Pulmonary abscess

Voiceover: Meet Arthur. This is Arthur. Let's pretend that Arthur's our patient for the day, and he comes in to see us because he's not feeling well at all. He comes in to his doctor's office, and we'll just pretend that's where we work, and he starts giving us these lists of symptoms that he's having. Some of the things that he says, he says generally he's been feeling really crummy, just really tired and fatigued. We'll make little Zs so you can see that he's just tired. He then tells us that he's even had a fever. He's been feeling really hot, and we ask him, "Have you had a high fever, or have you had a low fever?" because we want to collect more data, and he says it's been a high fever. So I'm just drawing some sweat beads so we can see that he's been hot lately. He tells us that he's been having some chest pain, so let's put a little ouch down here, and even shortness of breath, so he can't really catch his breath. But he tells us something that's really important. He says that he's been having a cough, but it's a productive cough, so that means he's bringing out something with it. When we ask Arthur what does it look it, he says it's really nasty. It's yellowy, it's green, it's thick. And he says that he even noticed that he's been having some bad breath lately. I'm going to make some bad breath fumes. Arthur's given us really a lot of information. We know that he's been feeling fatigued, he's had a high-grade fever, he has this really hallmark productive cough that sounds like it's pus-like, some chest pain and shortness of breath. With that information, that data that we've collected, we suspect that Arthur has a pulmonary abscess. Let's see if we're right. Let's take a trip down to Arthur's lungs. We'll just travel down through the trachea. Let's see if we can uncover anything. What we're going to do, and I'm just going to erase away to see if we find anything that might be hiding in there to give us a clue of what's happening. Look at that. That is a pulmonary abscess. There's two parts to this pulmonary abscess. I'm going to draw arrows going into both. This outside part that you see, this red part, this is like a hard shell. Think about a fruit for a second. Think about that. I can draw a fruit. I'll come over here and make a fruit. Let's say that you were eating this fruit. This fruit has this really hard outside layer, and that's that pink that I just drew. On the inside of this fruit it's this fleshy, wet, thick, gooey mess. Maybe fleshy is not a good idea. I want you to get the point that this is really thick and sticky and gooey on the inside. Imagine that that's the pit of the fruit. It's got this really hard shell, and this thick, gooey center. Well, that is what an abscess is. It has this hard shell on the outside, and it has this thick ... Woops, let's change my pen back. It has this thick and gooey center, so I'll put thick and gooey. This thick and gooey center is really where the infection is. That's the infection, and that's no good. The problem with a pulmonary abscess, versus other infections, is that because of this hard shell, it makes it almost impenetrable by anything else. That anything I want you to think about is blood supply. Even blood supply can't get inside of this to feed it with anything. With anything we're really talking about antibiotics, but we'll get to that in a minute. Let's come over here and talk about how he could get this pulmonary abscess. There's one or two ways. I'll put a 1, and that's going to be our primary, and a 2, and that will be our secondary. That first way is because of some other lung infection. I'm going to write pneumonia, because pneumonia is another type of lung infection, and pneumonia can actually lead to a pulmonary abscess. The secondary way would be from some other issue that's not from an infection. Think about aspiration. This is an important thing to think about. Aspiration. If Arthur had inhaled some type of foreign material, like if he inhaled a piece of food, for instance. So here's my cherry. Let's say that he inhaled some food. Even when we have patients that aspirate vomit, so there's my vomit, or even if he aspirated saliva, these are some things that we know normally, naturally rather, they carry bacteria. Our lungs naturally don't carry bacteria because it's a sterile environment. By breathing in or aspirating any of these things, you're introducing bacteria into the lungs, and that's going to cause an infection. Then under this secondary way as well, things like obstructions or abnormalities in the lung, those can actually cause a pulmonary abscess as well. I want you to remember that the primary way is pneumonia, and the secondary way is all other options. Aspiration's important, right? Make sure, too, and I just want to add, that you're considering your patients that are under sedation, or that are intubated. Because those are the patient's that are at risk for aspiration, and that in turn can turn into a pulmonary abscess. Now we know what the problem is. But how do we diagnose that for sure? What we've done is we collected the symptoms. We've collected the signs and symptoms that we've seen. We saw that he was having this high-grade fever, that he's tired, this hallmark productive cough that's very classic with a pulmonary abscess, the chest pain, the shortness of breath. We collected this information, and that lead us to believe that he has a pulmonary abscess, because they match up. But if we wanted to be definitive about it, we could do a couple other things. We could actually do a chest x-ray. So let's see that. The point of a chest x-ray is so that we can see. I'm just going to draw these eyes kind of looking over. The point is that we can see what's happening. A chest x-ray is really an image. It would like this on a radiography sheet. We wold be able to see the lungs. That way, we will know for sure if we spot this abscess. Ding! Ding! Then we know that that's for sure that he has an abscess. We could do a CT scan that would be a similar kind of method to be able to visualize the lungs. So CT scan, that's what we call that. Or we can do a chest x-ray. You might see that abbreviated as CXR, just in case you see that. Another thing we could do would be a bronchoscopy. Bron-cho-sco-py. I'm writing it because it's a big word. A bronchoscopy essentially means that we can take a scope. Let's pick this color as my scope. We can go through. I'm going to come through Arthur's mouth. We can bring this scope all the way through Arthur's mouth, down to his trachea, and we can go through the large airways. At the end of this scope, it's like a camera. I'll just pretend that's an eye, and here's an eye. We can see. We can see inside of the lungs, and that way we can actually spot what's happening first hand, kind of like if we were able to jump in his lungs ourselves and take a look. That's really going to help us definitely know that we have this abscess happening, what it looks like, where it's at, and get a better idea. Now we can do something else. Remember this nasty cough that he's had? We can actually take some of this sputum, that production that he's having when he's coughing, and we can check it. We can test it to see. What we'll check for is we can do a culture. A culture is going to tell us what bacteria, so what's the nasty bug. Which one is it? Is it this bug? Is it this bug? Or is it this bug that's actually causing the problem, and we can do a sensitivity. A sensitivity, and I'll write that right under here. A sensitivity is going to tell us what antibiotic is going to be effective in killing this microorganism or this pathogen. We know that pulmonary abscesses, they are bacterial in nature. We really want to make sure that we are treating it with an antibiotic. These are the definitive ways that we can diagnose. The treatment, like we just said, the treatment of choice would be antibiotics. I would want to give Arthur some pills. This is just an example, so we know that we could give him some medication. Here's two tabs of an antibiotic. But what was the problem. Remember that the problem is that this abscess has this really hard shell and it's not penetrated easily by the blood supply. That means that just a regular, run of the mill routine antibiotics, that's not going to be the most effective method. We're really going to have to put him on long-term antibiotics. I'm just going to add a couple more pills here, so you can see that he's going to be on antibiotics for quite a long time, because we want to make sure that it's going to be effective in penetrating that. Now, that doesn't always work, because again, remember, this fibrotic shell can make it pretty difficult to get into. If that doesn't work, then we have to try something a little bit more invasive. That would be doing surgery, to just cut it out completely. Remember, because we're going inside of the lung to actually remove this abscess, that means that this patient, which is Arthur, Arthur is going to probably end up with a chest tube. That chest tube, I'll just draw in this color, that chest tube is just going to facilitate the drainage of contents and of blood to make sure that it's not pooling inside of his lungs. That would be the ideal treatment for Arthur and his pulmonary abscess.