呼吸系统疾病（英文）ppt课件

Topics,Respiratory disorders Respiratory infections Pneumonia,Respiratory Disorders,50% of consultation with general practitioners or acute illness in young children and a third of consultations in older children 20-35% of acute pediatric admissions to hospital, some of which are life-threatening Asthma is the most common chronic illness of childhood Cystic fibrosis is the most common inherited disorder in Caucasians causing chronic disease,Respiratory Infections,The most frequent infections of childhood: 6- 8/year Pathogens:viruses,bacterial, other pathogens Host and environmental factors Classification of respiratory infections,Classification of Respiratory Infections,According to the level of the respiratory tree most involved: Upper respiratory tract infection Lower respiratory tract infection,Pneumonia,Enmei Liu Childrens Hospital, CMU,Case -1,Jack, age four months, is sent at home by his general practitioner because of two days of rapid, laboured breathing and poor feeding. He was born at 27 weeks gestation, birth weight 979g and was discharged home at three months of age. On examination he was a fever of 37.4C and a respiratory rate of 60 breaths/min. His chest is hyperinflated with marked intercoatal recession. On auscultation there are generalized fine crackles and wheezes.,Question,Do you have any comments or what do you conclude anything from this case?,Case -1,Jack, age four months, is sent at home by his general practitioner because of two days of rapid, laboured breathing and poor feeding. He was born at 27 weeks gestation, birth weight 979g and was discharged home at three months of age. On examination he was a fever of 37.4C and a respiratory rate of 60 breaths/min. His chest is hyperinflated with marked intercoatal recession. On auscultation there are generalized fine crackles and wheezes.,Question,What is pneumonia?,Pneumonia is an inflammation of the parenchyma of the lungs.,Definition,Question,How about the prevalence of pneumonia?,Pneumonia accounts for approximately 15% of all respiratory tract infections. Worldwide, about 3 million children die each year from pneumonia, with the majority of these deaths occurring in developing countries. Pneumonia remains the most common cause of morbidity in China.,Incidence,Question,How to classify pneumonia in clinic?,Anatomy Pathogens Severity Duration Onset site,Classification,Bronchopneumonia Lobar or Lobular Pneumonia Interstitial Pneumonia,Based on anatomy or X-ray manifestation,Based on etiology,Bacterial pneumonia Viral Pneumonia Mycoplasma Pneumonia Chlamydia Pneumonia,Acute Pneumonia Prolonged Pneumonia Chronic Pneumonia,Based on the process of pneumonia,Mild Pneumonia Severe Pneumonia,Based on the severity of pneumonia,Community Acquired Pneumonia (CAP) Hospital Acquired Pneumonia (HAP),Based on the onset site of pneumonia,Bronchopneumonia,Question,Why are children likely have bronchopneumonia?,Characters of childhood airway anatomic structure and their respiratory physiology Immune function of childhood High risk factors: premature baby, underlying disorders,Question,What cause bronchopneumonia?, Bacteria: Streptococcus pneumoniae, Haemophilus influenzae Viruses Mycoplasma,Causes of Bronchopneumonia,Pathology of Pneumonia,Inflammaory exudate,Inflammaory exudate,Pathology of Pneumonia,Question,What are the pathophysiology of pneumonia?,Pathogens,URTI,Bronchitis,Pneumonia,Inflammatory exudate,Obstruction of airway,Gas exchange abnormal,Ventilation abnormal,hypoxemia,hypercapnia,toxinemia,tachypnea cyanosis,rales,fever,cough,Question,What are the signs and symptoms of pneumonia?,The clinical signs and symptoms of pneumonia depend primarily on the age of the patient, the causative organism, and the severity of the disease.,Fever,Cough,Cyanosis,Tachypenea,Rales,out breathing in,With inspiration, the side of the nostrils flares outwards,Nasal Flaring,With inspiration, the lower chest wall moves in,Lower Chest Wall Indrawing,out breathing in,Fever,Cough,Cyanosis,Tachypenea,Rales,Classic findings of pneumonia that occur in adults and older children, such as fever,cough and rales, are often absent in infants and toddlers. Generally present with nonspecific signs and symptoms including lethargy, irritability, poor feeding, vomiting. If it appear respiratory failure or other abnormality of other system-severe pneumonia.,Important Points,Complications,Empyema Pyopneumothorax Pneumatocele Lung abscesses Atelectasis,Laboratory Examination,White blood cell count and C-reaction protein Pathogens examination: 1)Sputum cultures 2)Blood cultures 3)Rapid screening tests for virus or bacterial Bronchoscopy Blood gas analysis: hypoxia and/or hypercapnia,Radiograph Evaluation,Typical X-ray manifestation of bronchopneumonia is patchy infiltrates bilaterally Complication: lung abscesses, empyema, pyopneumothorax, pneumatocele, atelectasis CT,Patchy infiltrates,lung abscesses,pyopneumothorax,Question,How to diagnosis pneumonia clinically?,According to the typical clinical manifestation of bronchopneumonia. According to X-ray manifestation Pay attention to the atypical manifestation of infants Evaluate the severity of pneumonia Find the etiology of pneumonia,Differential Diagnosis,Bronchitis Foreign Body Inspiration Tuberculosis,Question,How is pneumonia treated?,Management,Supportive care Antimicrobials therapy Hospitalization in selected cases,Supportive Care Adolescents.,Respiratory care may range from oxygenation, bronchodilators for wheezing, humidification or mist, suctioning, and postural drainage, intubation and mechanical ventilation. Hydration (sometimes intravenous) Control of fever Management of complications,Antimicrobial Therapy Adolescents.,Viruses,Organisms Causing Pneumonia and Empiric Therapy in Pediatric,Question,How about the clinical course of pneumonia ?,With treatment, pneumonia caused by bacteria can usually be cured in 1 or 2 weeks Pneumonia caused by a virus often lasts longer,Clinical Course Adolescents.,Specific Pneumonias,Brochiolitis,Brochiolitis is the most common serious respiratory infection of infancy Two to three per cent of all infants are admitted to hospital with the disease each year during annual winter epidemics. Ninety per cent are aged 1-9 months bronchiolitis is rare after one year old. Respiratory syncytial virus (RSV) is the pathogen in 75- 80% cases,Clinical Features,Coryzal symptoms precede a dry cough and increasing breathlessness. Wheezing is often but not always present. Feeding difficulties associated with increasing dyspnoea are often the reason for admission to hospital. Recurrent apnoea is a serious complication in infants in the first few months of life. Infants born prematurely who develop bronchopulmonary dysplasia and infants with congenital heart disease are more severely affected. The finding on examination are characteristic: Sharp, dry cough Tachypnoea Subcostal and intercostals recession Hyperinflation of the chest,Investigations,RSV can be identified rapidly using a fluorescent antibody test on nasopharyngeal secretions. The chest X-ray shows hyperinflation of the lungs due to small airways obstruction and air trapping. Blood gas analysis, which is required in only the most severe cases, shows lowered arterial oxygen and raised CO2 tension,Hyperinflation of the lungs with flattening of diaphragm,Management,Is supportive. Humidified oxygen is delivered into a head- box Mist, antibiotics and steroids are not helpful Nebulised bronchodialators do not reduce the severity or duration of the illness The antiviral drug ribavirin only marginally shortens viral excretion and clinical symptoms, and should be considered only for infants with underlying cardiopulmonary disorders or immunodeficiency Fluids may need to be given by nasogastric tube or intravenously Mechanical ventilation is required in about 2% of infants admitted to hospital,Etiology： Respiratory syncytial virus (RSV) is the pathogen in 75-80% cases Clinical features: Age:3-6 month Season Wheezing X-ray Duration:7-10 days Management:,Bronchiolitis,Staphylococcus aureus .,S. aureus is an uncommon but important cause of pneumonia that can occur in any age group. S. aureus is a rapidly progressive fulminant illness S. aureus pneumonia easily occurs complications. Blood cultures are positive in 20-30% of patients . The pleural effusions should be drained by thoracentesis or, if large, by a chest tube. Pneumatoceles are also common and are found in 45- 60% of patients with S. aureus pneumonia. Methicillin or vancomycin should be administered for 3-4weeks.,Mycoplasma Pneumonia,M pneumoniae is a common cause of symptomatic pneumonia in older children. Endemic and epidemic infection can occur. The incubation period is long (2-3weeks), and the onset of symptoms is slow. Although the lung is the primary infection site, extrapulmonary complications sometimes occur.,Clinical Features,Fever, cough, headache, and malaise are common symptoms as the illness evolves. Rales are frequently present on chest examination, decreased breath sounds or dullness to percussion over the involved area may be present.,Laboratory findings,The total and differential white blood cell counts are usually normal. The cold hemagglutinin titier should be determined, because it may be elevated during the acute presentation. A titer of 1:64 or higher supports the diagnosis.,Imaging,Chest x-rays usually demonstrate intersititial or bronchopneumonic infiltrates, frequently in the middle or lower lobes. Pleural effusions are extremely uncommon.,Complications,Extrapulmonary involvement of the blood, CNS, skin, heart, or joints can occur Direct Coombs-positive autoimmune hemolytic anemia,Coagulation defects and thrombocytopenia can also occur A wide variety of skin rashes including erythema multiforma and Stevens-Johnson syndrome,Treatment,Antibiotic therapy with erythromycin for 7- 10 days usually shortens the course of illness. Supportive measures, including hydration, antipyretics, and bed rest, are helpful.,Chlamydial Pneumonia,Pulmonary disease due to C trachomatis usually evolves gradually as the infection descends the respiratory tract. Infants may appear quite well despite the presence of significant pulmonary illness. Appropriate age: 2-12 weeks Inclusion conjunctivitis, eosinophilia, and elevated immunoglobulins can be seen.,Clinical Features,About 50% of patients with chlamydial pneumonia have active inclusion conjunctivitis or a history of it Rhinopharyngitis with nasal discharge or otitis media may have occurred or may by currently present Cough is usually present. It can have a staccato character and resemble the cough of pertussis The infant is usually tachypenic. Scattered inspiraotrt rales are commonly heard, but wheezes rarely Significant fever suggests a different or additional diagnosis,Laboratory findings,Although patients may frequently be hypoxemic, CO2 retention is not common. Peripheral blood eosinphilia has been observed in about 75% of patients. Serum immunloglobulins are usually abnormal. IgM is virtually always elevated, IgG is high in many, and IgA is less frequently abnormal. C trachomatis can usually be identified in nasopharyngeal washings using fluorescent antibody or culture techniques.,Imaging,Chest x-rays usually reveal diffuse interstitial and patchy alveolar infiltrates, peribronchial thickening, or focal consolidation. A small pleural reaction can be present . Despite the usual absence of wheezes, hyperexpansion is commonly present.,Treatment,Erythromycin or sulfisoxazole therapy should be administered for 14 days. Oxygen therapy may be required for prolonged periods in some patients.,Summary,Pneumonia in pediatric patients encompasses a wide spectrum of etiologies and illness from mild to severe and life threatening. Therapy should include an antibiotic if a bacteria or atypical bacteria (chlamydia or mycoplasma) is suspected. No antibiotics are necessary for viral pneumonia. Supportive therapy also includes fever control, maintenance of hydration and respiratory care . Close follow-up is necessary in order to detect any secondary bacterial infection or the development of complications.,Key Issues,Etiology of pneumonia Pathophysiology of pneumonia Clinical feature of pneumonia Diagnosis and differential diagnosis of pneumonia Management of pneumonia Several special pneumonias,Case -2,History: A 9-week old female infa