Right-sided pneumonia in adults and children: causes, symptoms, treatment
The content of the article:
- The reasons for the development of the disease
- Symptoms of right-sided pneumonia
- Diagnostics
- Treatment
- Video
Right-sided pneumonia in adults and children is more common than left-sided, which is associated with the anatomical features of the structure of the bronchial tree.
The development of right-sided pneumonia is more common than left-sided, which is associated with the anatomical features of the structure of the lungs
Pneumonia is an acute infectious and inflammatory disease of the respiratory parts of the lungs, mainly of bacterial etiology. Anatomically, the right bronchus is shorter and wider than the left, therefore, infection is more often spread through it.
Every year millions of people fall ill with pneumonia in the world, and the correct diagnosis is not always made, since in many cases the disease is not recognized in time and the appropriate treatment is not carried out. This leads to a protracted, severe course of pathology with a high risk of complications. Therefore, it is very important to consult a specialist in a timely manner if symptoms occur.
The reasons for the development of the disease
Often the inflammatory process occurs as a result of infection with a pathogenic microorganism, less often after surgery and trauma. Bacteria can enter from the focus of an upper respiratory tract infection or through the air, it is also possible to spread through the blood and lymph.
The causative agent of pneumonia can enter the lungs through the blood and lymph
Etiological agents are staphylococci, pneumococci, Haemophilus influenzae, atypical pathogens (mycoplasma, chlamydia).
Pneumonia is characterized by infectious inflammation of the respiratory tract of the lungs. The defeat of the alveoli is accompanied by the accumulation of exudative fluid in them.
Pneumonia can be community-acquired or nosocomial.
Depending on the prevalence of the pathological process in the lung tissue, right-sided pneumonia can be focal, confluent, segmental, lobar (lower lobe and upper lobe) or interstitial.
Symptoms of right-sided pneumonia
Being a common, serious disease, pneumonia can lead to many complications if the main symptoms of the disease are not recognized in time:
- tremendous chills;
- fever (the temperature rises to 39–40 ° C);
- pain when breathing on the right side of the chest, which is worse when coughing;
- cough: dry at first, then wet with purulent or bloody sputum;
- shortness of breath on exertion, then at rest;
- tachycardia, decreased blood pressure;
- general weakness, lack of exercise, headaches, muscle and joint pain.
With the development of infectious-toxic shock, in addition to a decrease in blood pressure, pallor of the skin, clammy sweat, and cold extremities are noted. With an increase in heart failure, the heart rhythm is disturbed, a shock lung, hepatic / renal failure develops.
Diagnostics
Diagnosis of pneumonia includes a number of methods of objective, laboratory and instrumental research that help to collect a complete picture and establish the correct diagnosis.
To make a diagnosis, you must consult a doctor and undergo appropriate studies
The doctor conducts a thorough examination, percussion and auscultation of the lungs.
On examination, attention is drawn to the lag of the right half of the chest, pallor of the skin and visible mucous membranes. Herpetic eruptions are possible on the face.
The patient's breathing is rapid, shallow, with swelling of the wings of the nose.
A dull percussion sound is determined over the affected area. There is an increase in vocal tremor, which intensifies as the inflammatory changes increase.
During auscultation of the lungs on the right side, there is a weakened vesicular or bronchial breathing, crepitus, fine bubbling wet rales, pleural friction noise.
X-ray examination of the lungs is of particular diagnostic value.
The most informative diagnostic methods include:
- X-ray examination of the lungs;
- clinical blood test;
- microscopic examination of sputum;
- bacteriological culture of sputum with determination of antibiotic sensitivity.
X-ray examination reveals a dark area corresponding to a lobe or segment of the right lung.
In a clinical analysis of blood, leukocytosis is determined with a shift of the leukocyte formula to the left, an increased ESR (erythrocyte sedimentation rate).
In order to determine the cause of right-sided pneumonia, before starting therapy, sputum is cultured on a nutrient medium, which makes it possible to determine the type of pathogen and its sensitivity to antibiotics. Microscopic examination is also carried out to preliminary determine a possible pathogen.
If SARS is suspected, serologic testing is necessary.
During the diagnostic examination, it is important to assess the severity and prognosis of the disease in order to take this into account when deciding on the place of treatment for the patient. With a mild course of pneumonia, outpatient treatment is possible, with moderate and severe course, hospitalization is necessary. It is also important to take into account concomitant diseases, which may be in the stage of exacerbation or decompensation.
In case of pneumonia in a child, compulsory hospitalization is required.
Treatment
Correctly selected antibiotic therapy forms the basis of pneumonia treatment. An antibiotic is prescribed taking into account an indicative or confirmed etiological variant of the disease.
Antibiotics are usually prescribed to treat pneumonia, such as Amoxiclav
The choice of a drug is influenced by the following criteria:
- clinical situation;
- antimicrobial spectrum of action, pharmacokinetic properties and drug safety;
- tendency and likelihood of antibiotic resistance;
- the severity of pneumonia.
Antibiotic therapy should be prescribed immediately after diagnosis, even in the absence of data from microbiological examination of sputum or without prospects for etiological verification of the etiological variant of pneumonia.
An allergic history is taken into account without fail, and if necessary, a special test is carried out to identify drug intolerance.
In most cases, the drugs of choice are protected II – III generation cephalosporins, respiratory fluoroquinolones. These groups of antibiotics work well for pneumonia caused by Haemophilus influenzae, pneumococcus, Staphylococcus aureus and many other gram-positive pathogens.
If gram-negative flora or anaerobes are detected, the following are prescribed: Clindamycin, Metronidazole, respiratory fluoroquinolones (Moxifloxacin), carbapenems.
The drug from the group of protected penicillins - Amoxiclav - contains amoxicillin and clavulanic acid, which inhibiting beta-lactamase, prevents the inactivation of amoxicillin and expands the spectrum of its activity. Thus, the drug acts on bacteria that are usually resistant to amoxicillin and other penicillins, as well as to cephalosporins.
The spectrum of action of Amoxiclav includes many pathogens that cause pneumonia: Staphylococcus aureus, pneumococcus, Haemophilus influenzae, Klebsiella, Moraxella, Legionella, Proteus.
The effectiveness of the initially prescribed antibiotic is assessed 48–72 hours after starting therapy. The presence of a clinical effect in the form of a decrease in the severity of the symptoms of the disease, an improvement in the patient's well-being indirectly confirms the alleged etiological variant and allows continuing treatment with the selected antibacterial drug. The lack of positive dynamics is the basis for changing the drug.
The duration of antibiotic therapy and the length of hospital stay are determined by the attending physician on an individual basis. The average course of treatment is 10-14 days.
Antibiotic therapy should be complemented by other treatments, in particular oxygen therapy
In addition to antibiotics, it is important to correctly prescribe pathogenetic and symptomatic treatment. Detoxification therapy is carried out, including Gemodez and Reopolyglucin. Expectorants (Acetylcysteine, Ambroxol) and bronchodilators (Atrovent, Berodual) are prescribed, according to indications - immunomodulatory therapy, vitamin therapy. If respiratory failure occurs, oxygen therapy is required.
Video
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Alina Ervasova Obstetrician-gynecologist, consultant About the author
Education: First Moscow State Medical University. THEM. Sechenov.
Work experience: 4 years of work in private practice.
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