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1、小儿呼吸疾病（英文ppt）,Introduction,High Morbidity Rate High Mortality Rate,Each year,respiratory infection diseases cause about 15 million deaths among children younger than age 5 year through the world.Pediatric pulmonary infection accounts for about 63.89%of all hospitalizations of children,in which 44.6
2、percent are pneumonia.,Cricoid cartilage,Upper respiratory tract nose,paranasal sinuses,pharynx,eustachian tube,epiglottis,larynx,Lower respiratory tract:trachea,bronchi,bronchioles,alveolus,Anatomy,Anatomy,Upper respiratory tract,Short Nasal passages,nasolacrimal duct and eustachian tube,Significan
3、ce:These characters make nasal cavity easy to become hyperemia,edema,and congestion which will induce infection.Local infection can spread to nearby organs and tissues easily and cause dyspnea,hoarseness and apnea.,Nasal mucosaIs soft,More vascular,Nasal cavity is short and narrow,Anatomy,Narrowed a
4、irwaySoft mucous menbraneMore vascularSofter and more compliant,Clinical significance:Easy to become hyperemia,edema,and congestion which will induce infectionComplication:Pulmonary emphysema and atelectasis,Lower respiratory tract,Physiology,The younger the child The quicker the frequencyThe less r
5、egular the rhythm,Vital capacity(VC)Tidal volumeTotal lung capacity(TLC),Respiratory frequency and rhythm：The respiratory frequency is inversely related to age.neonate:4050 bpm；612mo:30-35 bpm；1-3 yr:2530 bpm；49 yr:20-25 bpm；8-14 yr:1820 bpm。(2)Some young infants present with irregular rhythm or apn
6、ea due to immature respiratory center.,Small,大家学习辛苦了，还是要坚持,继续保持安静,Immune System,Low level of sIgA,IgG on Respiratory Mucosa Low level of Th1 function,Acute Upper Respiratory Tract Infection“Common cold”,Acute Upper Respiratory Infection,Introduction,80-90%proportion of visit to clinic.spread to near
7、by organs and tissues(otitis media,conjunctivitis,lymphadenitis,lymphadenitis and pneumonia)Bronchial asthma,nephritis,myocarditis,measles and pertussis may also follow AURI,90%of AURI are caused by viral infection,Etiology,RhinovirusEcho virusCoxsackievirusParainfluenzaInfluenzaAdenovirusRSV(Respir
8、atory Syncytial Virus),PneumococcusMoraxelle catarrhalis,Haemophilus influenzaeStaphylococcus aureus,Bacteria,MycoplasmaChlamydia Other Microorganisms,Others,Mild symptom Nasal congestion,rhinorrhea,sneezing,sore throatSevere symptom High fever,convulsion,anorexia,frequency cough,Clinical Manifestat
9、ion,Symptoms of URI in children of different ages,The pharynx is red Retropharyngeal folliculosisErythematous enlarged tonsils Enlarged lymph nodesEnterovirus illnesses may be associated with a wide variety of skin rashes,Physical Sign,HerpanginaCoxsackievirus AMost often occurs in summer and autumn
10、More often in infants（0-3 yr of age）Characterized by sudden onset of fever,sore throat and dysphagia Characteristic lesions,present on the posterior pharynx,are discrete vesicles and ulcersDuration of illness is usually 7 days,Two Special Types,Occurs typically with type 3,7 adenovirus Most often oc
11、curs in spring and summerChildren（3 yr）more often affectedFeatures include:A high temperature that lasts 45 days,pharyngitis,conjunctivitis,cervical lymphadenopathy,and rhinitis.Duration of illness is usually 1-2 weeks,Pharyngoconjunctival Fever,Otitis mediaCervical lymphadenitisBronchitisPneumoniaS
12、epticemia,Complication,Viral Infection Viral Myocarditis Viral EncephalitisBacterial Infections（streptococcus)Acute Nephritis Rheumatic Fever,Diagnosis,Symptoms sighs,The differential diagnosis of the URl includes other acute infectious disease.In patient with febrile convulsion,central nervous syst
13、em Infections should also considered.Patients with abdominal pain may have acute abdomen.,Differential diagnosis,Difference Between Mesenteric Lymphadenitis and Acute appendicitis,Prophylaxis,Increase outdoor activities.Improve physical fitness.Enhance immunity function.Patients in collective instit
14、utions should be isolated.,General treatment Etiological treatment Anti-virus：Ribavirin Avoid the abuse of antibioticsSymptomatic treatment Severe nasal obstruction Irritability-restlessness High fever Pharyngeal portion ulcer Conjunctivitis,Treatment,Upper respiratory infection is the most common d
15、isease in childhood,most of which are caused by viral infections.The severity of clinical manifestations is related to age of the patients.Infants present mild local symptoms and severe systemic symptoms,while older children present on the contrary.A stuffy,congested nose may exist in infants younge
16、r than 3 months of age.Treatment for the common cold should be mainly symptomatic.Antibiotics should not be used unless in those young,infant patients which are suspected to complicate bacterial infections.,Summary,Acute bronchitis is inflammation of the tracheobronchial epithelium.Trachea is usuall
17、y involved，so acute bronchitis is also called acute tracheobronchitis.Acute bronchitis is commonly secondary to an acute viral infection,or just one manifestation of acute infectious disease.,Acute Bronchitis,Infectious factors：viral,bacterial or other pathogen infectionsCharacters of respiratory tr
18、act of infants:The mucous become edema and hyperemia which make the bronchus narrower when inflammation.Other factors：immunodeficiency,nutritional diseases,specific body constitution.,Etiology,Clinical Manifestation,Begins as an URICough is a significant signs nonproductive cough productiveThe syste
19、mic symptoms is usually severe in infants including fever,vomiting and diarrheaMedical examination：Respiratory rudeness Diffuse or scattered rales No dyspneaCXR:may be normal or thickening lung markings,Acute bronchitis is an inflammation of the major conducting airways within the lung which caused
20、by viral or bacteria,and is most often in infants.Cough is the most significant clinical manifestation.Fever,vomiting and diarrhea are frequent in infants.Respiratory sounds are rough and scattered rales are heard on auscultation.Radiographic examination of the chest may show a mild increase in bron
21、chovascular markings.Antibiotics are indicated if a bacterial infection of the airway is suspected or proven.Corticosteroids are recommended in severe cases.,Summary,Pneumonia is an inflammation of the parenchyma of the lungs.Most cases of pneumonia are caused by microorgnanisms,but there are severa
22、l noninfectious causes,which include aspiration of food or gastric acid,foreign bodies and so on.,Acute Pneumonia,Season of onset Age of onsetMorbidity rateMortality rate,Epidemiology,Classified according to the infecting organism:Viral pneumonia,bacterial Pneumonia,mycoplasma Pneumonia.Classified a
23、ccording to Pathology:Bronchopneumonia,lobar pneumonia,interstitial pneumonia.Classified according to duration of disease:Acute pneumonia(3mo).Classified according to severity of disease:Mild pneumonia and severe pneumonia.,Category,Etiology,Age,More often in infants,Disease,Environment,Malnutrition
24、,Congenital heart disease,Immunodeficiency disease,wetness,stuffiness and crowding.,Inducement,Patients with the following problems are particularly predisposed to this disease:,Hyperemia,edema and inflammatory infiltration of lung tissuesAlveolar exudate Patchy Inflammation focus,and consolidation
25、Atelectasis and emphysema of lung,Pathology,fever,cough,tachypnea,Rales,four,symptoms,Clinical Manifestion,Pneumonia,Apart from the general features of bronchopneumonia,severe pneumonia also present with systemic toxic symptoms in respiratory systemcirculatory systemnervous system digestive system,S
26、evere Pneumonia,Circulatory system,Myocarditis,heart failureMicrocirculation disturbance,Digestive system,Gastrointestinal dysfunction,enteroplegiaAlimentary tract hemorrhage,Nervous system,Intracranial hypertensionEncephaledema,Water-Electrolyte Balance,Mixed acidosis,dehydrationHyponatremia,Extrap
27、ulmoanry presentations,Suddenly onset of tachypnea,R60 bpm,increased pulmonary rales.Tachycardia that can not be explained by high fever or tachypnea,HR180 bpm Irritability and cyanosis Gallop rhythm or dull heart sound,distension of jugular vein and enlarged cardiac Increased liver with tenderness,
28、1.5cm.Oliguria or anuria that present with edema of eyelid or lower extremities.,Myocardial failure,Empyema of pleuraPurulent pneumothoraxBullae of lung Septicemia Purulent pericarditis,Complication,Peripheral blood examination White cell count CRP(C-reactive protein)Nitroblue tetrazolium testEtiolo
29、gical examination Bacteriological examination：Bacterial culture Virological examination：Viral isolation Examination of mycoplasma：Specific immunity examination,Laboratory Examination,Lobular pneumonia(Bronchopneumonia),Pathogen Streptococcus pneumoniae Haemophilus influenzaePathology Pathological ch
30、anges such as hyperemia and edema of bronchiolar wall,exudation of pulmonary lobule,and bronchiolar obstruction are scattered surround bronchus.Clinical manifestation Hyperpyrexia,cough,tachypnea and dyspnea More common in infants,aged people and weak people,Increase lung markings,Diffuse bilateral
31、Patchy infiltrates and consolidation scattered throughout both lungs,Atelectasis,hyperinflation,bullae of lung and pyothorax,Chest radiographic findings in bronchopneumonia,Chest radiographic findings in bronchopneumonia,Frontal views:Patchy infiltrates and consolidation at the inner zone and middle
32、 zone of bilateral lower lobes,with or without hyperinflation,Segmental atelectasis,Frontal views:It is a segmental atelectasis at the right superior lobe.The transversa fissure is displaced toward the airless lobe.There is a sector high density shadow with the apex toward the hilum of lung.The diap
33、hragm is elevated and the mediastinum is shifted to the side of involvement.,Lobar pneumonia,Pathogen:maily streptococcus pneumoniaePathology:inflammtion infiltrates throughout a whole lobe or segment of the lung.Main clinical manifestation:More common in adolescence,rare in young children.Hyperpyre
34、xia,cough,and rusty sputumX-ray findings Change after changes of clinical symptoms.,Lobar pneumonia at middle lobe of right lung,Frontal views:A consolidation within the transverse fissure and oblique fissure can be seen at the middle lobe of right lung,viral disease,RSV(85%).aged 2-6 months.airway
35、obstruction is due to pathological changes include swelling and distension of bronchioles,secretions blockage.,Bronchiolitis,expiratory wheezing tachypnea,nasal flaringCyanosis fine rales emphysemaThe duration of illness is 4 7 days,Clinical Manifestation,Hyperexpansion is commonly present Peribronc
36、hial cuffingIncreased interstitial markings Patchy infiltrates,Chest radiographic findings,Frontal views of CXR:Ground-glass opacity Decreased lung markingsPatchy infiltrates in innner and middle zoneAcquired hyperinflation,RSV Pneumonia,Escherichia coli is the most common pathogen in neonate.In you
37、ng infants 1 week,mainly pathogen are staphylococcus aureus and hemolytic streptococcus.Some patients may present only with signs of generalized toxicity.Patient uauslly present no cough or fever.Rales are seldom heard on ausculation.Clinical manifestation may be milk-resistant,drowsiness,low respon
38、se,and tachypnea.Cyanosis,foaming at mouth,nodding respiration or apnea may present in severe cases.Respiratory signs is rare.,Pneumonia of newborn,Chest X-ray,Frontal views:There is patchy shadows and infiltrates at right lung field.,Adenovirus pneumonia,Type 3,7 adenovirusYoung children（6 mo-2 yr）
39、are more often affectedAcute onset of high fever,toxic symptoms and pale face.Sometimes present with cardiac dysfunction and symptom of nervous system Severe cough,dyspnea and wheezing Respiratory signs such as fine rales occur after 3-4 daysPatchy infiltrates and consolidation with hyperinflation.,
40、Adenovirus pneumonia,Frontal views:Chest radiographs reveals diffuse interstitial and patchy alveolar infiltrates,peribronchial thickening,and focal consolidation throughout both lung field.,Staphylococcal pneumonia,More common in neonate and infantsPresent a sudden onset and progress quicklySigns i
41、nclude:rashes,severe toxic symptoms,digestive symptoms,convulsion and shockSigns vary with stage of diseaseConsolidation of lung is obviousChest X-ray reveals infiltrates,abscess and bullae of lung,Abscess of lung,Frontal views:Multiple round high density shadow in both sides,Pyopneumothorax,Encapsu
42、lated pleural effusion,Pulmonary Bulla,Female，7 day，hyperpyrexia and no cryingCXR:multiple giantair-containing cavity,Common cause of symptomatic pneumonia in older children Fever,dry cough are common symptoms Extrapulmonary complications sometimes occurChest radiographs are untypical,usually demons
43、trate interstitial or bronchopneumonic infiltrates,Mycoplasma pneumonia,Interstitial infiltrates in Mycoplasma pneumonia,A 5-year-old boycomplain of fever and cough.MP antibody(+)Frontal views of CXR:Increased lung markingsDiffuse patchy infiltratesVolume loss of lower lobes of bilateral lungEnlarge
44、d hilar shadow,Peak age of onset Clinical manifestation Laboratory examination X-ray examination Others,Diagnosis,Acute bronchitisPulmonary tuberculosisForeign body in bronchus,Differential Diagnosis,Nursing and supporting therapySymptomatic treatment：Oxygen supply Conscious sedation Pyretolysis Cou
45、gh suppressants Eliminate sputum Antimicrobial therapy Treatment of complicationEnhance immunity functionphysical treatment,Treatment,Principle of antibiotic treatment:Sensitive Early treatment Sufficiency Drug combination,Antimicrobial treatment,Antibiotic treatment,Antiviral treatment,There is no
46、ideal drug in antiviral therapy.Ribovirininterferon(IFN)Human Immunoglobulin Traditional chinese drug therapy Yuxingcao,Double coptis,Severe toxic symptom that include shock,ultrahyperpyrexia and toxic encephacopathy Increased secretions and bronchial spasm Complicated with pleural effusion in early
47、 period,Indication of Systemic corticosteroids,Heart failure：cardiotonic,sedative diuresis and oxygen supplyRespiratory Failure：suctioning,oxygen supply intubation and artificial respiratorToxic encephacopathy：anti-infection,oxygen supplY,correct acidosis,Treatment of severe pneumonia,Fever,cough,ta
48、chypnea and fine rales are four major symptoms of pneumonia.Besides,severe pneumonia present circulatory,neurological and digestive symptoms Diagnosis mainly depends on clinical manifestations and X-ray examination.According to the characteristics of clinical symptoms,signs and auxiliary examination,we classify different type and severity.Treatment should emphasize comprehensive treatment.Choose different antibiotics according to different pathogens.Pay attention to the importance of nursing,supporting therapy,and symptomatic therapy.,Summary,
