Homesleeping healthBsc Nursing NotesPneumonia, pulmonary tuberculosis, Lung cancer pathophysiology Notes

Pneumonia, pulmonary tuberculosis, Lung cancer pathophysiology Notes


  • An infection that inflames air sacs in one or both lungs which may fill with fluid or pus.


 according to Clinical classification

Lobar pneumonia:

All or large segment of pulmonary lobe is involved


Begins in terminal bronchioles and scattered in air spaces throughout the lungs.

Interstitial pneumonia:

Affects alveolar walls (Interstitium)


  • Community acquired pneumonia (CAP)
  • Hospital acquired pneumonia (HAP)
  • Ventilator-associated pneumonia (VAP)
  • Health care associated pneumonia (HCAP)
  • Aspiration pneumonia

Microorganism that cause pneumonia


  • Streptococcus pneumoniae, Haemophilus influenzae, Chlamydophila pneumoniae, Mycoplasma pneumoniae.


  •  Rhinoviruses, Coronaviruses, Influenza, RSV


  • Pneumocystis jeroveci, Aspergillus, Candida


  • Toxoplasma gondii, Stercoralis and others.

Risk factors of Pneumonia

  • Age: 65 or older and less than 2
  • Smokers
  • Recent respiratory infection
  • Chronic lung diseases COPD
  • Chronic illness heart disease, diabetes
  • Weak immune system
  • Difficulty swallowing like stroke, neurological condition
  • Long time Hospitalization

Sign and symptoms of Pneumonia

  • Chest Pain (while breathing or coughing)
  • Cough with phlegm or mucus
    • Bacterial pneumonia: green/yellow mucus
    • Atypical pneumonia: white mucus
    • Virus pneumonia: dry cough
  • Fatigue, loss of appetite
  • Fever, sweating, chills
  • Nausea, vomiting and diarrhoea
  • Shortness of breath


  • Tuberculosis is a contagious bacterial infection that involves the lung
  • Tuberculosis may involve multiple organs, such as the lung, liver, spleen, kidney, brain, and bone
  • but may spread to other organs
  • caused by Mycobacterium Tuberculosis. (or Tubercle bacillus)
  • Formation of granuloma in infected lung
  • Cell mediated hypersensitivity – Inflammation
  • Fibro cavity causing destruction in lung

Stages of Tuberculous infection

Primary stage:

  • exhibit symptoms 1 to 2 weeks after entry of micro-organism.

Latent stage:

  •  bacteria engulfed by macrophages lives in dormant phase. No symptoms. No spread of infection.

Active stage:

  •  whenever immune system weakens, germs will multiply and make sick.

Causes and risk factors of Pulmonary Tuberculosis

  • Close contact with infected person
  • Immunocompromised
  • Substance abuse
  • Pre-existing medical condition
  • Immigration from high prevalence country
  • Living in over crowded house
  • Inadequate health care
  • Malnutrition
  • Health care workers


Sign and symptoms of Tuberculosis

  • Cough (dry/mucopurulent/blood) more than 3 weeks
  • Fever/chills/night sweats
  • Unexplained weight loss
  • Loss of appetite
  • Fatigue
  • Breathing difficulty
  • Pain in chest
  • Fluid around lung
  • Enlarged/tender lymph nodes

Extrapulmonary Tuberculosis Signs

  • Lymph nodes: swollen and tender lymph nodes
  • Abdomen: pain, indigestion, diarrhoea, loss of appetite
  • Bones: swelling and pain in bones
  • Heart: inflammation of heart layers, chest pain
  • Kidney: pain, inflammation of kidney  and dysuria
  • Brain: tb meningitis, behaviour changes, meningitis causing headache, drowsy, convulsion
  • Skin: lumpy rashes, ulcers

Lung Carcinoma

  • is a malignant lung tumor, bronchogenic Carcinoma
  • tumors originating in the lung parenchyma or within the bronchi.
  •  characterized by uncontrolled cell growth in tissues of the lungs.
  • If left untreated, this growth can spread beyond  the lung by the process of metastasis into  nearby tissue or other parts of the body.
  • is one of the leading causes of cancer-related deaths.


  • Lung cancer is the most commonly diagnosed cancer worldwide, accounting for approximately 12.4% of all cancers diagnosed worldwide, and is the leading cause of cancer-related deaths.
  • The American Cancer Society estimates an annual incidence of more than 234,000 new lung cancer cases and over 154,000 lung cancer-associated deaths in the United States.
  • According to the Global Cancer Statistics report from 2020, lung cancer remained the leading cause of cancer death worldwide, with an estimated 1.8 million deaths.
  • In Nepal the country profile 2018 shows lung cancer to have highest incidence and mortality.

Risk factors of Lung Cancer

  •     Tobacco, smoking
  • Secondhand smokers
  • Heredity
  • Occupational and environmental exposure
    • Asbestos, radon ,arsenic, mustard gas, coke oven fumes, nickle, chromates, beryllium,silica Air pollution
    • Talc and talcum powder
  • Radioisotope exposure, ionizing radiation

Pathophysiology of lungs cancer


Non- small cell lung cancer (NSCLC)

  • Most common type
  • About 80-85% are NSCLC
  •  grows more slowly
  • It is further classified into the following

a. Epidermoid carcinoma or squamous cell carcinoma

  • 25-30% of lung cancer and more common in males
  • More centrally located and arise from bronchial epithelium
  • Cavitation may also occur
  • Slow growth, metastasis not common

b. Adenocarcinoma

  • Most prevalent carcinoma
  • Adenocarcinoma, arising from the bronchial mucosal glands, is the most common NSCLC cancer, representing 35-40% of all lung cancers.
  • It is the subtype observed most commonly in persons who do not smoke.
  •  It usually occurs in a peripheral location within the lung.

c. Large cell carcinoma

  • 10-15% of lung cancer
  • Large abnormal looking cell
  • Cavitation common
  • Slow, metastasis may occur to kidney, liver and adrenals
  • Metastasis via lymphatics and blood
  • May be located centrally, mid lung or peripherally

2. Small cell carcinoma

  • Spreads more quickly and aggressively
  • 65-75%
  • Small cell lung carcinoma (SCLC) arises in peribronchial locations and infiltrates the bronchial submucosa.

Clinical manifestations

  • Shortness of breath
  • Cough
  • Bone pain
  • Weight loss
  • Fatigue
  • Neurologic dysfunction


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