Aspiration Pneumonia

Aspiration Pneumonia

Overview
Incidence
Etiology
Epidemiology
Pathogenesis
Pathophysiology
Clinical Symptoms
Diagnosis
Examination Support
Mortality / Morbidity
Differential Diagnosis
Prognosis
Complication

Overview
Aspiration pneumonia is an inflammation of the lung parenchyma, distal to the terminal bronchioles which includes respiratory bronchioles, and alveoli, as well as consolidation of lung tissue and cause disorders setempat.yang gas exchange caused by foreign body aspiration bersal both in body and outside the patient's body. Histological examination of inflammatory reactions are pneumonitis or alveolitis and collection of exudate that can be caused by a variety of causes and takes place in the time period varies.

Incidence
- United States
Few studies have been conducted to know the difference between aspiration pneumonia and aspiration pneumonitis. Some studies claim that 5-15% of the 4.5 million cases of community-acquired pneumonia caused by aspiration pneumonia.
Approximately 10% of patients hospitalized with post-intoxication or drug overdose / toxicity would be aspiration pneumonitis.


Etiology
There are three kinds of causes of aspiration syndrome, pneumonia, aspiration of gastric acid that cause chemical pneumonia, aspiration of bacteria from the oral and oropharingeal cause bacterial pneumonia, aspiration of oil, such as mineral oil or vegetable oil can cause exogenous lipoid pneumonia. Apirasi an emergency lung foreign body and in some cases of bacterial pneumonia is a predisposing factor.
The most common causes of aspiration in adults is alkoholism, stroke, neuromuscular disorders, Anaestesi, under conditions where the cough reflex and depressed gag reflex, swallowing disorders, structural abnormalities of the esophagus, gastroesophageal reflux disease, and loss of consciousness.

Epidemiology

• Gender. Aspiration pneumonia is more common in men than women.
• Age. Aspiration pneumonia is more common in the elderly or young.
• Race. There is no evidence that certain races have a risk factor for aspiration pneumonia

Pathogenesis
Not occur in a healthy state of growth of microorganisms in the lungs, a condition caused by pulmonary defense mechanisms. The presence of microorganisms (bacteria) in the lung is the result of an imbalance between the immune system, microorganisms and environment, so the microorganisms can multiply and cause disease.
 The entry of microorganisms into the airways and lungs can be through a variety of ways:

• Inhalation directly from the air
• Aspiration of materials that exist in the nasopharynx and oropharynx
• Expansion of directly from other places
• Spread is haematogenous.

Pathophysiology
Aspiration is a thing that can happen to any action orang.Di here there is a role alveoler mukosilier and macrophages in the clearance of aspirated material. There are three determinant factors that play a role in aspiration pneumonia, the nature of the aspirated material, aspiration volume, as well as a host defensive factors.
Pathological changes in the airway are generally unable to distinguish between different causes of pneumonia, most cases occur in the parenchyma disruption and interference with bronchiolitis interstitial. Pathological changes include epithelial damage, mucus formation and eventually bronchial obstruction. Furthermore, inflammatory cell infiltration peribronkial (peribronkiolitis) and infection both in the interstitial tissue, alveolar ducts and alveolar walls, can also be accompanied by the formation of hyaline membranes and intra-alveolar hemorrhage. Pulmonary disorders may be a restriction, diffusion and perfusion.

Clinical Symptoms
Usually preceded by infection of acute upper respiratory tract for several days, followed by fever, chills, body temperature sometimes exceeds 40o Celsius, sore throat, pain in muscles and joints. Sometimes accompanied by a cough, with sputum mucoid or purulent and may be accompanied by phlegm.

Diagnosis
To diagnose aspiration pneumonia, health workers must see the patient's symptoms and findings of physical examination. Description of plain chest, blood tests and sputum cultures may also be beneficial. Photos of the piston is usually used to diagnose patients in hospitals and some clinics have facilities plain photos. However, in the community (general practice), pneumonia is usually diagnosed based on symptoms and physical examination alone. Diagnosing pneumonia can be difficult for some people, especially those with other comorbidities. Occasionally a chest CT scan or other tests needed to distinguish pneumonia from other illnesses.
People with symptoms of pneumonia need medical evaluation. Physical examination by health workers may indicate an increase in body temperature, increased respiratory rate, decreased blood pressure, rapid heart rate and low oxygen saturation, which is the amount of oxygen in the blood is indicated by oximetry or blood gas analysis. People with breathing difficulties, are confused, or had cyanosis requiring immediate attention.
The physical examination depends on the extent of lesions in the lung. On examination looks the part of the sick time left to breathe, increased fremitus touched the sick side. On the dim discovered percussion, bronchial breathing, fine moist crackles, egofoni, bronkofoni, "whispered pectoriloquy". Sometimes the friction murmur pleura (pleural friction rub). Abdominal distention, especially in the lower lobe pulmonary consolidation, which need to be distinguished from acute cholecystitis and peritonitis due to perforation.

Examination Support
a. Radiological picture
Examination is important for pneumonia in unclear circumstances is plain chest. Photo thoracic (PA / lateral) is a major investigation to establish the diagnosis. Radiological picture can be either infiltrates through consolidation with "Water bronchogram", spread bronkogenik and interstitial with or without an accompanying picture kaviti on an infected lung segment. Lusen picture showing necrotic infiltrate accompanied by pneumonia. Air fluid levels indicate lung abscess or fistula bronkopleura.Sudut costofrenicus the blunting and a positive meniscus shows the pneumonic pleural effusion.

b. Laboratory examination
A complete blood examination may show an increased leukocyte count (more than 10.000/mm3, sometimes reaching 30.000/mm3), which indicates the presence of infection or inflammation. But in 20% of patients there is no leukocytosis. Calculate the type of leukocyte "shift to the left". LED is always up. Billirubin direct or indirect can be increased, since the breakup of red blood cells that accumulate in the alveoli and dysfunction of the liver due to hypoxia. To determine the etiologic diagnosis required examination of sputum, blood culture and serology. Blood gas analysis showed hypoxemia and hipokarbia, at an advanced stage respiratory acidosis may occur.

Mortality / Morbidity
Mortality / morbidity associated with aspiration pneumonia are similar to community-acquired pneumonia in approximately 1% of patients and outpatients increased to 25% in patients who are hospitalized. The death rate is in scope depending on the presence of complicating factors or

Differential Diagnosis
• Atelectasis
• Pleural effusion
• Lung Tumor

Treatment
a. General supportive treatment

1. O2 therapy to achieve PaO2 80-100 mmHg or saturation of 95-96% based on examination of blood gas analysis.
2. Humidification with netribulizer for the dilution of thick sputum, can be accompanied by nebulizer for administration of bronchodilators if there is bronchospasm
3. Fluid arrangement.
4.  Mechanical ventilation.

b. Antibiotics
Intended as a causal therapy against the infecting organism.
- High doses of Penicillin G 6-12 million units / day
- Ampicilin / Amoxicilin 3-4 x (500-1000) mg / day
- Erythromycin 3-4 x 500 mg / day
- Cephalosporin dosage according to the type of preparations
- Cotrimoxazol 2 x (1-2) tablets
- Can also be given klindamycin for 1 to 2 weeks.

Prognosis
Prognosis is largely determined by the severity of pneumonia, the type of invading organism, and the lung area involved. If left unchecked it will develop in the acute respiratory failure and fatal that could cause death.

Complication

• Spread by hematogenous infection (bacteremia)
• Hypotension
• Shock
• Acute Respiratory Distress Syndrome (ARDS)
• Pneumonia with lung abscess
• Pleural effusion
• Empyema
• Sepsis

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