Topic 7: Propaedeutics of

Internal Medicine

Pneumonia and Pleurisy

Oritsemimajemite Dorcas Lori
ARMI Sumy State University
Group 026ан
 Introduction:

 Pneumonia is defined as an ‘acute inflammatory lung disease with obligatory alveoli involvement and exudative
formation in them’
 Pleurisy is defined as an ‘injury of pleura associated with fibrin formation on its surface – dry pleurisy – or fluid
accumulation in pleural cavity - exudative pleurisy.
 Classifications of pneumonia

I. By particularities of infection
 Non-hospital pneumonia
 Pneumonia in outpatients
 Pneumonia in inpatients
 Intra-hospital pneumonia
 Aspiration pneumonia
 Pneumonia in patients with severe immunodeficiency
Classifications of pneumonia

 Non-hospital pneumonia means that the pneumonia has developed from outside the
hospital (in conditions of life)
 Intra-hospital pneumonia means that the pneumonia has developed in first 48-72 hours
after hospitalisation in condition of reject infectious in incubation period on the moment
of admission to the hospital (nosocomial)
 Aspiration pneumonia means that the pneumonia has developed due to inhalation of food
or liquid, instead of being swallowed
Risk factors of pneumonia

 Smoking
 Alcohol
 Heart failure with congestion in lesser circulation
 Chronic obstructive lung diseases
 Chronic in nasopharynx
 Immunosuppressed patients
 Post-operative patients
 Old age
 Long confinement to bed
Pathological factors of pneumonia

 Entrancing of the pathological agent to the pulmonary tissue

 Impaired local bronchopulmonary resistance
 Development of the local inflammatory process and its overspreading in lung tissue
 Impaired micro circulation
 Activation of oxidative stress and proteolysis in lung tissue
 Antibody and immune complexes formation
 Clinical features of pneumonia

 Cough – initial stage is dry and has a reflective character, by second day
appears tenacious sputum. In patients with lobar pneumonia, sputum is
sticky and ‘rusty’ initially then “after mucous purulent
 Pain in the chest – symptom of lobar pneumonia in condition of pleura
involvement or intercostals nervous irritation. Pain occurs suddenly,
intensive and increased during cough or deep inspiration
 Dyspnea – in lobar pneumonia significant dyspnea accompanied by heaviness
in chest and tachypnoea (30-40 breathing acts per minute). Inspiratory or
mixed character and depends on pneumonia duration.
Objective examination for pnemonia

General condition of the patient can be from middle grave (acute

focal pneumonia) to extremely grave (lobar acute
pleuropneumonia)
Posture of patient is usually active