呼吸系统疾病英文.ppt

Topics,RespiratorydisordersRespiratoryinfectionsPneumonia,RespiratoryDisorders,50%ofconsultationwithgeneralpractitionersoracuteillnessinyoungchildrenandathirdofconsultationsinolderchildren20-35%ofacutepediatricadmissionstohospital,someofwhicharelife-threateningAsthmaisthemostcommonchronicillnessofchildhoodCysticfibrosisisthemostcommoninheriteddisorderinCaucasianscausingchronicdisease,RespiratoryInfections,Themostfrequentinfectionsofchildhood:6-8/yearPathogens:viruses,bacterial,otherpathogensHostandenvironmentalfactorsClassificationofrespiratoryinfections,ClassificationofRespiratoryInfections,Accordingtotheleveloftherespiratorytreemostinvolved:UpperrespiratorytractinfectionLowerrespiratorytractinfection,Pneumonia,EnmeiLiuChildrensHospital,CMU,Case-1,Jack,agefourmonths,issentathomebyhisgeneralpractitionerbecauseoftwodaysofrapid,labouredbreathingandpoorfeeding.Hewasbornat27weeksgestation,birthweight979gandwasdischargedhomeatthreemonthsofage.Onexaminationhewasafeverof37.4Candarespiratoryrateof60breaths/min.Hischestishyperinflatedwithmarkedintercoatalrecession.Onauscultationtherearegeneralizedfinecracklesandwheezes.,Question,Doyouhaveanycommentsorwhatdoyouconcludeanythingfromthiscase?,Case-1,Jack,agefourmonths,issentathomebyhisgeneralpractitionerbecauseoftwodaysofrapid,labouredbreathingandpoorfeeding.Hewasbornat27weeksgestation,birthweight979gandwasdischargedhomeatthreemonthsofage.Onexaminationhewasafeverof37.4Candarespiratoryrateof60breaths/min.Hischestishyperinflatedwithmarkedintercoatalrecession.Onauscultationtherearegeneralizedfinecracklesandwheezes.,Question,Whatispneumonia?,Pneumoniaisaninflammationoftheparenchymaofthelungs.,Definition,Question,Howabouttheprevalenceofpneumonia?,Pneumoniaaccountsforapproximately15%ofallrespiratorytractinfections.Worldwide,about3millionchildrendieeachyearfrompneumonia,withthemajorityofthesedeathsoccurringindevelopingcountries.PneumoniaremainsthemostcommoncauseofmorbidityinChina.,Incidence,Question,Howtoclassifypneumoniainclinic?,AnatomyPathogensSeverityDurationOnsetsite,Classification,BronchopneumoniaLobarorLobularPneumoniaInterstitialPneumonia,BasedonanatomyorX-raymanifestation,Basedonetiology,BacterialpneumoniaViralPneumoniaMycoplasmaPneumoniaChlamydiaPneumonia,AcutePneumoniaProlongedPneumoniaChronicPneumonia,Basedontheprocessofpneumonia,MildPneumoniaSeverePneumonia,Basedontheseverityofpneumonia,CommunityAcquiredPneumonia(CAP)HospitalAcquiredPneumonia(HAP),Basedontheonsetsiteofpneumonia,Bronchopneumonia,Question,Whyarechildrenlikelyhavebronchopneumonia?,CharactersofchildhoodairwayanatomicstructureandtheirrespiratoryphysiologyImmunefunctionofchildhoodHighriskfactors:prematurebaby,underlyingdisorders,Question,Whatcausebronchopneumonia?,Bacteria:Streptococcuspneumoniae,HaemophilusinfluenzaeVirusesMycoplasma,CausesofBronchopneumonia,PathologyofPneumonia,Inflammaoryexudate,Inflammaoryexudate,PathologyofPneumonia,Question,Whatarethepathophysiologyofpneumonia?,Pathogens,URTI,Bronchitis,Pneumonia,Inflammatoryexudate,Obstructionofairway,Gasexchangeabnormal,Ventilationabnormal,hypoxemia,hypercapnia,toxinemia,tachypneacyanosis,rales,fever,cough,Question,Whatarethesignsandsymptomsofpneumonia?,Theclinicalsignsandsymptomsofpneumoniadependprimarilyontheageofthepatient,thecausativeorganism,andtheseverityofthedisease.,Fever,Cough,Cyanosis,Tachypenea,Rales,outbreathingin,Withinspiration,thesideofthenostrilsflaresoutwards,NasalFlaring,Withinspiration,thelowerchestwallmovesin,LowerChestWallIndrawing,outbreathingin,Fever,Cough,Cyanosis,Tachypenea,Rales,Classicfindingsofpneumoniathatoccurinadultsandolderchildren,suchasfever,coughandrales,areoftenabsentininfantsandtoddlers.Generallypresentwithnonspecificsignsandsymptomsincludinglethargy,irritability,poorfeeding,vomiting.Ifitappearrespiratoryfailureorotherabnormalityofothersystem-severepneumonia.,ImportantPoints,Complications,EmpyemaPyopneumothoraxPneumatoceleLungabscessesAtelectasis,LaboratoryExamination,WhitebloodcellcountandC-reactionproteinPathogensexamination:1)Sputumcultures2)Bloodcultures3)RapidscreeningtestsforvirusorbacterialBronchoscopyBloodgasanalysis:hypoxiaand/orhypercapnia,RadiographEvaluation,TypicalX-raymanifestationofbronchopneumoniaispatchyinfiltratesbilaterallyComplication:lungabscesses,empyema,pyopneumothorax,pneumatocele,atelectasisCT,Patchyinfiltrates,lungabscesses,pyopneumothorax,Question,Howtodiagnosispneumoniaclinically?,Accordingtothetypicalclinicalmanifestationofbronchopneumonia.AccordingtoX-raymanifestationPayattentiontotheatypicalmanifestationofinfantsEvaluatetheseverityofpneumoniaFindtheetiologyofpneumonia,DifferentialDiagnosis,BronchitisForeignBodyInspirationTuberculosis,Question,Howispneumoniatreated?,Management,SupportivecareAntimicrobialstherapyHospitalizationinselectedcases,SupportiveCareAdolescents.,Respiratorycaremayrangefromoxygenation,bronchodilatorsforwheezing,humidificationormist,suctioning,andposturaldrainage,intubationandmechanicalventilation.Hydration(sometimesintravenous)ControloffeverManagementofcomplications,AntimicrobialTherapyAdolescents.,Viruses,OrganismsCausingPneumoniaandEmpiricTherapyinPediatric,Question,Howabouttheclinicalcourseofpneumonia?,Withtreatment,pneumoniacausedbybacteriacanusuallybecuredin1or2weeksPneumoniacausedbyavirusoftenlastslonger,ClinicalCourseAdolescents.,SpecificPneumonias,Brochiolitis,BrochiolitisisthemostcommonseriousrespiratoryinfectionofinfancyTwotothreepercentofallinfantsareadmittedtohospitalwiththediseaseeachyearduringannualwinterepidemics.Ninetypercentareaged1-9monthsbronchiolitisisrareafteroneyearold.Respiratorysyncytialvirus(RSV)isthepathogenin75-80%cases,ClinicalFeatures,Coryzalsymptomsprecedeadrycoughandincreasingbreathlessness.Wheezingisoftenbutnotalwayspresent.Feedingdifficultiesassociatedwithincreasingdyspnoeaareoftenthereasonforadmissiontohospital.Recurrentapnoeaisaseriouscomplicationininfantsinthefirstfewmonthsoflife.Infantsbornprematurelywhodevelopbronchopulmonarydysplasiaandinfantswithcongenitalheartdiseasearemoreseverelyaffected.Thefindingonexaminationarecharacteristic:Sharp,drycoughTachypnoeaSubcostalandintercostalsrecessionHyperinflationofthechest,Investigations,RSVcanbeidentifiedrapidlyusingafluorescentantibodytestonnasopharyngealsecretions.ThechestX-rayshowshyperinflationofthelungsduetosmallairwaysobstructionandairtrapping.Bloodgasanalysis,whichisrequiredinonlythemostseverecases,showsloweredarterialoxygenandraisedCO2tension,Hyperinflationofthelungswithflatteningofdiaphragm,Management,Issupportive.Humidifiedoxygenisdeliveredintoahead-boxMist,antibioticsandsteroidsarenothelpfulNebulisedbronchodialatorsdonotreducetheseverityordurationoftheillnessTheantiviraldrugribavirinonlymarginallyshortensviralexcretionandclinicalsymptoms,andshouldbeconsideredonlyforinfantswithunderlyingcardiopulmonarydisordersorimmunodeficiencyFluidsmayneedtobegivenbynasogastrictubeorintravenouslyMechanicalventilationisrequiredinabout2%ofinfantsadmittedtohospital,Etiology：Respiratorysyncytialvirus(RSV)isthepathogenin75-80%casesClinicalfeatures:Age:3-6monthSeasonWheezingX-rayDuration:7-10daysManagement:,Bronchiolitis,Staphylococcusaureus.,S.aureusisanuncommonbutimportantcauseofpneumoniathatcanoccurinanyagegroup.S.aureusisarapidlyprogressivefulminantillnessS.aureuspneumoniaeasilyoccurscomplications.Bloodculturesarepositivein20-30%ofpatients.Thepleuraleffusionsshouldbedrainedbythoracentesisor,iflarge,byachesttube.Pneumatocelesarealsocommonandarefoundin45-60%ofpatientswithS.aureuspneumonia.Methicillinorvancomycinshouldbeadministeredfor3-4weeks.,MycoplasmaPneumonia,Mpneumoniaeisacommoncauseofsymptomaticpneumoniainolderchildren.Endemicandepidemicinfectioncanoccur.Theincubationperiodislong(2-3weeks),andtheonsetofsymptomsisslow.Althoughthelungistheprimaryinfectionsite,extrapulmonarycomplicationssometimesoccur.,ClinicalFeatures,Fever,cough,headache,andmalaisearecommonsymptomsastheillnessevolves.Ralesarefrequentlypresentonchestexamination,decreasedbreathsoundsordullnesstopercussionovertheinvolvedareamaybepresent.,Laboratoryfindings,Thetotalanddifferentialwhitebloodcellcountsareusuallynormal.Thecoldhemagglutinintitiershouldbedetermined,becauseitmaybeelevatedduringtheacutepresentation.Atiterof1:64orhighersupportsthediagnosis.,Imaging,Chestx-raysusuallydemonstrateintersititialorbronchopneumonicinfiltrates,frequentlyinthemiddleorlowerlobes.Pleuraleffusionsareextremelyuncommon.,Complications,Extrapulmonaryinvolvementoftheblood,CNS,skin,heart,orjointscanoccurDirectCoombs-positiveautoimmunehemolyticanemia,CoagulationdefectsandthrombocytopeniacanalsooccurAwidevarietyofskinrashesincludingerythemamultiformaandStevens-Johnsonsyndrome,Treatment,Antibiotictherapywitherythromycinfor7-10daysusuallyshortensthecourseofillness.Supportivemeasures,includinghydration,antipyretics,andbedrest,arehelpful.,ChlamydialPneumonia,PulmonarydiseaseduetoCtrachomatisusuallyevolvesgraduallyastheinfectiondescendstherespiratorytract.Infantsmayappearquitewelldespitethepresenceofsignificantpulmonaryillness.Appropriateage:2-12weeksInclusionconjunctivitis,eosinophilia,andelevatedimmunoglobulinscanbeseen.,ClinicalFeatures,About50%ofpatientswithchlamydialpneumoniahaveactiveinclusionconjunctivitisorahistoryofitRhinopharyngitiswithnasaldischargeorotitismediamayhaveoccurredormaybycurrentlypresentCoughisusuallypresent.ItcanhaveastaccatocharacterandresemblethecoughofpertussisTheinfantisusuallytachypenic.Scatteredinspiraotrtralesarecommonlyheard,butwheezesrarelySignificantfeversuggestsadifferentoradditionaldiagnosis,Laboratoryfindings,Althoughpatientsmayfrequentlybehypoxemic,CO2retentionisnotcommon.Peripheralbloodeosinphiliahasbeenobservedinabout75%ofpatients.Serumimmunloglobulinsareusuallyabnormal.IgMisvirtuallyalwayselevated,IgGishighinmany,andIgAislessfrequentlyabnormal.Ctrachomatiscanusuallybeidentifiedinnasopharyngealwashingsusingfluorescentantibodyorculturetechniques.,Imaging,Chestx-raysusuallyrevealdiffuseinterstitialandpatchyalveolarinfiltrates,peribronchialthickening,orfocalconsolidation.Asmallpleuralreactioncanbepresent.Despitetheusualabsenceofwheezes,hyperexpansioniscommonlypresent.,Treatment,Erythromycinorsulfisoxazoletherapyshouldbeadministeredfor14days.Oxygentherapymayberequiredforprolongedperiodsinsomepatients.,Summary,Pneumoniainpediatricpatientsencompassesawidespectrumofetiologiesandillnessfrommildtosevereandlifethreatening.Therapyshouldincludeanantibioticifabacteriaoratypicalbacteria(chlamydiaormycoplasma)issuspected.Noantibioticsarenecessaryforviralpneumonia.Supportivetherapyalsoincludesfevercontrol,maintenanceofhydrationandrespiratorycare.Closefollow-upisnecessaryinordertodetectanysecondarybacterialinfectionorthedevelopmentofcomplications.,KeyIssues,EtiologyofpneumoniaPathophysiologyofpneumoniaClinicalfeatureofpneumoniaDiagnosisanddifferentialdiagnosisofpneumoniaManagementofpneumoniaSeveralspecialpneumonias,C