老年病学英文课件：CAP in the elderly
相关主题
- 1、下载文档前请自行甄别文档内容的完整性，平台不提供额外的编辑、内容补充、找答案等附加服务。
- 2、"仅部分预览"的文档,不可在线预览部分如存在完整性等问题,可反馈申请退款(可完整预览的文档不适用该条件!)。
- 3、如文档侵犯您的权益，请联系客服反馈,我们会尽快为您处理(人工客服工作时间：9:00-18:30)。
change
Diangnosis basis(cont)
Any one of those 1st~4th above，add 5th，and exclude diagnosis of TB ,cancer, pneumonedema, atelectasis etc ,then can establish the clinical diagnosis
– CT scan, especially high resolution CT (HRCT), is more sensitive than plain films for the evaluation of interstitial disease, bilateral disease, cavitation and empyema
nonbacterial pneumonia on the basis of the radiographic appearance – If performed early in the course of the disease, may be negative
•Despite clinical signs of right upper zone consolidation, chest x-ray showed only minor abnormalities
Diagnosis: Radiography
• CXR Βιβλιοθήκη BaiduPA and Lateral):
– American Thoracic Society (ATS) guidelines, “all patients with suspected CAP should have a chest radiograph to establish the diagnosis and identify complications (pleural effusions, multilobar disease)”
•Empirical therapy for community-acquired pneumonia was begun，47-yearold smoker presented after just a few hours of rigors and productive cough
• 12 hours later • Chest x-ray showed consolidation in the right upper lobe consistent with the
CAP in the elderly
Definition
CAP refers to pneumonia acquired outside of hospitals or extended-care facilities . an acute infection of the parenchyma or mesenchyma of the lung
– Thus, a chest radiograph is the preferred method for initial imaging, with CT scan or MRI reserved for further anatomical definition
– Lobar consolidation – more common in typical pneumonia – Bilateral, diffuse infiltrates – commonly seen in atypical pneumonia • However, radiologists cannot reliably differentiate bacterial from
earlier clinical signs • S. pneumoniae was isolated from blood cultures • The patient recovered fully
Diagnosis: Radiography (cont.)
• CT
– CT scan could be performed in patients with a negative chest radiograph when there is a high clinical suspicion for pneumonia
Age ≥ 60yrs
clinical features
1.atypical symptoms and signs，delay diagnosis and treatment
2.severe infection↑complication ↑ Mortality↑ 3.longer course of disease, recover slower 4.various kinds of chronic disease, immunity↓，
Diangnosis basis
①acute respiratory symptoms，Cough, purulent sputum， dyspnea and chest pain
② fever, chills ③ signs，consolidation ，moist rales ④ peripheral white blood cells>10×109/L or < 4×109/L， ⑤ chest X-ray：infiltrates or interstitial inflammation
effect of anti-infection ↓
pathogene
common：streptococcus pneumoniae， gramnegative bacillus ， haemophilus influenzae
atypical pathogen（ mycoplasma etc） staphylococcus aureus anaerobic infections（ aspiration pneumonia） Fungus，virus
Diangnosis basis(cont)
Any one of those 1st~4th above，add 5th，and exclude diagnosis of TB ,cancer, pneumonedema, atelectasis etc ,then can establish the clinical diagnosis
– CT scan, especially high resolution CT (HRCT), is more sensitive than plain films for the evaluation of interstitial disease, bilateral disease, cavitation and empyema
nonbacterial pneumonia on the basis of the radiographic appearance – If performed early in the course of the disease, may be negative
•Despite clinical signs of right upper zone consolidation, chest x-ray showed only minor abnormalities
Diagnosis: Radiography
• CXR Βιβλιοθήκη BaiduPA and Lateral):
– American Thoracic Society (ATS) guidelines, “all patients with suspected CAP should have a chest radiograph to establish the diagnosis and identify complications (pleural effusions, multilobar disease)”
•Empirical therapy for community-acquired pneumonia was begun，47-yearold smoker presented after just a few hours of rigors and productive cough
• 12 hours later • Chest x-ray showed consolidation in the right upper lobe consistent with the
CAP in the elderly
Definition
CAP refers to pneumonia acquired outside of hospitals or extended-care facilities . an acute infection of the parenchyma or mesenchyma of the lung
– Thus, a chest radiograph is the preferred method for initial imaging, with CT scan or MRI reserved for further anatomical definition
– Lobar consolidation – more common in typical pneumonia – Bilateral, diffuse infiltrates – commonly seen in atypical pneumonia • However, radiologists cannot reliably differentiate bacterial from
earlier clinical signs • S. pneumoniae was isolated from blood cultures • The patient recovered fully
Diagnosis: Radiography (cont.)
• CT
– CT scan could be performed in patients with a negative chest radiograph when there is a high clinical suspicion for pneumonia
Age ≥ 60yrs
clinical features
1.atypical symptoms and signs，delay diagnosis and treatment
2.severe infection↑complication ↑ Mortality↑ 3.longer course of disease, recover slower 4.various kinds of chronic disease, immunity↓，
Diangnosis basis
①acute respiratory symptoms，Cough, purulent sputum， dyspnea and chest pain
② fever, chills ③ signs，consolidation ，moist rales ④ peripheral white blood cells>10×109/L or < 4×109/L， ⑤ chest X-ray：infiltrates or interstitial inflammation
effect of anti-infection ↓
pathogene
common：streptococcus pneumoniae， gramnegative bacillus ， haemophilus influenzae
atypical pathogen（ mycoplasma etc） staphylococcus aureus anaerobic infections（ aspiration pneumonia） Fungus，virus