PNEUMONIA

Pneumonia is an infection of the lungs that is caused by bacteria, viruses, fungi, or parasites. It is characterized primarily
by inflammation of the alveoli in the lungs or by alveoli that are filled with fluid (alveoli are microscopic sacs in the lungs that
absorb oxygen). At times a very serious condition, pneumonia can make a person very sick or even cause death. Although the
disease can occur in young and healthy people, it is most dangerous for older adults, babies, and people with other diseases or
impaired immune systems.
CAUSES
Bacterial
Streptococcus pneumoniae is the most common cause of bacterial pneumonia. People who suffer from chronic obstructive
pulmonary disease (COPD) or alcoholism most often get pneumonia from Klebsiella pneumoniae and Hemophilus influenzae.
Atypical pneumonia, a type of pneumonia that typically occurs during the summer and fall months, is caused by the
bacteria Mycoplasma pneumoniae. People who have Legionnaire's disease caused by the bacterium Legionella
pneumoniae (often found in contaminated water supplies and air conditioners) may also develop pneumonia as part of the
overall infection. Another type of bacteria responsible for pneumonia is called Chlamydia pneumoniae. Pneumocystis
carinii pneumonia is a form of pneumonia that usually affects both lungs and is found in patients with weakened or
compromised immune systems from such conditions as cancer and HIV/AIDS and those treated with TNF (tumor necrosis
factor) for rheumatoid arthritis.
Viral
Viral pneumonias are pneumonias that do not typically respond to antibiotic treatment (in contrast to bacterial pneumonias).
Adenoviruses, rhinovirus, influenza virus (flu), respiratory syncytial virus (RSV), and parainfluenza virus are all potential causes
of viral pneumonia.
Fungal
Histoplasmosis, coccidiomycosis, blastomycosis, aspergillosis, and cryptococcosis are fungal infections that can lead to fungal
pneumonia. These types of pneumonias are relatively infrequent in the United States.
Nosocomial and others
Organisms that have been exposed to strong antibiotics and have developed resistance are called nosocomial organisms. If they
enter the lungs, a person may develop nosocomial pneumonia. Resistant bacteria are often found in nursing homes and
hospitals. An example is MRSA, or methicillin-resistant Staph aureus, which can cause skin infections as well as pneumonia.
Similarly, outbreaks of the H5N1 influenza (bird flu) virus andsevere acute respiratory syndrome (SARS) have resulted in
serious pneumonia infections. Anthrax, plague, and tularemia also may cause pneumonia, but their occurrences are rare.
RISK FACTORS
Individuals who are at a higher risk of acquiring pneumonia are those who:
Smoke.

Abuse alcohol.
Have other medical conditions, such as chronic obstructive pulmonary disease (COPD), emphysema, asthma, or HIV/AIDS.
Are younger than 1 year of age or older than 65.
Have a weakened or impaired immune system.
Take medicines for gastroesophageal reflux disease (GERD).
Have recently recovered from a cold or influenza infection.
Are malnourished.
Have been recently hospitalized in an intensive care unit.
Have been exposed to certain chemicals or pollutants.
Are Native Alaskan or certain Native American ethnicity.
Have any increased risk of breathing mucus or saliva from the nose or mouth, liquids, or food from the stomach into the
lungs.

TESTS AND DIAGNOSIS

Physical exam
Chest X-ray (if your doctor suspects pneumonia)
Some patients may need other tests, including:

CBC blood test to check white blood cell count

Arterial blood gases to see if enough oxygen is getting into your blood from the lungs

CT (or CAT) scan of the chest to see how the lungs are functioning

Sputum tests to look for the organism (that can detected by studying your spit) causing your symptoms

Pleural fluid culture if there is fluid in the space surrounding the lungs

Pulse oximetry to measure how much oxygen is moving through your bloodstream, done by simply attaching a small clip
to your finger for a brief time

Bronchoscopy, a procedure used to look into the lungs' airways, which would be performed if you are hospitalized and
antibiotics are not working well
SIGNS AND SYMPTOMS
Symptoms of pneumonia caused by bacteria usually come on more quickly than pneumonia caused by virus. Elderly persons
and small children may actually have fewer or more mild symptoms than expected for such high risk groups. Most people with
pneumonia begin with cold and flu symptoms and then develop a high fever, chills, and cough with sputum.
Although symptoms may vary greatly depending on other underlying conditions, common symptoms include:
Cough
Rusty or green mucus (sputum) coughed up from lungs
Fever
Fast breathing and shortness of breath
Shaking chills

 Chest pain that usually worsens when taking a deep breath (pleuritic pain)
Fast heartbeat
Fatigue and feeling very weak
Nausea and vomiting
Diarrhea
Sweating
Headache
Muscle pain
Confusion or delirium
Dusky or purplish skin color (cyanosis) from poorly oxygenated blood
COMPLICATIONS
Often, people who have pneumonia can be treated successfully with medication. But some people, especially those in high-risk
groups, may experience complications, including:

Bacteria in the bloodstream (bacteremia). Bacteria that enter the bloodstream from the lungs can spread the
infection to other organs, potentially causing organ failure.
Lung abscess. An abscess occurs if pus forms in a cavity in the lung. An abscess is usually treated with antibiotics.
Sometimes, surgery or drainage with a long needle or tube placed into the abscess is needed to remove the pus.
Fluid accumulation around your lungs (pleural effusion).Pneumonia may cause fluid to build up in the thin space
between layers of tissue that line the lungs and chest cavity (pleura). If the fluid becomes infected, there is a need to have it
drained through a chest tube or removed with surgery.
Difficulty breathing. If pneumonia is severe or there are concurrent chronic underlying lung diseases, there may be
trouble breathing in enough oxygen. There may be a need to be hospitalized and a need to use a mechanical ventilator.

TREATMENT
Viral Pneumonia
Typical antibiotics will not work for viral pneumonia; sometimes, however, the doctor may use antiviral medication. Viral
pneumonia usually improves in 1 to 3 weeks.
Bacterial Pneumonia
Patients with mild pneumonia who are otherwise healthy are sometimes treated with oral macrolide antibiotics (azithromycin,
clarithromycin, or erythromycin). Patients with other serious illnesses, such as heart disease, chronic obstructive pulmonary
disease, or emphysema, kidney disease, or diabetes are often given more powerful and/or higher dose antibiotics.
In addition to antibiotics, treatment includes: proper diet and oxygen to increase oxygen in the blood when needed. In some
patients, medication to ease chest pain and to provide relief from violent cough may be necessary.

ANATOMY AND
PHYSIOLOGY
ANATOMY AND
PHYSIOLOGY

RESPIRATORY SYSTEM
The primary function of the
respiratory system is
supplying oxygen to the
blood and expelling waste gases, of which carbon dioxide is the main constituent, from the body. This is achieved through
breathing: we inhale oxygen and exhale carbon dioxide. Respiration is achieved via inhalation through the mouth or nose as a
result of the relaxation and contraction of the diaphragm. The functional anatomy of the respiratory system would include the
conducting zone composing of the nose, pharynx, larynx, trachea and bronchi that serve as conduits to and from the respiratory
zone and the respiratory zone, the only site of gas exchange, is compose of bronchioles, alveolar ducts, alveolar sacs and
alveoli.

Conducting zone
Nose
During breathing, air enters to the nose passing through the nostrils. The interior part of the nose consists of the nasal cavity
which is divided by a midline nasal septum. The mucosa lining the nasal cavity rests on a rich network of thin walled veins that

warms the air as it flows past and the sticky mucus produced by the mucosas gland moistens the air and traps incoming foreign
debris. the lateral walls of the nasal mucosa has uneven projections called conchae, which greatly increase the surface area of
the mucosa exposed to the air and also increases the air turbulence in the nasal cavity. The nasal cavity is surrounded by a ring
of paranasal sinuses located in the forntal, sphenoid, ethmoid and maxillary bones. The sinuses lighten the skull and act as
resonance chambers for speech.

Pharynx
This funnel-shaped tube is about 12 cm long and has three sections - the nasopharynx, just behind the nasal cavities, the
oropharynx behind the mouth and the lowest section, the laryngopharynx. The pharynx acts as a passageway for food on its
way to the stomach and for air to the lungs. The mucosal epithelium in the pharynx is thicker than elsewhere in the respiratory
tract as it has to protect the tissues from any abrasive and chemical trauma caused by food. Two eustachian or auditory tubes
connect the middle ears with the nasopharynx and allow pressure in the middle and outer ear to equalize. The oropharynx can
be entered from the mouth as well as from the nasopharynx, while the laryngopharynx, divides into the esophagus which carries
food to the stomach and the larynx through which air passes to the lungs. Tonsils are mounds of lymphatic tissue embedded in
the pharynx - the pharyngeal tonsils are found in the nasopharynx and the palatine tonsils in the oropharynx. Air is drawn
through the pharynx into the larynx.

Larynx
The larynx is located immediately below the pharynx and is formed of pieces of cartilage bound together by ligaments. The
largest of these, the thyroid cartilage, is often visible in the neck of adult males and is known as the Adams apple. Another leafshaped piece of cartilage, the epiglottis, partly covers the opening of the larynx and acts like a trapdoor, closing off the glottis
during swallowing so that food and fluids cannot enter the trachea. If anything other than air enters the larynx, the cough reflex
is triggered to try to expel the foreign matter. As well as being part of the airway, the larynx contains the highly elastic vocal
cords or folds. These two short, fibrous bands are stretched across the inside of the larynx. The space between the two cords is
known as the glottis. Exhaled air passing through the glottis makes the vocal cords vibrate, producing sound waves.
Trachea
Air entering the trachea form the larynx travels down its length (10-12cm) to the level of the fifth thoracic vertebra, which is
approximately midchest. The trachea is fairly rigid because its walls are reinforced with C-shaped rings of hyaline cartilage.
These rings serve a double purpose. The open parts of the rings abut the esophagus and allow it to expand anteriorly when we
swallow a large piece of food. The solid portions support the trachea walls and keep it patent in spite of the pressure changes

that occur during breathing. The trachea is lined with a ciliated mucosa. The cilia beaontinuously and in a direction opposite to
that of the incoming air and propels mucus.
Bronchi
The trachea branches off into two main bronchi, your left and right primary bronchi, which lead to the left and right lung . Your
right lung is slightly wider, shorter, and taller that the left, which makes it more vulnerable to foreign invasion. At this point in
breathing, the air has been moistened, purified and warmed. Each bronchi enters its lung and begins on a series of branches,
called the bronchial or respiratory tree. The first of these branches is the lobar (secondary) branch. On the left, there are two
lobar branches, while on the right, there are three. Each lobar branches into one lobe. The next branch is called the segmental
(tertiary) branch. Each branch continues to branch into smaller and smaller bronchioles. The final branch is called the terminal
bronchioles. These bronchioles are smaller than 0.5 mm in diameter. The first few levels of bronchi are supported by rings of
cartilage. Branches after that are supported by irregularly shaped discs of cartilage, while the latest levels of the tree have no
support.

Lungs
The Right Primary Bronchus is the first portion we come to, it then branches off into the Lobar (secondary) Bronchi, Segmental
(tertiary) Bronchi, then to the Bronchioles which have little cartilage and are lined by simple cuboidal epithelium (See fig. 1). The
bronchi are lined by pseudostratified columnar epithelium. Objects will likely lodge here at the junction of the Carina and the
Right Primary Bronchus because of the vertical structure. Items have a tendency to fall in it, where as the Left Primary Bronchus
has more of a curve to it which would make it hard to have things lodge there. The Left Primary Bronchus has the same setup as
the right with the lobar, segmental bronchi and the bronchioles. The lungs are attached to the heart and trachea through
structures that are called the roots of the lungs. The roots of the lungs are the bronchi, pulmonary vessels, bronchial vessels,
lymphatic vessels, and nerves. These structures enter and leave at the hilus of the lung which is "the depression in the medial
surface of a lung that forms the opening through which the bronchus, blood vessels, and nerves pass" (medlineplus.gov). There
are a number of terminal bronchioles connected to respiratory bronchioles which then advance into the alveolar ducts that then
become alveolar sacs. Each bronchiole terminates in an elongated space enclosed by many air sacs called alveoli which are
surrounded by blood capillaries. Present there as well, are Alveolar Macrophages, they ingest any microbes that reach the
alveoli. The Pulmonary Alveoli are microscopic, which means they can only be seen through a microscope, membranous air sacs
within the lungs. They are units of respiration and the site of gas exchange between the respiratory and circulatory systems

Respiratory zone
Respiration begins when the terminal bronchioles lead into the respiratory bronchioles. These bronchioles are covered with thinskinned air sacs that allow for gases to pass through them. These sacs, which contain alveoli, are called alveolar sacs, and are at
the end of alveolar ducts. The alveoli are very small curves in the sac walls. The lung has millions of alveoli, which gives your
lungs an incredible surface area for gas exchange. The alveoli are covered in interlinking capillaries through which blood flows.
The alveoli and the capillary walls form the respiratory membrane. Your lungs rely simply on diffusion to exchange the gases,
and that moves enough gas to have a steady supply of oxygen in your body. For maximum efficiency, the amount of blood
passing through a capillary on an alveoli and the amount of gas exchange should match precisely. When there is not enough gas
in those alveoli, certain pulmonary vessels tighten, slowing the flow of blood, which causes more blood to flow elsewhere. When
there is a lot of gas exchange happening, those vessels widen, allowing more blood to pass through. A similar process happens
to bronchioles. When alveoli have lots of carbon dioxide in it, the bronchioles that connect it to the outside air widen, allowing it
to leave more quickly. The bronchial arteries, which branch from the aorta, supply the lungs with oxygen, and the bronchial and
pulmonary veins take old blood away.
Respiratory physiology
The major function of the respiratory system is to supply the body with oxygen and to dispose carbon dioxide. To do this,
respiration must occur:

Pulmonary ventilation- air must move in and out of the lungs so that gases in the alveoli of the lungs are continuously
changed and refreshed. This process is called breathing.
External respiration- gas exchange between the blood and alveoli must take place.
Respiratory gas transport- oxygen and carbon dioxide must be transported to and from the lungs and tissue cells of the
body via the bloodstream.
Internal respiration- at the systemic capillaries, gas exchanges must be made between the blood and tissue cells.

Mechanics of breathing
The action of breathing in and out is due to changes of pressure within the thorax, in comparison with the outside. This
action is also known as external respiration. When we inhale the, intercostal muscles and diaphragm contract to expand the
chest cavity. The diaphragm flattens and moves downwards and the intercostal muscles move the rib cage upwards and out.
This increase in size decreases the internal air pressure and so air from the outside (at a now higher pressure that inside the
thorax) rushes into the lungs to equalize the pressures. When we exhale the diaphragm and intercostal muscles relax and
return to their resting positions. This reduces the size of the thoracic cavity, thereby increasing the pressure and forcing air
out of the lungs.

Respiratory Volumes and Capacities.

-The resting tidal volume is the amount of air you move into or out of your lungs during a single respiratory cycle under resting
conditions. The resting tidal volume averages about 500 ml.

-The inspiratory reserve volume (IRV) is the amount of air that you can take in over and above the tidal volume. The inspiratory
reserve volume is between 2100 and 3200 ml.

-The expiratory reserve volume (ERV) is the amount of air that you can voluntarily expel after you have completed a normal,
quiet respiratory cycle, is approximately 1200 ml. The residual volume is the amount of air that remains in your lungs
even after a maximal exhalationtypically, about 1200 ml.

-The vital capacity is the maximum amount of air that you can move into or out of your lungs in a single respiratory cycle. The
vital capacity is the sum of the expiratory reserve, the tidal volume, and the inspiratory reserve and averages around 4800 ml.

-The total lung capacity is the total volume of your lungs. The sum of the vital capacity and the residual volume, the total lung
capacity averages around 6000 ml.