Diseases of the respiratory tract
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Transcript of Diseases of the respiratory tract
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Diseases of the Diseases of the respiratory tractrespiratory tract
Dr. György Fekete Dr. György Fekete
www.gyer2.sote.huwww.gyer2.sote.hu
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Pediatric pulmonary diseasesPediatric pulmonary diseases
50% of deaths under age of 1 yr50% of deaths under age of 1 yr 20% of all hospitalisations under age 20% of all hospitalisations under age
of 15 yrsof 15 yrs 7% of children: chronic disorder of the 7% of children: chronic disorder of the
lower respiratory systemlower respiratory system
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Most common diseasesMost common diseases
Viral upper respiratory infectionsViral upper respiratory infections Otitis mediaOtitis media PneumoniaPneumonia AsthmaAsthma Cystic fibrosisCystic fibrosis
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SymptomsSymptoms
Dyspnea, tachypnea, hyperpneaDyspnea, tachypnea, hyperpnea CoughCough Chest painChest pain Rales(crackles), rhonchiRales(crackles), rhonchi WheezingWheezing RetractionsRetractions FeverFever
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Diagnostic measuresDiagnostic measures
History (parents, child)History (parents, child) Inspection (flaring of alae nasi)Inspection (flaring of alae nasi) Auscultation (take a deep breath: blow out a candle)Auscultation (take a deep breath: blow out a candle) Respiratory rate (younger than 1 year: 25-35/min, Respiratory rate (younger than 1 year: 25-35/min,
sleeping)sleeping) Imaging techniquesImaging techniques Arterial blood gas analysisArterial blood gas analysis Pulse oximetry, capnographyPulse oximetry, capnography Pulmonary function testingPulmonary function testing Laryngoscopy, bronchoscopyLaryngoscopy, bronchoscopy
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Congenital disordersCongenital disorders
Laryngomalacia:Laryngomalacia: first 6 weeks, first 6 weeks, inspiratory stridor, underdevelopment inspiratory stridor, underdevelopment of supraglottic cartilageof supraglottic cartilage
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Subglottic hemangiomasSubglottic hemangiomas
stridorstridor
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Vascular ringsVascular rings
Compress the trachea /esophagus: double Compress the trachea /esophagus: double aortic arch, pulmonary slingaortic arch, pulmonary sling
In infants: chronic airway obstruction, In infants: chronic airway obstruction, stridor, wheezing, croupy cough, apnea stridor, wheezing, croupy cough, apnea
Dg:Dg: barium swallow: esophageal barium swallow: esophageal compressioncompression
Th:Th: surgical correction surgical correction
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Allergic rhinitisAllergic rhinitis
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Allergic rhinitisAllergic rhinitis
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Allergic rhinitisAllergic rhinitis
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Croup syndromeCroup syndrome
Viral croup:Viral croup: parainfluenza, RSV, parainfluenza, RSV, adenovirusadenovirus
Mycoplasma pneumoniaeMycoplasma pneumoniae Barking cough, stridor, retractions, Barking cough, stridor, retractions,
cyanosiscyanosis Th:Th: oral hydration, nebulized racemic oral hydration, nebulized racemic
epinephrine (2.25% sol.), oral epinephrine (2.25% sol.), oral dexamethasone (0.15 mg/kg), inhaled dexamethasone (0.15 mg/kg), inhaled budenosidebudenoside
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EpiglottitisEpiglottitis
Emergency! 2-7 yrsEmergency! 2-7 yrs Haemophilus influenzae type B (vaccination)Haemophilus influenzae type B (vaccination) Sudden onset of feverSudden onset of fever Dysphagia, muffled voice, cyanosis, stridor, Dysphagia, muffled voice, cyanosis, stridor,
inspir. retractionsinspir. retractions Progression to total airway obstructionProgression to total airway obstruction Th:Th: endotracheal intubation, ceftriaxone iv. endotracheal intubation, ceftriaxone iv. Manipulate as little as possible!Manipulate as little as possible!
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Foreign body aspiration, upper Foreign body aspiration, upper respiratory tractrespiratory tract
6 mo. – 4 yrs (small toys, peanuts)6 mo. – 4 yrs (small toys, peanuts) Acute onset of cyanosis, choking, stridor Acute onset of cyanosis, choking, stridor
(partial obstruction), inability to caugh or (partial obstruction), inability to caugh or vocalize / aphonia / (complete obstruction)vocalize / aphonia / (complete obstruction)
Loss of consciousness, seizures, Loss of consciousness, seizures, cardiopulmonary arrestcardiopulmonary arrest
Th:Th: emergency intubation, tracheostomy emergency intubation, tracheostomy
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Foreign body aspiration, lower Foreign body aspiration, lower respiratory tractrespiratory tract
Sudden onset of caugh, wheezing,later chronic Sudden onset of caugh, wheezing,later chronic cough, recurrent pneumoniacough, recurrent pneumonia
Bronchiectasis, lung abscessBronchiectasis, lung abscess Physical finding: asymmetric breath sounds, Physical finding: asymmetric breath sounds,
localized wheezinglocalized wheezing Dg.:Dg.: inspiratory and forced expiratory chest X- inspiratory and forced expiratory chest X-
ray : mediastinal shift away from the affected ray : mediastinal shift away from the affected side (Holzknecht sign)side (Holzknecht sign)
Complete obstruction: atelectasisComplete obstruction: atelectasis Th:Th: bronchoscopy bronchoscopy
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BronchitisBronchitis
Acute:Acute: nonproductive caugh, low fever nonproductive caugh, low fever Physical symptom: diffuse rhonchiPhysical symptom: diffuse rhonchi Viral infectionViral infection Chronic:Chronic: non-infectious causes: asthma, non-infectious causes: asthma,
sinusitis, cystic fibrosis, respiratory tract sinusitis, cystic fibrosis, respiratory tract anomalies, foreign bodies, recurrent anomalies, foreign bodies, recurrent aspirationaspiration
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AsthmaAsthma
Risk factors:Risk factors: atopic dermatitis, smoking in atopic dermatitis, smoking in the familythe family
Shedding of airway epithelium, edema, Shedding of airway epithelium, edema, mucus plug formation, mast cell activationmucus plug formation, mast cell activation
Sensitisation to inhalant allergens: Sensitisation to inhalant allergens: perennial aeroallergens, dust mites, perennial aeroallergens, dust mites, cockroaches, animalscockroaches, animals
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Mast cell, Normal marrowOne mast cell partially degranulated (vacuolated areas), 1 plasma cell, 1 blast (top right center) 4 neutrophilic myelocytes, 2 band neutrophils, 1 smudge cell. Normal marrow - 100X
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AsthmaAsthma
Wheezing, caugh, dyspnea, exercise Wheezing, caugh, dyspnea, exercise intolerance, recurrent bronchitis and intolerance, recurrent bronchitis and pneumonia, prolongation of the expiratory pneumonia, prolongation of the expiratory phasephase
Flaring of nostrils, intercostal- suprasternal Flaring of nostrils, intercostal- suprasternal retractionsretractions
Hypoxia: cyanosis of the lips, nail beds, Hypoxia: cyanosis of the lips, nail beds, tachycardia, agitation tachycardia, agitation
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AsthmaAsthma
X-ray: hyperinflation , atelectasisX-ray: hyperinflation , atelectasis Serum IgE elevated, RIA for specific Serum IgE elevated, RIA for specific
allergensallergens Skin testsSkin tests Pulmonary function tests (FEV1, PEFR)Pulmonary function tests (FEV1, PEFR)
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Asthma treatmentAsthma treatment
Stepwise approach, assessment of clinical Stepwise approach, assessment of clinical symptomssymptoms
Inhaled corticosteroidsInhaled corticosteroids Long-acting inhaled beta-2 agonistsLong-acting inhaled beta-2 agonists Rescue: systemic corticosteroidsRescue: systemic corticosteroids BronchodilatorsBronchodilators Leukotriene receptor antagonists and modifiers Leukotriene receptor antagonists and modifiers
(Montelukast, zileuton)(Montelukast, zileuton) Anti-inflammatory drugsAnti-inflammatory drugs
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< back
Nebulizer use - part one
Nebulizers are used to treat asthma, Chronic Obstructive Pulmonary Disease (COPD), and other conditions where inhaled medicines are indicated. Nebulizers deliver a stream of medicated air to the lungs over a period of time.
Review Date: 9/11/2002 12:00:00 AMReviewed By:A.D.A.M Medical Illustration Team
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Bronchopulmonary dysplasia Bronchopulmonary dysplasia (BPD)(BPD)
Acute respiratory distress, first week of lifeAcute respiratory distress, first week of life 30% of infants with birth-weight of less 30% of infants with birth-weight of less
than 1000 gramsthan 1000 grams Chronic lung disease, inflammatory Chronic lung disease, inflammatory
mediators, infection, lung development, mediators, infection, lung development, barotraumabarotrauma
Oxygen requirement for more than 28 Oxygen requirement for more than 28 days, positive pressure ventilation, CPAP, days, positive pressure ventilation, CPAP, gestational agegestational age
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Bacterial pneumoniaBacterial pneumonia
Risks:Risks: aspiration, immunodeficiency, aspiration, immunodeficiency, tracheoesophageal fistula, cleft palate, CF, tracheoesophageal fistula, cleft palate, CF, congestive heart failure, splenectomia,etc.congestive heart failure, splenectomia,etc.
Fever, cough, dyspnea, meningismus, Fever, cough, dyspnea, meningismus, abdominal pain, otitis media, abdominal pain, otitis media,
Laboratory findings:Laboratory findings: elevated WBC, CRP elevated WBC, CRP Chest X-rayChest X-ray Age-specific bacteriaAge-specific bacteria Complications:Complications: empyema, sepsis, abscesses empyema, sepsis, abscesses
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Mediastinal massesMediastinal masses
Cough, wheezing, symptoms of infection, Cough, wheezing, symptoms of infection, hemoptysis, dysphagia, pressure on the hemoptysis, dysphagia, pressure on the recurrent laryngeal nerve: hoarseness, recurrent laryngeal nerve: hoarseness, vena cava superior syndromevena cava superior syndrome
Cystic hygromas, vascular or neurogenic Cystic hygromas, vascular or neurogenic tumors, thymic masses, lymphomas, tumors, thymic masses, lymphomas, teratomas, esophageal lesions, teratomas, esophageal lesions, mediastinal abscessmediastinal abscess