Lung Abscess, Shalya Tantra
LUNG ABSCESS
Localised lung infections leading to necrosis of lung tissue, result in the appearance of lung abscess. The infection
causes thrombosis of segmental artery and vein resulting in necrosis.
The commoaest cause of lung abscess is pneumoma secondary to aspiration of gastric contents. The other causes bemg
septic emboli, penetrating injuries, chronic upper respiratory tract infections etc.
Clinical features-
(i) Patient is ill for few days with dry cough and pleural pain
(ii) Once the abscess ruptures into bronchus, patient complains of expectoration of large quantity of sputum which is Offensive, containing pus and blood.
Management-
Majority of lung abscesses canbe managed by medicines. The main methodologies involved are
(i) Intense antibiotic therapy
(ii) Adequate drainage of abscess cavity through postural means
Culture and sensitivity test of the sputum indicates the appropriate antibiotic to be prescribed. The prescribed antibiotic
should be administered in a dose, double the normal dose, for a period of atleast 3 weeks.
Postural drainage is done for 2 hours, 3 times daily. Appropriately, bronchodialotors are used to promote drainage of pus.
Surgical management
Surgery is considered only when the abscess fails to respond t0"medical management. It is mainly of two types
(a) pneumonotomy, or drainage of abscess
(b) pulmonary resection
(a) Pneumonotomy- This procedure is not indicated much in recent times because of the availability of higher antibiotics. In this procedure, direct drainage of abscess through the chest wall is done (after resecting a short segment of the overlying rib). Healing of the track through the chest wall takes several months. .
(b) Pulmonary resection - when lung abscess becomes chronic, associated with cavity in the lung, lobectomy is the indicated procédure. During surgery adequate care is necessary to prevent the spread of abscess to the adjacent lobes or to the opposite lung.
Localised lung infections leading to necrosis of lung tissue, result in the appearance of lung abscess. The infection
causes thrombosis of segmental artery and vein resulting in necrosis.
The commoaest cause of lung abscess is pneumoma secondary to aspiration of gastric contents. The other causes bemg
septic emboli, penetrating injuries, chronic upper respiratory tract infections etc.
Clinical features-
(i) Patient is ill for few days with dry cough and pleural pain
(ii) Once the abscess ruptures into bronchus, patient complains of expectoration of large quantity of sputum which is Offensive, containing pus and blood.
Management-
Majority of lung abscesses canbe managed by medicines. The main methodologies involved are
(i) Intense antibiotic therapy
(ii) Adequate drainage of abscess cavity through postural means
Culture and sensitivity test of the sputum indicates the appropriate antibiotic to be prescribed. The prescribed antibiotic
should be administered in a dose, double the normal dose, for a period of atleast 3 weeks.
Postural drainage is done for 2 hours, 3 times daily. Appropriately, bronchodialotors are used to promote drainage of pus.
Surgical management
Surgery is considered only when the abscess fails to respond t0"medical management. It is mainly of two types
(a) pneumonotomy, or drainage of abscess
(b) pulmonary resection
(a) Pneumonotomy- This procedure is not indicated much in recent times because of the availability of higher antibiotics. In this procedure, direct drainage of abscess through the chest wall is done (after resecting a short segment of the overlying rib). Healing of the track through the chest wall takes several months. .
(b) Pulmonary resection - when lung abscess becomes chronic, associated with cavity in the lung, lobectomy is the indicated procédure. During surgery adequate care is necessary to prevent the spread of abscess to the adjacent lobes or to the opposite lung.
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