小儿呼吸疾病课件.ppt

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1、小儿呼吸疾病（英文ppt）IntroductionIntroductionn High Morbidity RateHigh Morbidity Raten High Mortality RateHigh Mortality RatelEach year,respiratory infection diseases cause about 15 million deaths among children younger than age 5 year through the world.l Pediatric pulmonary infection accounts for about 63.

2、89%of all hospitalizations of children,in which 44.6 percent are pneumonia.Cricoid cartilageUpper respiratory tractUpper respiratory tract nose,paranasal sinuses,pharynx,eustachian tube,epiglottis,larynxLower respiratory tractLower respiratory tract:trachea,bronchi,bronchioles,alveolus Anatomy Anato

3、my Anatomy Anatomy Upper respiratory tractUpper respiratory tract Short Short Nasal passages,nasolacrimal duct and eustachian tubeNasal passages,nasolacrimal duct and eustachian tubeSignificance:These characters make nasal cavity easy to become hyperemia,edema,and congestion which will induce infect

4、ion.Local infection can spread to nearby organs and tissues easily and cause dyspnea,hoarseness and apnea.Nasal mucosaNasal mucosaIs softIs softMore vascularMore vascular Nasal cavity Nasal cavity is short and is short and narrow narrow Anatomy Anatomy Narrowed airwayNarrowed airwayNarrowed airwayNa

5、rrowed airwaySoft mucous menbraneSoft mucous menbraneSoft mucous menbraneSoft mucous menbraneMore vascularMore vascularMore vascularMore vascularSofter and more compliantSofter and more compliantSofter and more compliantSofter and more compliant Clinical significance:Easy to become hyperemia,edema,a

6、nd congestion Easy to become hyperemia,edema,and congestion which will induce infection which will induce infectionComplication:Pulmonary emphysema and atelectasisComplication:Pulmonary emphysema and atelectasisLower Lower respiratory respiratory tracttractPhysiologyPhysiologyThe younger the child T

7、he younger the child The younger the child The younger the child The quicker the frequencyThe quicker the frequencyThe quicker the frequencyThe quicker the frequencyThe less regular the rhythmThe less regular the rhythmThe less regular the rhythmThe less regular the rhythmVital capacity(VC)Vital cap

8、acity(VC)Tidal volumeTidal volumeTotal lung capacity(TLC)Total lung capacity(TLC)Respiratory frequency and rhythm：The respiratory frequency is inversely related to ageThe 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

9、 bpm。(2)Some young infants present with irregular rhythm or apnea 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 lLow level of sIgA,IgG on Low level of sIgA,IgG on Respiratory Mucosal Low level of Low level of Th1 functionAcute Upper Respiratory Tract Acute Upper Respirator

10、y Tract Acute Upper Respiratory Tract Acute Upper Respiratory Tract Infection Infection Infection Infection “Common Common Common Common cold”cold”cold”cold”Acute Upper Respiratory Acute Upper Respiratory InfectionInfectionIntroductionIntroductionl 80-90%proportion of visit to clinic.l spread to nea

11、rby organs and tissues (otitis media,conjunctivitis,lymphadenitis,lymphadenitis and pneumonia)lBronchial asthma,nephritis,myocarditis,measles and pertussis may also follow AURI 90%of 90%of AURI are AURI are caused by caused by viral viral infectioninfectionEtiology Etiology RhinovirusEcho virusCoxsa

12、ckievirusParainfluenzaInfluenzaAdenovirusRSV(Respiratory Syncytial Virus)PneumococcusMoraxelle catarrhalis Haemophilus influenzaeStaphylococcus aureusBacteriaBacteriaMycoplasmaChlamydia Other MicroorganismsOthersOthersMild symptomMild symptomMild symptomMild symptom Nasal congestion,rhinorrhea,Nasal

13、 congestion,rhinorrhea,sneezing,sore throat sneezing,sore throatSevere symptomSevere symptomSevere symptomSevere symptom High fever,convulsion,High fever,convulsion,anorexia,frequency cough anorexia,frequency coughClinical ManifestationClinical Manifestation Symptoms of URI in Symptoms of URI in chi

14、ldren of different children of different agesageslThe pharynx is red lRetropharyngeal folliculosislErythematous enlarged tonsils lEnlarged lymph nodeslEnterovirus illnesses may be associated with a wide variety of skin rashesPhysical SignPhysical Sign HerpanginaHerpanginalCoxsackievirus AlMost often

15、 occurs in summer and autumnlMore often in infants（0-3 yr of age）lCharacterized by sudden onset of fever,sore throat and dysphagia lCharacteristic lesions,present on the posterior pharynx,are discrete vesicles and ulcerslDuration of illness is usually 7 days Two Special TypesTwo Special TypeslOccurs

16、 typically with type 3,7 Occurs typically with type 3,7 adenovirus adenovirus lMost often occurs in spring and Most often occurs in spring and summersummerlChildren Children（3 yr 3 yr）more often more often affectedaffectedlFeatures include:Features include:A high temperature that lasts A high temper

17、ature that lasts 45 days,pharyngitis,45 days,pharyngitis,conjunctivitis,cervical conjunctivitis,cervical lymphadenopathy,and rhinitis.lymphadenopathy,and rhinitis.lDuration of illness is usually 1-2 Duration of illness is usually 1-2 weeksweeksPharyngoconjunctival FeverPharyngoconjunctival FeverOtit

18、is mediaCervical lymphadenitisBronchitisPneumoniaSepticemiaComplication Viral Infection Viral Myocarditis Viral EncephalitisBacterial Infections（streptococcus)Acute Nephritis Rheumatic FeverDiagnosisDiagnosislSymptoms lsighslThe differential diagnosis of the URl includes other acute infectious disea

19、se.lIn patient with In patient with febrile convulsion,central nervous system Infections should also considered.lPatients with abdominal pain may have acute abdomen.Differential diagnosisDifferential diagnosisDifference Between Mesenteric Difference Between Mesenteric Difference Between Mesenteric D

20、ifference Between Mesenteric Lymphadenitis Lymphadenitis Lymphadenitis Lymphadenitis and and and and Acute appendicitisAcute appendicitisAcute appendicitisAcute appendicitisProphylaxisProphylaxisl Increase outdoor activities.l Improve physical fitness.l Enhance immunity function.l Patients in collec

21、tive institutions should be isolated.lGeneral treatment Etiological treatment Anti-virus：Ribavirin Avoid the abuse of antibioticslSymptomatic treatment Severe nasal obstruction Irritability-restlessness High fever Pharyngeal portion ulcer ConjunctivitisTreatmentTreatmentl Upper Upper respiratory res

22、piratory infection infection is is the the most most common common disease disease in in childhood,childhood,most of which are caused by viral infections.most of which are caused by viral infections.l The The severity severity of of clinical clinical manifestations manifestations is is related relat

23、ed to to age age of of the patients.the patients.Infants Infants present present mild mild local local symptoms symptoms and and severe severe systemic systemic symptoms,while older children present on the contrary.symptoms,while older children present on the contrary.A A stuffy,stuffy,congested con

24、gested nose nose may may exist exist in in infants infants younger younger than than 3 months of age.3 months of age.l Treatment Treatment for for the the common common cold cold should should be be mainly mainly symptomatic.symptomatic.Antibiotics Antibiotics should should not not be be used used u

25、nless unless in in those those young,young,infant infant patients patients which which are are suspected suspected to to complicate complicate bacterial bacterial infections.infections.SummarySummarylAcute bronchitis is inflammation of the tracheobronchial epithelium.lTrachea is usually involved，so

26、acute bronchitis is also called acute tracheobronchitis.lAcute bronchitis is commonly secondary to an acute viral infection,or just one manifestation of acute infectious disease.Acute BronchitisAcute BronchitislInfectious factors：viral,bacterial or other pathogen infectionslCharacters of respiratory

27、 tract of infants:The mucous become edema and hyperemia which make the bronchus narrower when inflammation.lOther factors：immunodeficiency,nutritional diseases,specific body constitution.EtiologyEtiologyClinical Clinical ManifestationManifestation lBegins as an URIlCough is a significant signs nonpr

28、oductive cough productivelThe systemic symptoms is usually severe in infants including fever,vomiting and diarrhealMedical examinationMedical examination：Respiratory rudeness Diffuse or scattered rales No dyspnealCXR:CXR:may be normal or thickening lung markings Acute bronchitis is an inflammation o

29、f the major Acute bronchitis is an inflammation of the major conducting airways within the lung which caused by viral or conducting airways within the lung which caused by viral or bacteria,and is most often in infants.Cough is the most bacteria,and is most often in infants.Cough is the most signifi

30、cant clinical manifestation.Fever,vomiting and significant clinical manifestation.Fever,vomiting and diarrhea are frequent in infants.Respiratory sounds are diarrhea are frequent in infants.Respiratory sounds are rough and scattered rales are heard on auscultation.rough and scattered rales are heard

31、 on auscultation.Radiographic examination of the chest may show a mild Radiographic examination of the chest may show a mild increase in bronchovascular markings.increase in bronchovascular markings.Antibiotics are Antibiotics are indicated if a bacterial infection of the airway is indicated if a ba

32、cterial infection of the airway is suspected or proven.Corticosteroids are recommended in suspected or proven.Corticosteroids are recommended in severe cases.severe cases.SummarySummary lPneumonia is an inflammation of the parenchyma of the lungs.l Most cases of pneumonia are caused by microorgnanis

33、ms,but there are several noninfectious causes,which include aspiration of food or gastric acid,foreign bodies and so on.Acute PneumoniaAcute PneumonialSeason of onsetSeason of onset lAge of onsetAge of onsetlMorbidity rateMorbidity ratelMortality rateMortality rateEpidemiologyEpidemiologyClassified

34、according to the infecting organism:Classified according to the infecting organism:Classified according to the infecting organism:Classified according to the infecting organism:Viral pneumonia,bacterial Pneumonia,mycoplasma Pneumonia.Classified according to Pathology:Classified according to Patholog

35、y:Classified according to Pathology:Classified according to Pathology:Bronchopneumonia,lobar pneumonia,interstitial pneumonia.Classified according to duration of disease:Classified according to duration of disease:Classified according to duration of disease:Classified according to duration of diseas

36、e:Acute pneumonia(3mo).Classified according to severity of disease:Classified according to severity of disease:Classified according to severity of disease:Classified according to severity of disease:Mild pneumonia and severe pneumonia.CategoryCategoryBacteriaBacteriaStreptococcus pneumoniae,Haemophi

37、lus influenzae,Staphylococcus aureus,Escherichia coli,Pseudomonas pyocyaneaVirusesRespiratory Syncytial Viruses,adenovirus,influenza,parainfluenzaothersIncidence rate of Chlamydia pneumoniae and Mycoplasma pneumoniae are increasing recent years.EtiologyEtiologyAgeAge More often in infantsDiseaseEnvi

38、ronmentMalnutrition,Congenital heart disease,Immunodeficiency diseasewetness,stuffiness and crowding.InducementInducementPatients with the following problems are particularly predisposed to this disease:lHyperemia,edema and inflammatory infiltration of lung tissueslAlveolar exudate lPatchy Inflammat

39、ion focus,and consolidation lAtelectasis and emphysema of lungPathologyPathologyfeverfevercoughcoughtachypneatachypneaRalesClinical ManifestionPneumoniaPneumoniaApart from the general features of bronchopneumonia,Apart from the general features of bronchopneumonia,severe pneumonia also present withs

40、evere pneumonia also present withl l systemic toxic symptoms in respiratory systemic toxic symptoms in respiratory system systeml lcirculatory systemcirculatory systeml lnervous system nervous system l ldigestive systemdigestive systemSevere PneumoniaSevere PneumoniaCirculatory systemMyocarditis,hea

41、rt failureMicrocirculation disturbanceDigestive systemGastrointestinal dysfunction,enteroplegiaAlimentary tract hemorrhageNervous systemIntracranial hypertensionEncephaledemaWater-Electrolyte BalanceMixed acidosis,dehydrationHyponatremiaExtrapulmoanry presentationsExtrapulmoanry presentations l Sudd

42、enly onset of tachypnea,R60 bpm,increased pulmonary rales.l Tachycardia that can not be explained by high fever or tachypnea,HR180 bpml Irritability and cyanosisl Gallop rhythm or dull heart sound,distension of jugular vein and enlarged cardiacl Increased liver with tenderness,1.5cm.lOliguria or anu

43、ria that present with edema of eyelid or lower extremities.Myocardial failureMyocardial failurelEmpyema of pleuralPurulent pneumothoraxlBullae of lung lSepticemia lPurulent pericarditis ComplicationlPeripheral blood examination White cell count CRP(C-reactive protein)Nitroblue tetrazolium testlEtiol

44、ogical examination Bacteriological examination：Bacterial culture Virological examination：Viral isolation Examination of mycoplasma：Specific immunity examination Laboratory ExaminationLaboratory ExaminationLobular pneumonia Lobular pneumonia (Bronchopneumonia)(Bronchopneumonia)lPathogenPathogen Strep

45、tococcus pneumoniae Haemophilus influenzaelPathologyPathology Pathological changes such as hyperemia and edema of bronchiolar wall,exudation of pulmonary lobule,and bronchiolar obstruction are scattered surround bronchus.lClinical manifestationClinical manifestation Hyperpyrexia,cough,tachypnea and

46、dyspnea More common in infants,aged people and weak peoplel lIncrease lung markingsIncrease lung markingsl lDiffuse bilateral Patchy infiltrates and Diffuse bilateral Patchy infiltrates and consolidation scattered throughout both consolidation scattered throughout both lungslungslAtelectasis,hyperin

47、flation,bullae of lung and pyothoraxChest radiographic findings in bronchopneumoniaChest radiographic findings in bronchopneumoniaFrontal views:Patchy infiltrates and consolidation at the inner zone and middle zone of bilateral lower lobes,with or without hyperinflationSegmental atelectasisSegmental

48、 atelectasisFrontal 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 diaphragm is elevated and the mediastinum is shifted to the side of involvem

49、ent.Lobar pneumonialPathogen:maily streptococcus pneumoniaelPathology:inflammtion infiltrates infiltrates throughout throughout a a whole lobe or segment of the lung.whole lobe or segment of the lung.lMain clinical manifestation:lMore common in adolescence,rare in young children.lHyperpyrexia,cough,

50、and rusty sputumlX-ray findings Change after changes of clinical symptoms.Lobar pneumonia at middle lobe of right lungFrontal views:A consolidation within the transverse fissure and oblique fissure can be seen at the middle lobe of right lung,lviral disease,RSV (85%).l aged 2-6 months.lairway obstru