:
A 48-year-old man(chronic alcoholic) presented with fever and
cough. He has fever, fatigue and generalized malaise for about 8
weeks. During this period, he has been having increasing cough
with foul smelling dark sputum production at least 3 tablespoons
daily that has been blood streaked at times. He has evidence of
temporal wasting with very poor dentition. A foul odor is present
on his breath. Amphoric breath sounds are heard posteriorly in
the right lower lung field. What is the best initial choice for
therapy in this patient and investigations to be planned ?
4. At the end of this presentation we would be able to:
1. Know the different types of suppurative lung diseases.
2. Describe the etiology and pathogenesis of each type.
3. Describe the clinical features of each disease.
4. Interpret the specific investigations.
5. Discuss the different complications.
6. Discuss the treatment modalities including surgery.
5. The term suppurative lung diseases implies the following:
Bronchiectasis
Lung abscess
Empyema thoracis
6. History
Fever, persistent cough with copious sputum production
Weeks to months
+
Risk of aspiration
GERD
Tooth infections (bad breath)
Months to years
+
h/o recurrent/long standing infections
Postural increase in sputum production
Congenital defects
Autoimmune disorder
Rhinosinusitis
7. Examination
Auscultation:
Wheezing + coarse
crepts
General : mouth
for decaying teeth,
gag reflex may be
absent.
Palpation :
increased vocal
fremitus
Percussion :
dullness
Auscultation :
Amphoric or
cavernous sounds
General: mouth for
decaying teeth
Inspection : restricted
movement, Crowding
of ribs
Palpation :
tracheal shift ± shifting
of apex beat
Decreased Vocal
fremitus
Reduced chest
expansion
Auscultation
Decreased/absent
breath sounds
Decreased/ absent
vocal resonance
8.
9. Bronchiectasis
Abnormal irreversible dilatation of the bronchi (medium sized
bronchioles).
Not a disease per se but end stage of a variety of pathological
processes.
Extent may focal (localized to an area distal to mechanical
bronchial obstruction) or diffuse (systemic pathology).
25. Antibiotics
Indications:
1. Mucoid sputum muco-purulent sputum.
2. Chronic muco-purulent or purulent sputum ↑ amount or
purulence, change of color, systemic symptoms or
worsening of lung functions.
26. Antibiotic therapy
Start with β lactum antibiotics preferably with pseudomonal
coverage.
Add antibiotics according to culture and sensitivity.
Duration – 7-10 days(acute exacerbations) upto 14 days.
27. Bronchial hygiene
Aim:
Mobilization of secretions from the lung periphery (or
affected area)towards the more central unaffected segments
in which cough reflex is intact and mucociliary function is
preserved.
Approaches :
Hydration and mucolytic administration
Brochodilators
Chest physiotherapy
30. Lung Abscess
Localized area of destruction of lung parenchyma where
pyogenic infection is the cause of tissue necrosis and suppuration.
Primary lung abscesses - arise from aspiration (anaerobic
bacteria), absence of an underlying pulmonary or systemic
condition.
Secondary lung abscesses – underlying pulmonary
condition(postobstructive e.g. a bronchial foreign body or
tumor) or a systemic process (e.g., HIV infection or another
immunocompromising condition).
31. Primary lung abscess
1. Factors predisposing to aspiration
Dental caries
Impaired consciousness
Anaesthesia (general)
Stroke (cerebro-vascular accident)
Seizures including post-ictal state
Head trauma
Alcohol intoxication
Drug overdose or abuse (narcotics, sedatives)
Metabolic encephalopathy
Neuromuscular diseases
32. 2. Oesophageal disorders
Achalasia and other dysmotility syndromes
Gastro-oesophageal reflux
Stricture (benign or malignant)
Zenker’s diverticulum
33. Clinical features
Symptoms: chronic indolent course
1. Fever
2. Cough with expectoration(copious & foul smelling)
3. Chest pain.
4. Hemoptysis.
5. Dyspnea
6. Fatigue, night sweats and anemia.
34. Signs:
General: clubbing, mouth for decaying teeth, gag reflex may
be absent.
Palpation : increased vocal fremitus
Percussion : dullness
Auscultation :
amphoric or cavernous sounds