METHODICAL INSTRUCTION FOR 6th YEAR STUDENTS
METHODOLOGICAL INSTRUCTION FOR LESSON №15
“PURULENT DISEASES OF LUNG AND PLEURA”
The aim: To be able to diagnose the acute and chronic abscess of lung depending on their localization and complications, to give urgent help to the patients with the acute abscess of lung complicated by the pulmonary bleeding, to diagnose and liquidate complications, indications for conservative and operative treatment, to know the methods of their operative treatment.
Professional orientation of students:
Over the past 40 years, the frequency of lung abscesses has declined in 10 times, whereas the mortality rate among patients decreased only on 5-10 % and consists of 4-7 %. In aspiration of fluid, which contains microflora, the mortality can reach 20 % and more, especially if the reaction of the liquid is acid. Most deaths in lung abscess associated with Pseudomonas aeruginosa, Staphylococcus aureus and Klebsiella pneumoniae.
Late and inappropriate antibiotic therapy, inadequate drainage of the abscess, inadequate use of bracing treatment leads to the formation of chronic abscess and consequently its surgical treatment, with mortality rate more than 5 %.
Complications of suppurative processes of the lungs and pleura are difficult to treat and have a serious prognosis.
Methodology of Practical Class 9.00-12.00.
Algorithm of communicative skills:
To greet and name itself.
Friendly behavour.
To explain to the patient a purpose of the visit, duration of conversation and to get his agreement.
Correct and quiet conversation with a patient.
To get the agreement of patient for the performance of the examination.To take complaints. Correct and quiet conversation with a patient. A patient is in vertical position persons to the doctor, neck and shoulders of patient is maximally weakened.
Student’s independent work program:
Work
A student must give a question on which to the answer.
Work 2. Students independently inspect sick purulent diseases of lung, meet with a medical document, confirm diagnosis and methods of treatment. After it the survey sciagrams of organs of thorax are analysed, differential diagnostics is performed with urgent thoracic pathology.
Work 3. Students independently inspect patients with different types of purulent diseases of lung, meet with the methods of diagnostics, by a medical document, confirm diagnosis and methods of treatment, the survey sciagrams of organs of thorax are analysed, CT, information of clinical methods of examination, differential diagnostics is performed with urgent thoracic pathology.
Individual Students Program.
- Reasons of origin of acute abscess of lung.
- Clinical forms of gangrene of lung.
- Clinical symptoms of acute abscess of lung in a stage “before opening”.
- Clinical symptoms of acute abscess of lung in a stage “after opening”.
- Clinic of chronic abscess of lung.
- Additional methods of examination of patients with the purulent diseases of lung.
- Differential diagnostics of chronic abscess of lung and cancer.
- Differential diagnostics of air cyst and chronic abscess of lung.
- 11. Treatment of gangrenous abscess of lung.
- Treatment of acute abscess of lung. Indication to operative treatment.
- Tactic of treatment of the complicated acute abscess of lung.
Work 4. Students independently examine patients with the purulent diseases of pleura, meet with the methods of diagnostics, by a medical document, confirm diagnosis and methods of treatment, information of the survey sciagrams is analysed, clinical methods of examination, differential diagnostics is performed with urgent thoracic pathology.
Individual Students Program.
- Acute empyema of pleura: Etiology, pathogeny, clinic.
- Clinical signs of the limited empyema pleura: roentgenologic picture.
- Clinic of limited piopneumothorax: roentgenologic signs.
- Reasons of origin and clinic of total piopneumothorax.
- Additional methods of examination at the chronic purulent processes of pleura.
- Differential diagnostics of empyema pleura and piopneumothorax.
- Clinic of chronic empyema.
- Additional methods of examination at piopneumothorax.
- Tactic of treatment of patients with piopneumothorax.
- Indication to puncture of pleura cavity.
- Technique of execution of pleura puncture.
- Indication to drainage of pleura cavity.
- Technique of execution of drainage of pleura cavity.
- Features of conservative treatment of piopneumothorax.
Break 12.00-12.30
Seminar discussion of theoretical issues 12.30-14.00.
1. Reasons of origin of acute abscess of lung.
2. Clinical forms of gangrene of lung.
3. Clinical symptoms of acute abscess of lung in a stage “before opening”.
4. Clinical symptoms of acute abscess of lung in a stage “after opening”.
5. Clinic of chronic abscess of lung.
6. Additional methods of examination of patients with the purulent diseases of lung.
7. Differential diagnostics of chronic abscess of lung and cancer .
8. Differential diagnostics of air cyst and chronic abscess of lung.
9. Methods of sanation of bronchial tree.
10. Treatment of gangrenous abscess of lung.
11. Treatment of acute abscess of lung. Indication to operative treatment.
12. Tactic of treatment of the complicated acute abscess of lung.
13. Acute empyema of pleura: Etiology, pathogeny, clinic.
14. Clinical displays of the limited pleura empyema: roentgenologic picture.
15. Clinic of limited pyopneumothorax: roentgenologic signs.
16. Reasons of origin and clinic of total pyopneumothorax.
17. Additional methods of examination at the chronic purulent processes of pleura.
18. Differential diagnostics of empyema pleura and pyopneumothorax.
19. Clinic of chronic empyema.
20. Additional methods of examination at pyopneumothorax.
21. Tactic of treatment of patients with pyopneumothorax.
22. Indication to puncture of pleura cavity.
23. Technique of execution of pleura puncture .
24. Indication to drainage of pleura cavity.
25. Technique of execution of drainage of pleura cavity.
26. Features of conservative treatment of pyopneumothorax.
Test evaluation and situational tasks 14.00-15.00.
Initial level of knowledge and skills are checked by solving situational tasks for each topic, answers in test evaluations and constructive questions.
(the instructor has tests & situational tasks)
The tests for self-checking of knowledge, skills.
- What is the predominant factor which causes the lung abscess?
A. Increased cholesterol, dyslipoproteinemia
B. Pulmonary hypertension
C. Rheumatism, endocarditis
D. Myocardial infarction
E. Disturbances of bronchial permeability with the development of atelectasis
- What is the cause of pyopneumothorax?
A. Bronchiectatic disease
B. Obstructive bronchitis
C. Pulmonary embolism
D. Bronchial asthma
E. Pulmonary emphysema
3. For the clinical manifestation of pyopneumothorax is typical:
A. Chest pain
B. Vomiting
C. Regurgitation
D. Dysphagia
E. Dilated cervical veins
4. What acute complication is characteristic for lung abscess?
A. Emphysema
B. Pulmonary bleeding
C. Rib fracture
D. Malignancy
E. Esophageal bleeding
5. What acute complication is characteristic for lung abscess?
A. Rib fracture
B. Emphysema
C. Pyopneumothorax
D. Malignancy
E. Esophageal bleeding
6. What complication is characteristic for lung abscess?
A. Esophageal bleeding
B. Rib fracture
C. Emphysema
D. Sepsis
E. Malignancy
7. What complication is characteristic for lung abscess?
A. Esophageal bleeding
B. Rib fracture
C. Bronchogenic dissemination
D. Emphysema
E. Malignancy
8. In the patient of 35 years old during physical exertion have appeared a sharp pain in the left half of the chest. On examination: the patient is covered with cold sweat, difficult breathing on the left side. A tachycardia. By percussion: the bandbox sound from the left side. By auscultation: respiration on the right side is vesicular, on the left side is absent. The probable diagnosis?
A. Spontaneous pheumothorax
B. Angina on exertion
C. Acute myocardial infarction
D. Left pleurisy
E. Pneumonia
9. The patient А., 37 years old, has entered with the complaints of cough with daily excretion of a purulent sputum to 150 ml, pain in the right half of the chest, increase of temperature to
A. Acute bronchitis
B. Acute abscess of lung
C. Exacerbation of a chronic abscess
D. Exacerbation of bronchiectatic disease
E. Pleural empyema
10. The patient А., 42 years old entered the clinic. During two months was treated for acute abscess of the upper lobe of the right lung. The treatment included intramuscular injections of antibiotics. Improvement inappreciable as there stayed a cough with expectoration of a purulent fetid-odor sputum to 80-100 ml per day, high temperature. The diagnosis?
A. Acute abscess of the right lung
B. Tubercular cavern
C. The cavity form of a lung cancer
D. Chronic abscess of lung
E. Purulent polycystosis
A student must know:
1. Reasons of origin of acute abscess of lung.
2. Clinical forms of gangrene of lung.
3. Clinical symptoms of acute abscess of lung in a stage “before opening”.
4. Clinical symptoms of acute abscess of lung in a stage “after opening”.
5. Clinic of chronic abscess of lung.
6. Additional methods of examination of patients with the purulent diseases of lung.
7. Differential diagnostics of chronic abscess of lung and cancer .
8. Differential diagnostics of air cyst and chronic abscess of lung.
9. Methods of sanation of bronchial tree.
10. Treatment of gangrenous abscess of lung.
11. Treatment of acute abscess of lung. Indication to operative treatment.
12. Tactic of treatment of the complicated acute abscess of lung.
13. Acute empyema of pleura: Etiology, pathogeny, clinic.
14. Clinical displays of the limited pleura empyema: roentgenologic picture.
15. Clinic of limited pyopneumothorax: roentgenologic signs.
16. Reasons of origin and clinic of total pyopneumothorax.
17. Additional methods of examination at the chronic purulent processes of pleura.
18. Differential diagnostics of empyema pleura and pyopneumothorax.
19. Clinic of chronic empyema.
20. Additional methods of examination at pyopneumothorax.
21. Tactic of treatment of patients with pyopneumothorax.
22. Indication to puncture of pleura cavity.
23. Technique of execution of pleura puncture .
24. Indication to drainage of pleura cavity.
25. Technique of execution of drainage of pleura cavity.
26. Features of conservative treatment of pyopneumothorax.
A student must be able:
1. To expose the basic clinical signs of the uncomplicated and complicated trauma of thorax, ground and formulate a clinical diagnosis, to perform a differential diagnosis, to ground surgical tactic of treatment.
2. To expose the basic variants of clinical display of acute and chronic abscess of lung, ground and formulate a diagnosis, to perform a differential diagnosis, to ground conservative and operative treatment.
3. To expose the basic clinical signs of acute empyema of pleura and pyopneumothorax, to formulate a clinical diagnosis, to perform a differential diagnosis, to ground the shows and methods of operative treatment.
4. To expose the basic clinical aspects of purulent processes of lung.
5. To ground and formulate a clinical diagnosis.
6. To perform a differential diagnosis.
7. To formulate the shows to surgical and conservative treatment.
The answers for the self-checking tests.
1 – E.
2 – A.
3 – A.
4 – B.
5 – C.
6 – D.
7 – C.
8 – A.
9 – B.
10 – D.
References:
- Manual “Facultative Surgery” under the edition of V.O.Shidlovsky – Ternopil: Ukrmedknyga, 2002, section “Diseases of the lung”,compact disc “Facultative surgery, file “Diseases of the lung”.
- Wang JL, Chen KY, Fang CT, Hsueh PR, Yang PC, Chang SC. Changing bacteriology of adult community-acquired lung abscess in Taiwan: Klebsiella pneumoniae versus anaerobes. Clin Infect Dis. Apr 1 2005;40(7):915-22.
- Takayanagi N, Kagiyama N, Ishiguro T, Tokunaga D, Sugita Y. Etiology and outcome of community-acquired lung abscess. Respiration. 2010;80(2):98-105.
- Mwandumba HC, Beeching NJ. Pyogenic lung infections: factors for predicting clinical outcome of lung abscess and thoracic empyema. Curr Opin Pulm Med. May 2000;6(3):234-9.
- Celli BR. Diseases of the diaphragm, chest wall, pleura, and mediastinum. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 100.
- Broaddus VC, Light RW. Pleural effusion. In: Mason RJ, Broaddus VC, Martin TR, et al, eds. Murray and Nadel’s Textbook of Respiratory Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 68.
- Website of the Ternopil University
Additional
- L.Ya.Kovalchuck, Yu.P.Spizhenko, V.F.Sayenko and others. “Hospital surgery”. Ternopil: Ukrmendknyga, 1999-
590C .
Обговорено на засіданні кафедри
“03” червня 2014 р. протокол №2
