Acute Bron Rds
-
Upload
rikasusanti101001201 -
Category
Documents
-
view
237 -
download
0
description
Transcript of Acute Bron Rds
Prof. dr.H.Rusdidjas, SpA(K) Prof.dr.Hj. Rafita Ramayati.
SpA(K) dr Hj. Oke Rina Ramayani.SpA Bgn Ilmu Kes. Anak FK-UISU, Jalan
SM Raja Medan
20.6.2000
1
1. Bronchitis and 2. Aspiration Pneumonia
3. Emphysema; 4. Chronic Brochitis; 5. Asthma
1. Acute bronchitis Acute inflammation of the mucous
membranes of the trachea and bronchi (duration < 4 weeks)
+ productive cough
+ upper respiratory tract symptoms
+ general symptoms (in 10 - 50%)
29.8.2011
2
20.6.2000
3
CRDTF
Calor, Rubor, Dolor, Tumor, Fungsio lesa)
20.6.2000
4
Aetiology of acute bronchitis
Common resp. tract viruses (80%) RSV Bacteria (in about 20% of cases):
Pneumococci ( in 2 - 30%)? Haemophilus ( in 2 - 8%)? Mycoplasma (in 0.5 - 11%) Chlamydia (in 0 -18%) (Pertussis (in 0 - 7%))
(RSV) Respiratory Syncitial Virus
20.6.2000
5
Diagnosis of acute bronchitis
The aim is to Dari semua pasien yg BATUK, Identifikasi peny.
Lain yg memerlukan pengobatan spesifik ( ump: pneumonia, sinisitis, asthma)
(identify, among all patients with cough, those with other illnesses other illnesses needing specific treatment needing specific treatment (e.g. pneumonia, sinusitis, asthma)
Dari semua pasien yg BRONCHITIS, Identifikasi Peny. yg memerlukan Antibiotika (identify, among all patients with bronchitis, those who would who would benefit from antibiotics)benefit from antibiotics)
20.6.2000
6
(Differential) diagnosis
History (e.g. asthma)
Health status (general condition, auscultation) X-ray (to exclude pneumonia)
CRP (high CRP refers to bacterial aetiology or pneumonia)
Sinus ultrasound (to exclude sinusitis)
Antibody testing (of a few representative patients if needed to establish an epidemic)
Easy access to a follow-up visit (inform your assistants!)
20.6.2000
7
Kapan perlu di X-ray When is chest x-ray needed?
patient is particularly unwell (Kurang sahat) patient is particularly prone to pneumonia due
(menjurus ke )
to underlying disease, age or alcoholism history of pneumonia within the preceding year upper respiratory tract symptoms absent patient requests x-ray (pneumonia can not be
excluded on clinical symptoms and findings only)
20.6.2000
8
Treatment of acute bronchitis
First choice: First choice: no antibiotics!
Factors supporting antibiotic treatment:Factors supporting antibiotic treatment:
CRP > 50 mg/l patient is particularly unwell or becoming so pyrexia of over week’s duration or patient
pyrexial following a period of apyrexia epidemiological state patient is immunocompromised
20.6.2000
9
Antimicrobial therapy of acute bronchitis 1
First choice:First choice: in most cases good effect on pneumococci is
sufficient penicillin resistance in pneumococci in Finland is
low (R < 1%) (A) penicillin Vpenicillin V: 1-1.5 mega units 8 hourly for 5 – 7 days [ 1
tab = 250 mg = 400.000 unit] Dosis: < 12 thn : 25-50 mg/Kg/day dibagi 6-8 jam /x > 12 thn, adult : 125 – 500 mg/Kg/day –”- for patients with penicillin allergy a first -generation a first -generation
cephalosporincephalosporin
20.6.2000
10
Antimicrobial therapy of acute bronchitis 2
Other choices:Other choices: probable mycoplasma or chlamydia infection:
doxycyclinedoxycycline 100-150 mg daily for 5 – 7 days a macrolidea macrolide: erythromycin 500mg 3 - 4 times
daily, roxithromycin 150 mg twice daily, klarithromycin 250mg twice daily or azithromycin 250 mg daily for 5 –7 days
underlying chronic lung disease: amoxicillin, sulphatrimethoprimamoxicillin, sulphatrimethoprim
20.6.2000
11
Symptomatic treatment of acute bronchitis
No benefit is gained on cough with codeine, salbutamol or dextromethorphan as compared with a placebo,
...but cough improves considerably even during a placebo-treatment
patient often presents with additional symptoms, which can be eased with antihistamines, anticholinergic and/or sympatomimetic agents, but their benefit benefit remains controversialremains controversial!!
TKS
20.6.2000
12
Sambung ke Aspirasi pneumonia
2. Aspirasi Pneumonia
Pada anak Bayi sering ter sedak, masuk susu / ASI atau benda asing (corpus aliena) kedalam Alveoli. edema, cairan Radang
Pada anak Besar :-Kacang tojin-wang coin- Benda asing - dll
Managemen Aspirasi Pneumonia
Dpt dikethui dengan Anamnesis yang teliti
Konsultkan ke Bgn THT
Benda asing yang padat Endoskopy
Susu / ASI sama dgn pengobatan Pneumonia
Harus dirawat di RS
TKSS
20.6.2000
17
Emphysema Chronic Bronchitis Asthma
Obstructive and Inflammatory Lung Disease
20.6.2000
18
Chronic Bronchitis Recurrent or chronic productive cough
for a minimum of 3 months for 2 consecutive years.
Risk factors Cigarette smoke Air pollution
20.6.2000
19
Emphysema: Pathophysiology
Structural changes Hyperinflation of alveoli Destruction of alveolar &
alveolar-capillary walls Small airways narrow Lung elasticity
decreases
20.6.2000
20
Abnormal distension of air spaces
Actual cause is unknown
Ok ada Pores of Kohn (ada hubungan dari alv ke alv yg lain)
Emphysema: Pathophysiology
20.6.2000
21
Chronic Bronchitis Pathophysiology
Chronic inflammation
Hypertrophy & hyperplasia of bronchial glands that secrete mucus
Increase number of goblet cells
Cilia are destroyed
20.6.2000
22
Chronic Bronchitis Pathophysiology …….. Bronchospasm often occurs End result
Hypoxemia Hypercapnea Polycythemia (increase RBCs)
Cyanosis Cor pulmonale (enlargement of right side of heart)
20.6.2000
23
Narrowing of airway Starting w/ bronchi
smaller airways airflow resistance work of breathing Hypoventilation & CO2
retention hypoxemia & hypercapnea
Chronic Bronchitis Pathophysiology ……..
Chronic Bronchitis: Diagnostic Tests
PFTs (Pulmonary Function Tests) FVC: Forced vital capacity FEV1: Forcible exhale in 1 second FEV1/FVC = <70%
ABGs (Arterial Blood Gas analysis) PaCO2 PaO2
CBC (Cell Blood Counts) Hct
Asthma Reversible inflammation & obstruction Intermittent attacks Sudden onset Varies from person to person Severity can vary from shortness of breath
to death
Asthma Triggers
Allergens Exercise Respiratory infections Drugs and food additives Nose and sinus problems GERD Emotional stress
ANTIMICROBIAL TREATMENT STRATEGIES
Asthma: Pathophysiology
Swelling of mucus membranes (edema)
Spasm of smooth muscle in bronchioles
Increased airway resistance
Increased mucus gland secretion
QuickTime™ and aTIFF (LZW) decompressor
are needed to see this picture.
Asthma: Early Clinical Manifestations
Expiratory & inspiratory wheezing Dry or moist non-productive cough Chest tightness Dyspnea Anxious &Agitated Prolonged expiratory phase Increased respiratory & heart rate Decreased PEFR
Pencetus
20.6.2000
30
TKSS