Pneumonia | Pathophysiology

[Music] what's up ninja nerds today we're going to talk about pneumonia so let's go ahead and get started all right ninja so let's go ahead and get started with the pathophysiology of pneumonia well first off what is pneumonia if i were to ask you just a general definition of pneumonia what would you say it is pneumonia is just the infection and inflammation of the lung parenchyma the lung tissue itself now the question is how do we acquire this infection in this inflammation of the lung tissue there's two main ways we'll talk about a semi third way but the first one that i want you to remember is going to be inhalation so inhalation of some foreign pathogen okay you'll see that whenever we talk about these the most common pathogen that's causing pneumonia is going to be bacterial 75 to 80 percent of the the actual infections another situation besides inhalation is going to be aspiration so another one we'll talk about is called aspiration now aspiration all of us at some point time of our life have experienced this where food or fluids has gone down the wrong pipe if you will and whenever that happens generally what should happen is we should have some defense mechanisms that our pulmonary system provides us one is you immediately should cough and that coughing is designed to be able to work that actual food or fluids back up to spit it out or swallow it instead of it going down to the respiratory system right now there is situations where aspiration however can become more common and we'll talk about what are those situations where people can develop aspiration pneumonia particularly of anaerobic bacterial etiology and we'll talk about that another one we'll talk about it's not as common but it can be common in iv drug users it is staph aureus so hematogenous spread is another one it's not that common but it can be in those who are iv drug users particularly the bacteria staphylococcus aureus again we'll get into that a little bit more later but these are the two ways now again i already mentioned that we have some defense mechanisms to prevent us because we normally are going to inhale pathogens we're normally sometimes going to experience aspiration that aspiration just can also be due to like regurgitation so sometimes if people have some underlying uh swallowing issue like a zinger's diverticulum or ecclesia where they're more prone to having regurgitations that can also increase the risk of aspiration as well but normally we have defense mechanisms what are those i want you to remember these okay the first one i want you to realize is you have these things the cilia they're little cytoplasmic extensions that help to be able to beat mucus and large bacteria upwards so that we can either spit it out or swallow it right preferably you'd probably want to spit it out but again that's going to be these things right here and but the tissue which contains the cilia which are commonly within the respiratory system i'm going to abbreviate it here for you it's pseudo stratified ciliated columnar epithelial tissue pcce pseudostratified ciliated columnar epithelial tissue again that's one big defense is this cilia the second defense is we already talked about it what should happen if food or fluids go down through your respiratory tract undesirably you should have a cough reflex so there should be another situation where you'll have a cough reflex so one should be the pseudostratified ciliated columnar epithelial tissue beating up the large bacteria mucus upwards and the food if there is some type of food or fluids coming and the second thing is it's going to be the cough reflex another thing is lining the mucosa of our respiratory tract our gi tract a lot of our even our genital urinary tract is these little suckers here called antibodies so you do have these little antibodies here and these are called your i g a antibodies these are part of your mucosal immunity so these are also little antibodies that are within the mucosa of this epithelial system within the respiratory tract that also can bind on to their certain types of foreign bacteria or pathogens and trigger the immune system right so that's the third thing so a third thing would be your iga antibodies so we got pseudostratified ciliated columnar epithelial tissue we got our cough reflex we got our ig antibodies what's the fourth one the fourth situation here that is a part of our normal pulmonary defenses is going to be our macrophages and these are specific now macrophages you have fixed macrophages and then you have other macrophages which can be kind of all around the different tissues this is an example of a permanent or resident or fixed macrophage they're called alveolar macrophages this is our fourth defense system okay and these are really important for being able to phagocytose engulf foreign matter and then in response to that secrete cytokines that pull in other immune system cells via chemotaxis to come and digest or break down those actual bacteria as well as trigger the inflammatory response so in this situation if for some reason someone has a defect in their pseudostratified ciliated columnar epithelius you know you know what another name for this is they also give this another name they call it the muco ciliary escalator and the mucociliary escalator designed again to be able to beat the bacteria form pathogens mucus up towards the mouth to be able to spit it out or swallow it if there's some type of defect with the mucociliary escalator for example people who smoke people who smoke there's going to be more damage to these cilia are they going to be able to beat the bacteria and other substances up no that means that more bacteria are going to be able to colonize in this area that's not good because whenever they colonize they can start leading to tissue damage inflammation infection another situation cough reflex normally this should be activated whenever there's remember there's irritant receptors within our actual bronchi and whenever they're activated they send efferent fibers via the vagus nerve to your respiratory center in the medulla activate the efferent fibers of the vagus nerve which then i'm sorry efferent fibers of your intercostal nerves and your phrenic nerve to trigger the cough reflex to be able to spit that stuff up but what if someone is taking opioid analgesics right hydrocodone fentanyl morphine things like that that's going to actually inhibit the cough reflex what if they're taking antitussives right so anti-cough medicines that's also going to inhibit the cough reflex even alcohol other sedatives damage to the brain stem those are all things that can make them less able to trigger that cough reflex and spit that bacteria out and the other thing is macrophages macrophages they can be damaged by smoking as well and even by excessive alcohol consumption so for any reason whether it be due to the defect in any of these normal mechanisms here that can lead to a colonization of bacteria or if there's a really nasty bacteria sometimes it doesn't even matter if you have all these things sometimes the bacteria is just so hardy and so dangerous that it can still produce tissue damage and lead to pneumonia so again we're going to talk mate we're going to talk about a bunch of causes bacterial viral and fungal but i want you to remember the most common one is bacterial so let's pretend here for a second that we have a bacteria okay so here we're going to have our bacteria and here's these little evil guy right he's ready to produce some tissue damage so what is he going to do well these bacteria you know that they can release a bunch of different types of toxins right so they can release different types of endotoxins and these endotoxins can start producing tissue damage right so you're going to start damaging these tissues when these tissues are damaged what are some of the chemicals that are being released in response to tissue damage well some of the big ones is going to be your leukotrienes one that i really want you to remember is really important here is going to be your leukotriene b4 leukotriene b4 is a really important one the reason why is it moves into the circulatory system and acts as a chemotactic agent in other words it's a chemical that draws white blood cells and other different immune system structures into this area where the infection or inflammation is occurring that's important another thing is bacteria also have particular amino acids that we don't have specifically we have methionine they have what's called informal methionine so sometimes this informal methionine can actually get into the circulation and again that can cause chemotaxis but here's where it really gets bad remember there's all this tissue damage in response to the tissue damage you're going to have some other different leukotrains and prostaglandins so you're going to have some other leukotrienes one is going to be your leukotriene c4 your leukotriene d4 and your leukotriene e4 and what these are going to do is they're going to start binding on to these different endothelial cells here and it's going to increase the capillary permeability now what does that mean so let's say that i actually caused these spaces i'm going to start increasing the spaces here when i increase the spaces i'm going to allow for more fluid to start leaking out and as fluid starts leaking out we start experiencing this edema this inflammation another thing that starts happening besides the increase in the vascular permeability is whenever there's tissue damage it activates mast cells mast cells produce a really important chemical that chemical is called histamines histamines will actually act on these blood vessels and cause them to dilate not only will it cause them to dilate but it'll also increase the vascular permeability so now you have more vascular permeability you have more blood flow coming to this area why do you want it to be so permeable why do you want there to be so much blood flow coming to the area well there's an infection i want to bring my white blood cells my complement proteins all these different structures to the area to fight off that bacteria that's a good thing but at the same time it's also going to start causing what we know as pneumonia another thing that happens here is is besides having a lot of this edema due to the vascular permeability and besides the vasodilation is leukotriene c4 d4 and e4 also bind on the respiratory smooth muscle what do you think it's going to do to the respiratory smooth muscle it's going to cause it to constrict so at the same time this leukotriene c4 d4e4 is going to cause bronchospasming that's going to cause some of the symptoms that we'll see like dyspnea shortness of breath here's the next thing with macrophages they encounter these bacteria right so the bacteria has started to produce damage this this inflammatory response the macrophages come here and they try to interact with it engulf it when they do they release more chemicals that just continue to increase this whole inflammatory cascade what are some of those chemicals interleukin-1 tumor necrotic factor alpha and these are really important the reason why is these again help to increase vascular permeability but they also induce what's called pyrexia fever that's why sometimes when people have pneumonia one of the signs is they're going to have a fever other chemicals at the release not super super important but they can release more chemotactic factors again some of those chemotactic factors that they can release is like interleukin-8 so it can release other chemicals here like interleukin 8. and interleukin-8 can also act as a chemotactic agent so let's sum up what we have here so far that's caused all of this inflammation and edema and stuff like that again bacteria colonized due to maybe these systems these pulmonary defense mechanisms not working or the bacteria is just so hardy and so dangerous that it didn't even matter that these defense mechanisms were here he comes to the area produces endotoxins that cause tissue damage overall even if you don't want to remember all of these different chemicals just remember what's the overall effect they're going to start releasing inflammatory mediators of inflammation histamines leucochenes prostaglandins platelet activating factor what are those going to do big thing cause the vessels to dilate and increase the permeability so fluid starts leaking out that's going to start allowing for more white blood cells more complement proteins more inflammatory structures to come to the area to fight off the bacteria next thing macrophages start trying to come and fight with the bacteria whenever they do and they engulf it they start releasing cytokines to let more white blood cells to come to the area what are some of those cytokines interleukin-1 tumor necrotic factor alpha and what is the important thing i want you to remember that it can cause pyrexia okay now after all of this inflammation happens this is a stage within the pneumonia that we start to experience because what are we going to start having in this area if i were to draw like a little mini thing here another mini alveoli so imagine here i have another mini alveoli okay and then here i'm going to have my capillary right and just to sum up some of this stuff here what do we have happening well the first thing was vasodilation that's going to start causing a lot of fluid to leak here into the alveoli this is the first part that we start to experience within day one day two of the infection of pneumonia this stage here this first stage is called congestion so this is the first stage this is usually around days one and two okay but this is again due to all this inflammation vascular permeability vasodilation second thing sometimes what can happen is is as this inflammation starts occurring remember we said macrophages will start releasing chemotactic factors so will these other chemotactic factors cause white blood cells to come to the area now there's going to be fluid which is going to be an exudative fluid meaning it has a high specific gravity meaning it has a lot of proteins in it now you're going to have white blood cells and if the pulmonary capillaries become damaged so much guess what else can start leaking into the area red blood cells so then you're going to start experiencing what's called red hepatization so we call this red hepatization and this usually appears around days to days three to four so this is usually around days three to four and again what is this remember we have the alveolar exudate so here's this blue is going to be the protein and the water and all the different plasma components okay that's congestion days three to four you're gonna start having what other things you're going to have white blood cells and red blood cells if the pulmonary capillaries start becoming damaged and something else that might even accumulate in the area is fibrin so then you can have some fibrin this whole thing right here is the red hepatization and this has another term that we're going to talk about and this is called consolidation this is the classical sign consolidation this is a classical thing with pneumonia it's all this alveolar exudate white blood cells red blood cells fibrin now this is days three to four what happens is usually around days four about day seven is you experience this thing called gray hepatization so let's write this here gray hepatization what this is is your red blood cells start getting destroyed and as the red blood cells start getting destroyed they start taking on a different appearance this gray appearance and again this is usually going to be days four to seven okay so we start having alveolar exudate red hepatization and then gray hepatization which is the breakdown of the red blood cells now what should happen is generally the fourth stage the fourth stage of this consolidation which is this is classical of what's called low bar demonia and we'll talk about what that means but that's one of the most common ammonias that you will be exposed to is low bar pneumonia which is classically seen with consolidation what happens is the fourth step is it should lead to resolution let's do that one here in purple so resolution so what that means is this is usually from days eight and up so days eight plus okay what you start to experience here is there's going to be a breakdown of all of this gray hepatization there's going to be a breakdown of more of the red blood cells the white blood cells the fibrin all of that stuff we're going to start trying to clear that out now some of it will get broken down completely but some of it will actually get coughed up now that's important the reason why that's important is if someone does experiencing low bar pneumonia with consolidation when you have this resolution this breakdown of all of that structures there this consolidated material you're going to have a sputum a cough that's actually more what's called productive cough so you're going to see that sputum production and that is another important sign of pneumonia so we've already been able to isolate a couple symptoms that we can already notice with pneumonia dyspnea and shortness of breath due to that bronchoconstriction fever due to the tumor necrotic factor alpha and interleukin-1 you're also going to have a lot of inflammatory exudate there and then inflammatory exit is going to produce consolidation which is also going to cause this can lead to hypoxia if really really bad and if it resolves you're going to start having that sputum that we'll experience with the cough and we'll talk about some other things that you'll see here because with consolidation just remember what can happen this alveolar is it properly ventilated no go back to physiology what does ventilation go with perfusion your vq ratio which is normally approximately 0.8 right now if your ventilation is decreasing this number is going to decrease so what do we have to do to the perfusion well now if this is decreasing this number is going to go down i want the number to go back up so i have to have my perfusion drop so guess what happens not only do i have poor ventilation but i'm going to try to constrict the capillaries they're going to this poorly ventilated area to prevent them from going to this area where there's no proper ventilation send them to some other area of the lungs where there is proper ventilation so that we can get a good perfusion there okay so that's important but again because of this they'll experience hypoxia and hypoxia can actually induce tachycardia and tachypnea so those would be some other signs that we'll see as well okay so that covers the path uh the pathophysiology we're gonna move into the causes now all right so now causes of pneumonia we know that pneumonia we've already said that it's most commonly caused by bacterial infection how much of them usually 75 to 80 of pneumonias are usually bacterial in origin there's viruses in fungi we'll put a little tidbit on there about those but it's really going to be bacteria so what are some of these bacteria that we are going to come across specifically well one of the big ones that i want you guys to remember is strep pneumo okay strep pneumo is a really really important one the reason why is 65 percent 65 percent of community acquired pneumonias are due to this strep pneumo it's a gram positive bacteria okay gram positive the next one is going to be hemophilus influenza we're going to denote that as h flu okay h flu hemophilus influenza is a gram-negative bacteria now what's important about this guy he is the second most common cause of community acquired pneumonia and we'll talk about what community acquired and hospital acquired healthcare associated and ventilator required all of those are but this is most commonly from community acquire now why do uh this is important because this is common in those with underlying pulmonary diseases copd asthma bronchiectasis cystic fibrosis okay so that's important to remember that you can see h fluid usually some underlying pulmonary pathology another one that we're going to come across is going to be mycoplasma so mycoplasma pneumonia mycoplasma pneumonia is interesting because it's not even really a it's not a gram negative it's not gram-positive bacteria because it doesn't actually have a cell wall one of the big things about mycoplasma pneumonia is it actually occurs in people who are of college school age so it's usually in younger individuals now this is a type of atypical pneumonia and it's the most common cause of the atypical pneumonias now with this mycoplasma pneumonia they also call it walking pneumonia you'll see other symptoms that come up that are pretty helpful in your diagnostic sense so sometimes what you'll see is they can produce these things called bula or bullis meringitis abula is just kind of it's a skin lesion it's a circumscribed deposit of serous fluid and it actually comes on the tympanic membrane and there's also some inflammation of the tympanic membrane that's one situation another thing is they also show some signs of pharyngitis too so that's important usually people have school age high school college and they can show signs of some e and t situations like bullish meningitis and pharyngitis another situation and this is an intracellular parasite so we have to be careful with this one we have another one called chlamydia okay so there's another one which is called chlamydia and this one can actually cause it chlamydial pneumonia another one is called lesionella now lesionella is a gram-negative bacteria this one is interesting this is the one that you can actually develop it's not from person-to-person transmission it's actually through contaminated water sources for example cooling towers um air conditioners these are some things where it's more common you can develop these infections now here's another thing with the legionella it presents with other things that usually show up like gi symptoms nausea some vomiting they also can show things like increased liver function enzymes alt ast those enzymes alk foss and they can show signs of hyponatremia decrease sodium levels within the blood and that's important all right so lesionella what are some other ones another important one is called staph aureus now this is a really really nasty bacteria particularly if it is methicillin resistant so mrsa this one you can get it's actually common post-viral infections so post-viral upper respiratory tract infections and remember i told you a little bit that it can be through hematogenous spread and those individuals who are iv drug users so that's another situation that you want to remember it can even be in those who are immunocompromised or elderly okay so that's staph aureus another one that's important is called klebsiella this one is kind of like one of the interesting ones klebsiella is common in individuals who are chronic alcoholics so people who are chronic alcoholics have an increased susceptibility of developing pneumonia due to klebsiella another thing is it can also be common in people who are aspirators who have some condition that make them more susceptible or prone to aspirating remember aspiration pneumonia and this one is also seen as some certain chronic illnesses that again put them into an increased susceptibility of developing pneumonia some other ones is going to be a pseudomonas so this is a really really important one i want you guys to please don't forget about this one it's called pseudomonas originosa this one is seen in individuals who are immunocompromised so hiv aids or they also they have some type of structural abnormality of the respiratory system cystic fibrosis or bronchiectasis so again that's another important one to not forget okay so these these are some of the big big bacteria that i don't want you guys to forget about okay now what are some other causes it's not just bacterial but you also have viral so what are some viral causes here there's not many viruses we'll throw these puppies right here so viral what are some viral causes what one is called you might have actually heard of it's called respiratory syncytial virus rsv or the para influenza virus so one situation could be r s v respiratory and systeovirus are the para influenza virus this is more common um within infants and in young children there's another one which is called your influenza your influenza virus this one is another one but it's more common in adults and here's the really interesting one this one is called cmv cytomegalovirus cytomegalovirus can also cause pneumonia but it's particularly in people who are like status post transplants so they've had an organ transplant or they're immunocompromised like aids there is another one we can put it in there it's really severe in adults it can cause some pretty nasty pneumonia this is called varicella zoster okay so that's our viral causes now the next one is fungal so fungal is an interesting one fungal ones are a little bit more common in certain areas of the of the us or other of the world but they're also common in those who are immunocompromised one of the really really common ones and those who are immunocompromised particularly those with neutropenic fevers or hiv aids or immunosuppressive disease or taking immunosuppressive drugs this is called i'm not it's called pneumocystic girovisi but they also call it pneumocystic pneumonia pcp not the drug okay pneumocystic pneumonia are pneumocystic giravici common in those who are actually immunocompromised that's a really important one another one is called histoplasmosis capsulatum histoplasmosis histoplasmosis this is a beautiful color histoplasmosis is actually seen in the mississippi river valleys or in the ohio river rallies where there's a lot of bird and bat droppings so there's increased chances of developing a fungal infection particularly with pneumonia okay another one is called coccioides coccioides is particularly within the soil like in the southwestern united states or in california so in desert areas there's an increased chance of developing infections via these but again the one i want you to remember here which is the most important the most common cause is bacteria please don't forget this this is the most common cause another nice thing is viral generally we don't have to treat these they usually take their own course over a period of a couple weeks fungal we usually treat with the antibiotics as well as some type of antifungal as well but we're going to mainly focus on bacterial okay so we have our causes now what we're going to do is we're going to move into the clinical settings okay so when we talk about pneumonia we can kind of categorize them about how they were acquired if you will so what do i mean here one of the big ones that we see a lot is called community acquired pneumonia and this is abbreviated c a p all right so that's what we'll see community acquired pneumonia now community acquired pneumonia it's simple it's pneumonia that was acquired while in the community but we got to be careful so it is a pneumonia so acquired in community but we have to throw this little tidbit in there or in hospital less than two days or 48 hours so we can also say that they can have community acquired pneumonia if they've been admitted into the hospital but they've had to be in the hospital less than two days okay so that's what we'll talk about with community acquired pneumonia so community acquired pneumonia is pneumonia that can be acquired from the community or when you're admitted into the hospital it has to be less than 48 hours or two days now community acquired pneumonia there is some particular bacteria that are more common with this okay so what are some of those let's use this pretty color here so some of the big ones the most common the most common uh bacteria here is going to be your strep pneumo so your strep pneumo don't forget that one okay your haemophilus influenza your mycoplasma pneumonia your chlamydia so chlamydia is another one another one which is called lesionella and here's the last one that i want to mention and i didn't mention it up here but it can happen it's called marexella catarralis and it's particularly common in those who have some underlying pulmonary disease most commonly copd so again another one that you can see here is called merexella catarralis and you can see klebsiella here as well but i'm not going to include that one here it's more common in hospital but again just to be aware you can see it in community acquired as well all right so this is the ones that i want to remember community acquired pneumonia specifically these are the common bacteria that you'll see with it now the next one is you have what's called hospital acquired pneumonia let's do this one in this color here i like this one too so hospital acquired pneumonia we'll abbreviate this h a p now hospital acquired pneumonia it's simple acquired within the hospital but how long does it have to be how how long have they had to be admitted into the hospital greater than two days so it's simple right so hospital acquired pneumonia was acquired from hospital after being admitted greater than two days in the hospital so you've had to be in the hospital greater than two days in order to be able to say that it's hospital acquired pneumonia now hospital acquired pneumonia here's the thing with this bad boy this one gives some really nasty bacteria the reason why is when you're in a hospital you have to think about it people are really sick and so they're going to have some really nasty pathogens that they can pass on this what's called virulence or even resistance that's what you've got to be careful of so specifically i want you to remember this with hospital acquired pneumonia they can develop these things called multi-drug resistant pathogenic bacteria and this is what's really dangerous about hospital acquired pneumonia that's why staying in the hospital for a long time or having some healthcare associated procedures or ventilators acquired pneumonia these things are all really bad because there's a chance of developing some multi-drug resistant pathogenic bacteria what that means resistance in the simplest way is they develop enzymes like beta-lactamases that are produced to break down the betalactams which is your penicillins your cephalosporins your carbapenems your monobactums and render them ineffective which how is that going to benefit you trying to be able to treat the underlying cause which is the bacteria now what are some of the bacteria that you see here with hospital acquired pneumonia so the ones that i want you to remember here is going to be your uh specifically staph aureus but here let's actually make it more specific because with staph aureus you can even see staph aureus and community acquired pneumonia but it ha it's not mrsa it's methicillin sensitive so they're not resistant and community acquired in hospital acquired they're usually resistant so mrsa is one remember the other one i told you pseudomonas so pseudomonas originosa another one klebsiella another one is going to be your enterobacteria your actino bacteria and some other ones which are going to be like serratia serratia is another pretty nasty bacteria that is also uh seen here as well but again the main ones i want you to remember is mrsa and pseudomonas these are the really really nasty ones and if you want to remember some extra ones klebsiella and pterobacteria actinobacteria and even some serratia two other types of pneumonia i'm just going to list them here we're not going to talk too much about them because they're kind of like subtypes one of them is called ventilator acquired pneumonia and ventilator and aquarium you can put vap and all it is is this it happens when someone has been intubated so endotracheal tube intubation for greater than 48 to 72 hours they have an increased incidence of developing pneumonia because they can form these biofilms which are pretty nasty stuff another one which is kind of a sub type of community-acquired pneumonia is called healthcare associated pneumonia now i'm going to put h cap for this one briefly talk about this one h-cap is common in those who are a resident of a long-term care facility like a nursing home or they receive home infusion therapy or they get chronic dialysis treatment and particularly within the last 30 days if they're coming into to be seen they have some family member with a multi-drug resistant pathogen who is at high risk or they've had some particularly they've been in an acute care facility for two or more days within the past 90 days these are all things that increase the risk factor for healthcare associated pneumonia okay so again big ones i want you to remember the more important ones community acquired pneumonia hospital acquired pneumonia acquired in the community or being in the hospital admitted into the hospital but has to be less than two days here's the bacteria that are most commonly seen with it hospital acquired pneumonia usually whenever the patient is admitted into the hospital and they've been in the hospital for greater than two days or they've developed a multi-drug resistant pathogen they don't have to develop a multi-drug resistant pathogen but it is seen especially when they're in the hospital greater than five days and then there's the two other subtypes here which is ventilator required pneumonia which can be after endotracheal tube intubation 40 to 72 hours or healthcare associated pneumonia and we've already talked about all those in detail okay all right so what we're going to do is we're going to talk about the two different types of presentations or symptoms that can be seen with someone with typical and atypical pneumonia now we've already talked a lot about the typical things that we'll see here so what what have we said we said that remember there's going to be a lot of that consolidation that consolidation which is the accumulation of alveolar exiting red blood cells and fibrin and white blood cells and all that stuff there that it can lead to dyspnea which can lead to hypoxia hypoxia can increase your heart rate and increase your respiratory rate so what are some of the things that you'll see upon initial inspection of the patient or you're getting their vital signs you'll tachycardia so you'll see an increase in their heart rate you'll see tachypnea increase in the respiration rate now a little bit on that just remember that all it is is whenever there is hypoxia or this consolidation co2 levels build up in the blood it stimulates your central and peripheral chemoreceptors what do those do that activates your respiratory center in the medulla and increases the rate and depth of the breathing that's where you get the tachypnea but there's other another interesting reflex that whenever the chemoreceptors are stimulated not only do they activate the medullary respiratory centers but they activate the cardiac excellatory center which then increases your heart rate so those are things that you'll see we said pyrexia or fever we'll see that remember whenever there's complete resolution of the consolidation we can see some productive mucopurulent sputum so we'll see a cough with muco purulent sputum production and there's something we can talk about with cytology we'll talk about in the diagnostic workups but the next thing that you can experience here is besides that you're also going to notice that they'll have some other extrapulmonary symptoms fatigue because of the hypoxia so they'll have fatigue and another thing that you'll they'll see is distance so they'll have shortness of breath so they'll have shortness of breath these are going to be some of the main things that you're going to see with a patient who is having typical presentation of pneumonia what i mean by typical bacterial in origin all of these bacteria that we've already mentioned the other one let's do this color here you're atypical this is going to be more for those special bacteria that we talked about remember the mycoplasma the chlamydia the lesionella viruses fungi all of those are atypical they don't generally present with any increase in uh respiratory rate or heart rate they generally present with extrapulmonary symptoms so what do i mean they present with like a headache some nausea maybe vomiting maybe diarrhea another thing that they do is they actually present with a significant fatigue and malaise so they can present with fatigue malaise and a lot of muscle pain so myalgia okay now they can have a fever but their fever is usually very low grade so they can exhibit a fever but the fever is usually a very low grade fever so low grade pyrexia and here's another big one remember this one was a cough with a sputum production it was a productive cough usually those with atypical pneumonia it's a dry cough so it's mainly a dry cough okay so these are some of the there's many other symptoms that we can see but these are the most common ones that you're probably going to see whenever you're seeing a patient with typical or atypical pneumonia okay all right ninja so in this video we've talked about the pathophysiology of pneumonia we've talked about the causes we've talked about the clinical settings we even went into the signs and symptoms what we're going to do in the next video is we're actually going to go over the diagnostic workup so specifically we're going to have a patient that we're going to try to replicate what you would see upon inspection and palpation and percussion and auscultation we'll have some chest x-rays that we're going to look at and see if we can point out those abnormalities and then we'll come back to the board and we'll talk about other signs that we could see in the diagnostic workup we'll talk about blood tests and urinalysis and things of that nature but i want to say thank you guys for watching this video if you guys could please go visit our gofundme page we'll have it in the description box if you guys could donate whatever amount you can we would truly appreciate it everything that goes from that gofundme page is directly funneled into getting us better equipment helping us to pay for editing software and all the things that we need to provide these free videos for you guys enjoyment also check out our patreon if you guys could donate there we would truly appreciate it check out our facebook our instagram account we just want to make sure that we're in constant communication with you guys and letting you guys know what's happening and what we're going to be doing next and as always ninja nerds until next time [Music] you

Channel: Ninja Nerd

Views: 367,822

Keywords: Ninja Nerd Lectures, Ninja Nerd, Ninja Nerd Science, education, whiteboard lectures, medicine, science, pneumonia, pathophysiology of pneumonia, health, nursing, bacterial pneumonia, pneumonia pathophysiology, pathophysiology, bacteria, respiratory system, pneumonia symptoms, alveolus, pneumonia nursing, pathology, lung infection, Disease Or Medical Condition

Id: -HkPEi5qYzk

Length: 42min 11sec (2531 seconds)

Published: Tue Jan 05 2021