WordNet

a will to succeed
a manner of articulation involving an audible release of breath
respiratory disease characterized by inflammation of the lung parenchyma (excluding the bronchi) with congestion caused by viruses or bacteria or irritants

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大望,熱望 / 呼気,呼吸 / 気音を伴って発音すること(例:penの[p],killの[k])
肺炎

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/06/16 12:53:35」(JST)

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Aspiration pneumonia is bronchopneumonia that develops due to the entrance of foreign materials into the bronchial tree,^[1] usually oral or gastric contents (including food, saliva, or nasal secretions). Depending on the acidity of the aspirate, a chemical pneumonitis can develop, and bacterial pathogens (particularly anaerobic bacteria) may add to the inflammation.

Causes

Aspiration pneumonia is often caused by an incompetent swallowing mechanism, such as occurs in some forms of neurological disease or injury including multiple sclerosis, CVA (stroke), Alzheimer's disease or intoxication. An iatrogenic cause is during general anaesthesia for an operation and patients are therefore instructed to be nil per os (abbrev. as NPO), i.e. nothing by mouth, for at least four hours before surgery.

Risk factors

Ethnicity^[2]^{[further explanation needed]}

Age, being male, poor dental hygiene, lung disease, swallowing difficulties, diabetes mellitus, severe dementia, malnutrition, Parkinson's disease, use of antipsychotic drugs, proton pump inhibitors, and angiotensin-converting enzyme inhibitors.^[3]^[4]

Reduced functional status, resident in institutional setting, prolonged hospitalization or surgical procedures, impaired consciousness, chronic swallowing disorders, mechanical airway interventions, immuno-compromised, history of smoking, antibiotic therapy, advanced age, reduced pulmonary clearance, diminished cough reflex, disrupted normal mucosal barrier, impaired mucociliary clearance, alter cellular and humoral immunity, obstruction of the airways, and damaged lung tissue.^[5]

Whether aspiration pneumonia represents a true bacterial infection or a chemical inflammatory process remains the subject of significant controversy. Both causes may be present with similar symptoms.

Implicated bacteria

When bacteria are implicated, they are usually aerobic:

Streptococcus pneumoniae^[6]
Staphylococcus aureus^[6]
Haemophilus influenzae^[6]
Pseudomonas aeruginosa^[6]

They may also be admixed with anaerobic bacteria oral flora:

Bacteroides^[6]
Prevotella^[6]
Fusobacterium^[6]
Peptostreptococcus^[6]

Location

The location is often gravity dependent, and depends on the patient position. Generally, the right middle and lower lung lobes are the most common sites of infiltrate formation due to the larger caliber and more vertical orientation of the right mainstem bronchus. Patients who aspirate while standing can have bilateral lower lung lobe infiltrates. The right upper lobe is a common area of consolidation in alcoholics who aspirate in the prone position.^[7]

Diagnosis

Aspiration pneumonia is typically diagnosed by a combination of clinical circumstances (debilitated or neurologically impaired patient), radiologic findings (right lower lobe pneumonia) and microbiologic cultures. Some cases of aspiration pneumonia are caused by aspiration of food particles or other particulate substances like pill fragments; these can be diagnosed by pathologists on lung biopsy specimens.^[8]

References

^ "aspiration pneumonia" at Dorland's Medical Dictionary
^ Oliver, N.M., Stukenborg, G.J., Wagner, D.P., Harrell, F.E., Kilbirdge, K.L., Lyman, J.A., Einbinder, J., & Connors, A.F. (2004). Ethnicity on In-Hospital Mortality from Aspiration Pneumonia. Journal of the National Medical Association, 96(11), 1462-1469.
^ Scannapieco, F.A., Mylotte, J.M. (1996). Relationship between periodontal disease and bacterial pneumonia. Journal of Periodontal, 67, supple 10, 1114-1122.
^ van der Maarek-Wierink, C.D., Vanobbergen, J.N., Bronkhorst, E.M., Schols, J.M., & de Baat, C., (2011). Risk factors for aspiration pneumonia in frail older people: a systematic literature review. Journal of American Medical Directors Association, 12(5), 344-354.
^ Taylor, G.W., Loesche, W.J., & Terpenning, M.S. (2000). Impact of Oral Diseases on Systemic Health in the Elderly: Diabetes Mellitus and Aspiration Pneumonia. Journal of Public Health Dentistry, 60(4), 313-320
^ ^a ^b ^c ^d ^e ^f ^g ^h Table 13-7 in: Mitchell, Richard Sheppard; Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson. Robbins Basic Pathology: With STUDENT CONSULT Online Access. Philadelphia: Saunders. ISBN 1-4160-2973-7. 8th edition.
^ Anand Swaminathan, MD. "eMedicine.com: Pneumonia, Aspiration". Retrieved: 2007-01-20
^ Mukhopadhyay S, Katzenstein AL (2007). "Pulmonary disease due to aspiration of food and other particulate matter: a clinicopathologic study of 59 cases diagnosed on biopsy or resection specimens.". American Journal of Surgical Pathology 31 (5): 752–759. doi:10.1097/01.pas.0000213418.08009.f9. PMID 17460460.

UpToDate Contents

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1. 成人における嚥下性肺炎 aspiration pneumonia in adults
2. 小児における肺炎：入院治療 pneumonia in children inpatient treatment
3. Kleine-Levin syndrome (recurrent hypersomnia)
4. 小児における肺炎：疫学、病因、および原因 pneumonia in children epidemiology pathogenesis and etiology
5. 幼児および小児における嚥下障害による誤嚥 aspiration due to swallowing dysfunction in infants and children

English Journal

The Effect of Arytenoidectomy on Functional and Oncologic Results of Supracricoid Partial Laryngectomy.

Basaran B1, Unsaler S2, Ulusan M2, Aslan I2.
The Annals of otology, rhinology, and laryngology.Ann Otol Rhinol Laryngol.2015 Oct;124(10):788-96. doi: 10.1177/0003489415585866. Epub 2015 May 5.
OBJECTIVE: The effect of arytenoid resection was investigated in patients who had undergone supracricoid partial laryngectomy (SCPL) by comparing functional and oncologic results between patients with both arytenoids preserved with those with one arytenoid resected.METHODS: Patients were divided int
PMID 25944594

Experimental pulmonary fibrosis in rats with chronic gastric acid reflux esophagitis.

Shimazu R1, Aoki S2, Kuratomi Y3.
Auris, nasus, larynx.Auris Nasus Larynx.2015 Oct;42(5):382-4. doi: 10.1016/j.anl.2015.03.005. Epub 2015 Apr 8.
OBJECTIVE: To elucidate the association between gastric acid reflux and respiratory diseases by studying the histological changes of the lower airway in rats with chronic acid reflux esophagitis.METHODS: An experimental rat model of chronic acid reflux esophagitis was surgically created. The lower a
PMID 25863641

Oncologic outcomes of supratracheal laryngectomy: Critical analysis.

Rizzotto G1, Crosetti E2, Lucioni M1, Bertolin A1, Monticone V3, Sprio AE4, Berta GN4, Succo G3,5.
Head & neck.Head Neck.2015 Oct;37(10):1417-24. doi: 10.1002/hed.23773. Epub 2014 Jul 19.
BACKGROUND: Laryngeal cancer management should pursue function-sparing therapeutic options. Even though demolitive surgery provides better control of disease at intermediate to advanced stages when compared to chemoradiotherapy, it does not preserve laryngeal function. Supratracheal partial laryngec
PMID 24839082

Japanese Journal

誤嚥性肺炎を予防する口腔ケアで、医療費削減 (特集地域連携における歯科の役割)

8020 : はち・まる・にい・まる : 財団法人8020推進財団会誌 (15), 92-95, 2016-16
NAID 40020754569

入院後発症した誤嚥性肺炎の追加的医療費と在院日数 : DPCデータを用いた観察研究

日本医療マネジメント学会雑誌 = The journal of the Japan Society for Health Care Management 17(3), 123-128, 2016-12
NAID 40021021545

誤嚥性肺炎の予後因子の検討

呼吸器内科 = Respiratory medicine 30(5), 442-447, 2016-11
NAID 40021015669

Related Pictures

★リンクテーブル★

リンク元	「誤嚥性肺炎」「嚥下性肺炎」
関連記事	「aspiration」

「誤嚥性肺炎」

Aspiration pneumonia
	Histopathologic image of aspiration pneumonia in an elderly patient with debilitating neurologic illness. Note foreign-body giant cell reaction. Autopsy case. H & E stain.
Classification and external resources
ICD-10	J69.0, P24.9
ICD-9	507,770.18 997.32
MedlinePlus	000121
eMedicine	emerg/464
MeSH	D011015

　　[★]

日: ごえんせいはいえん
英: aspiration pneumonia
同: 誤飲性肺炎、嚥下性肺炎 deglutition pneumonia、吸引性肺炎

原因

口腔内容物の気道侵入
逆流胃内容の気道侵入

病原体

IRE.521

口腔内嫌気性菌

嫌気性グラム陽性球菌：Peptostreptococcus
色素(産生)性グラム陰性桿菌：Prevotella, Porphyromonas, Bacteroides
Fusobacterium

QB.H-157

リスクファクター

IRE.520 QB.H-157 YN.I-48

意識障害：脳血管障害
食道疾患：食道通過障害、噴門部逆流
嚥下障害：(高齢者)、中枢神経変性疾患(パーキンソン病？)
鎮静薬の使用　　←　例えば、101E013
口腔内環境の不衛生

「嚥下性肺炎」

　　[★]

英: aspiration pneumonia
関: 誤嚥性肺炎

国試

103A037

「aspiration」

　　[★]

n.

吸引

関: inspiration 吸気, expiration 呼気, respiration 呼吸

[1] "aspiration pneumonia" at Dorland's Medical Dictionary

[2] Oliver, N.M., Stukenborg, G.J., Wagner, D.P., Harrell, F.E., Kilbirdge, K.L., Lyman, J.A., Einbinder, J., & Connors, A.F. (2004). Ethnicity on In-Hospital Mortality from Aspiration Pneumonia. Journal of the National Medical Association, 96(11), 1462-1469.

[3] Scannapieco, F.A., Mylotte, J.M. (1996). Relationship between periodontal disease and bacterial pneumonia. Journal of Periodontal, 67, supple 10, 1114-1122.

[4] van der Maarek-Wierink, C.D., Vanobbergen, J.N., Bronkhorst, E.M., Schols, J.M., & de Baat, C., (2011). Risk factors for aspiration pneumonia in frail older people: a systematic literature review. Journal of American Medical Directors Association, 12(5), 344-354.

[5] Taylor, G.W., Loesche, W.J., & Terpenning, M.S. (2000). Impact of Oral Diseases on Systemic Health in the Elderly: Diabetes Mellitus and Aspiration Pneumonia. Journal of Public Health Dentistry, 60(4), 313-320

[Kumar13-7-6] ^ ^a ^b ^c ^d ^e ^f ^g ^h Table 13-7 in: Mitchell, Richard Sheppard; Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson. Robbins Basic Pathology: With STUDENT CONSULT Online Access. Philadelphia: Saunders. ISBN 1-4160-2973-7. 8th edition.

[7] Anand Swaminathan, MD. "eMedicine.com: Pneumonia, Aspiration". Retrieved: 2007-01-20

[8] Mukhopadhyay S, Katzenstein AL (2007). "Pulmonary disease due to aspiration of food and other particulate matter: a clinicopathologic study of 59 cases diagnosed on biopsy or resection specimens.". American Journal of Surgical Pathology 31 (5): 752–759. doi:10.1097/01.pas.0000213418.08009.f9. PMID 17460460.

匿名

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案内

案内

aspiration pneumonia