Lung Abscess

Lung abscess is a suppurative lesions accompanied by necrosis of tissue in it.

Etiology
Germs cause usually consist of a mixture of aerobic and anaerobic bacteria such as: peptokokus, peptostreptokokus, fusobakterium spp, bakteroides spp, which is the flora of oropharynx.
An abscess can occur because: aspiration, complications of pneumonia, lung trauma wounds are infected, and infected with pulmonary infarction or originating from empyema.
In the subsequent discussion only lung abscess caused by the aspiration to be described further.

Pathogenesis

Infection will easily arise when there predisposing factors, such as:
  1. A source of infection is an infection of the respiratory tract mouth, larynx tumors infected, infected bronchiectasis, and lung tumors are infected.
  2. The resistance of the airways that decrease, due to disorders such as laryngeal paralysis, a decreased patient consciousness, achalasia, esophageal carcinoma, and disorders expectorated.
  3. Mechanical airway obstruction due to aspiration of blood clots, pus, teeth, vomit, bronchial tumors.


Material that is inhaled into the lungs will lower lying (gravity-dependent segments). In the upright position will aspirate into the basal segment of inferior lobe, especially the right, but if aspiration occurs during sleep supine aspiratnya will go to the posterior segment of superior lobe and inferior lobe superior segment.
The process begins as a pneumonia, and if they do not receive adequate treatment, then the process will evolve into "necrotizing pneumonia" or a lung abscess.

Pathology
Cavity caused by tissue necrosis, surrounded by thick walls and surrounding lung inflammation. Usually have a relationship with bronchial cavities.

Clinical Symptoms
Cough, foul smelling sputum, fever, pleuritic pain, the agency added skinny, sweaty night. A typical course of the disease is chronic and slow (chronic and indolent) potential for the occurrence of sudden and serious complications such as brain abscess, coughing up blood profus, piopneumothorax.

Diagnosis
Diagnosis of lung abscess due to aspiration is made by:
  1. A history of aspiration, especially in sufferers with impaired consciousness, impaired swallowing. But the state of sleep often unconscious aspirations. Another predisposing condition for anaerobic infections.
  2. Typical clinical symptoms: a chronic course of the disease and indolent. Cough with purulent sputum stink.
  3. Abnormalities in one place in the lung in accordance with the position of the patient at the time of aspiration.

Physical examination
Found signs of consolidation and the sign of a cavity in the sore area.
Inspection: decreased respiratory movement
Palpation: fremitus conjecture elevated in diseased areas. Sometimes palpable pleural friction.
Percussion: sounds overcast condition at the regional hospital.
Auscultation: the diseased areas of bronchial breathing sounds. Accompanied by additional sound rough to smooth. Above the cavity will sound amforik.
Laboratory:
- Blood edge: leukocyte increase was 12,000 - 20.000/ml erythrocyte sedimentation rate increased anemia.
- Sputum: Gram staining obtained many PMNs, and bacteria of various types.
Chest X-ray photo: looking to the consolidation of part or one lobe in which there is "water fluid levels".

Differential Diagnosis of Lung abscess
  1. Pulmonary tuberculosis is usually not accompanied by "air fluid levels"
  2. Bronchogenic carcinoma who experienced necrosis. Cavity wall thick, not flat.
  3. Bulla or cysts that are infected are marked with thin walls, no surrounding inflammatory reaction.
  4. Pulmonary hematoma is characterized by a history of trauma, no signs of infection.
  5. Skwester experiencing lung abscess formation. No association with bronchial (bronchography).
  6. Pneumoconiosis are experiencing cavitation and marked by a "simple pneumoconiosis" around it.
  7. Hiatus hernia. In hiatus hernia, there are no symptoms from the lungs. Found the existence of retrosternal pain and burning sensation is felt in the pit of the stomach (heart burn). This pain will be worse if the patient bent.
Complications of Lung abscess
  1. Coughing blood profus
  2. Empyema or piopneumothorax
  3. Brain abscess
  4. Anemia,caHection and amyloidosis can occur in chronic disease.
Clikc Here Management Of  Lung Abscess

Prognosis
When treatment is appropriate, given the prognosis is not too late either.


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