LOBAR PNEUMONIA
DEFINITION:-
Consolidation or solidification of the lung due to inflammation of the lung alveoli is known as pneumonia. Consolidation of one or more lobes of the lung caused by pneumococcus is known as lobar pneumonia or pneumococcal pneumonia. It is the commonest type of pneumonia.
AETIOLOGY:-
- The causative agent is pneumococcus in that commonest being ‘streptococcus pneumoniae’.
- Infection spreads from person to person by droplet infection, overcrowding.
- Sudden exposure to cold is a strong predisposing factor.
- The disease more common during winter months and in condition like nephritis or chronic alcoholism.
- The disease more common in ‘adults’ in the age group of ’15-40 years’.
PATHOLOGY:-
The pneumonic process passes through 3 stages. Stage of hyperaemia, stage of consolidation and the stage of resolution. During the stage of hyperaemia there is exudation of inflammatory exudates (consisting of fibrin, leucocytes and red blood cells)into the lung alveoli. During the subsequent stage of consolidation the exudation get solidified and solidified lung looks like liver. Hence the stage is often called the stage of hepatisation. Initially there is red hepatisation followed by grey heaptisation. During the stage of resolution, jelly like solidified exudates are once again liquefied by the action of macrophages. The liquefied exudates are thereafter either absorbed or coughed out and the normal stage of lung alveoli is restored back. Occasionally, the incomplete resolution may lead to fibrosis or bronchiectatic changes in the affected part of the lung.
SYMPTOMS:-
- The onset is sudden.
- The temperature rises to 103 F or higher, often associated with rigors and vomiting.
- Initially the cough is unproductive and dry, harassing but later, during the stage of resolution, it is associated with expectoration.
- The sputum is thick and tenacious initially but later turns rusty in colour .the sputum maybe tinged with frank blood.
- Pain may felt in the shoulder on the affected side or the upper abdomen if the diaphragmatic pleura is involved.
- Dyspnoea, breathing is rapid and shallow due to the associated chest pain.
- Headache, malaise, body ache, anorexia and weakness are other notable symptoms.
- On examination, the patient looks toxic, dyspnoic and often cyanosed.
INVESTIGATIONS:-
- There is marked leucocytosis with increased polymorphonuclear cell count.
- Culture of sputum shows presence of pneumococci.
- X-ray – shows a homogenous opacity confined to the affected lobe or lobes.
COMPLICATIONS:-
1. PULMONARY COMPLICATIONS:-
- Suppurative pneumonia or lung abscess.
- Creeping pneumonia or double pneumonia.
- Pleural effusion or empyema.
- Respiratory failure.
2. CARDIVASCULAR COMPLICATIONS:-
- Peripheral circulatory failure.
- Pericarditis.
- Endocarditis.
- Deep vein thrombosis.
3. GASTROINTESTINAL COMPLICATIONS:-
- Jaundice.
- Meteorism.
- Paralytic ileus.
4. NEUROLOGICAL COMPLICATIONS:-
- Meningism.
- Pneumococcal meningitis.
5. BONES AND JOINTS:-
- Osteomyelitis.
- Suppurative arthritis.
6. MISCELLANEOUS;-
- Septicaemia.
- Oliguria and uraemia.
- Acute suppurative Otitis media and mastoiditis.
TREATMENT:-
- The patient should be confined to bed.
- If dyspnoic, he should kept in a propped up position. Oxygen inhalation is needed if the patient is cyanosed.
- Benzyl penicillin should be injected intra muscularly in every 6 hours. Ampicillin 500 mg IM 6 hours once, erythromycin should be given.
HOMEOPATHIC TREATMENT:-
1. ACONITE:-
Acute, sudden, and violent invasion, with fever, call for it. First remedy for inflammations, inflammatory fevers. Hoarse, dry, croupy cough; loud, labored breathing. Child grasps at throat every time he coughs. Cough, dry, short, hacking; worse at night and after midnight. Cold sweat and icy coldness of face during fever. Thirst and restlessness always present.
2. ANTIMONIUM TARTARICUM:-
Great rattling of mucus, but very little is expectorated. Rapid, short, difficult breathing; seems as if he would suffocate; must sit up. Coughing and gaping consecutively. Bronchial tubes overloaded with mucus. Cough excited by eating, with pain in chest and larynx. Pulse rapid, weak, trembling. Dyspnoea relieved by eructation. Cough and dyspnoea better lying on right side - (opposite Badiaga). Coldness, trembling, and chilliness in fever. Intermittent fever with lethargic condition.
3. ARSENICUM ALBUM:-
For any dryness, when due to some organic trouble, particularly of the heart, or with emphysema, the cough is violent and dry, with shortness of the breath and suffocative spells, worse at night.raipid emaciation and debility, restlessness, anguish and fear of death.
4. BRYONIA ALBA;-
Dry, hacking cough from irritation in upper trachea. Cough, dry, at night; must sit up; worse after eating or drinking, with vomiting, with stitches in chest, and expectoration of rust-colored
sputa. Difficult, quick respiration; worse every movement; caused by stitches in chest. Expectoration brick shade, tough, and falls like lumps of jelly. Coming into warm room excites cough. [Nat. carb.]. Chill with external coldness, dry cough, stitches in fever.
5. CHELIDONIUM:-
Very quick and short inspirations; pain on deep inspiration. Dyspnoea. Short, exhausting cough; sensation of dust not relieved by cough. Whooping-cough; spasmodic cough; loose, rattling; expectoration difficult. Small lumps of mucus fly from mouth when coughing. Constriction of chest.
6. FERRUM PHOS:-
Bronchitis of young children. First stage of all inflammatory affections. Congestions of lungs. Short, painful tickling cough. Hard, dry cough, with sore chest. Expectoration of pure blood in pneumonia. [Millefol.]. Cough better at night. During fever Chill daily at 1 pm. All catarrhal and inflammatory fevers; first stage.
7. IPECAC:-
Dyspnoea; constant constriction in chest. Yearly attacks of difficult shortness of breathing. Cough incessant and violent, with every breath. Chest seems full of phlegm, but does not yield to coughing. Suffocative cough; child becomes stiff, and blue in the face. Bleeding from lungs, with nausea; feeling of constriction; rattling cough. Intermittent fever, irregular cases, after Quinine. Slightest chill with much heat, nausea, vomiting, and dyspnoea in fever.
8. PHOSPHOROUS:-
Cough from tickling in throat; worse, cold air, reading, laughing, talking, from going from warm room into cold air. Sweetish taste while coughing. Hard, dry, tight, racking cough. Congestion of lungs. Pneumonia, with oppression; worse, lying on left side. Sputum rusty, blood-colored, or purulent. Nervous coughs provoked by strong odors, entrance of a stranger; worse in the presence of strangers; worse lying upon left side; in cold room.
9. PULSATILLA:-
Dry cough in evening and at night; must sit up in bed to get relief; and loose cough in the morning, with copious mucus expectoration. Expectoration bland, thick, bitter, greenish. Short breath, anxiety, and palpitation when lying on left side. [Phos.]. Smothering sensation on lying down. Chilliness, even in warm room, without thirst in fever. Chill about 4 pm.
10. TUBERCULINUM:-
Hard, dry cough during sleep. Expectoration thick, easy; profuse bronchorrhoea. Sensation of suffocation, even with plenty of fresh air. Hard, hacking cough, profuse sweating and loss of weight, rales all over chest. Deposits begin in apex of lung. (Repeated doses). Shortness of breath. Post-critical temperature of a remittent type. Here repeat dose every two hours. (Macfarlan).
Some of other drugs are ammonium iod, ammonium mur, antimonium ars, belladonna, iodum and kali carb.
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