呼吸系统疾病(英文)PPT课件.ppt

Topics,RespiratorydisordersRespiratoryinfectionsPneumonia,1,RespiratoryDisorders,50%ofconsultationwithgeneralpractitionersoracuteillnessinyoungchildrenandathirdofconsultationsinolderchildren20-35%ofacutepediatricadmissionstohospital,someofwhicharelife-threateningAsthmaisthemostcommonchronicillnessofchildhoodCysticfibrosisisthemostcommoninheriteddisorderinCaucasianscausingchronicdisease,2,RespiratoryInfections,Themostfrequentinfectionsofchildhood:6-8/yearPathogens:viruses,bacterial,otherpathogensHostandenvironmentalfactorsClassificationofrespiratoryinfections,3,ClassificationofRespiratoryInfections,Accordingtotheleveloftherespiratorytreemostinvolved:UpperrespiratorytractinfectionLowerrespiratorytractinfection,4,Pneumonia,EnmeiLiuChildrensHospital,CMU,5,Case-1,Jack,agefourmonths,issentathomebyhisgeneralpractitionerbecauseoftwodaysofrapid,labouredbreathingandpoorfeeding.Hewasbornat27weeksgestation,birthweight979gandwasdischargedhomeatthreemonthsofage.Onexaminationhewasafeverof37.4Candarespiratoryrateof60breaths/min.Hischestishyperinflatedwithmarkedintercoatalrecession.Onauscultationtherearegeneralizedfinecracklesandwheezes.,6,Question,Doyouhaveanycommentsorwhatdoyouconcludeanythingfromthiscase?,7,Case-1,Jack,agefourmonths,issentathomebyhisgeneralpractitionerbecauseoftwodaysofrapid,labouredbreathingandpoorfeeding.Hewasbornat27weeksgestation,birthweight979gandwasdischargedhomeatthreemonthsofage.Onexaminationhewasafeverof37.4Candarespiratoryrateof60breaths/min.Hischestishyperinflatedwithmarkedintercoatalrecession.Onauscultationtherearegeneralizedfinecracklesandwheezes.,8,Question,Whatispneumonia?,9,Pneumoniaisaninflammationoftheparenchymaofthelungs.,Definition,10,Question,Howabouttheprevalenceofpneumonia?,11,Pneumoniaaccountsforapproximately15%ofallrespiratorytractinfections.Worldwide,about3millionchildrendieeachyearfrompneumonia,withthemajorityofthesedeathsoccurringindevelopingcountries.PneumoniaremainsthemostcommoncauseofmorbidityinChina.,Incidence,12,Question,Howtoclassifypneumoniainclinic?,13,AnatomyPathogensSeverityDurationOnsetsite,Classification,14,BronchopneumoniaLobarorLobularPneumoniaInterstitialPneumonia,BasedonanatomyorX-raymanifestation,15,Basedonetiology,BacterialpneumoniaViralPneumoniaMycoplasmaPneumoniaChlamydiaPneumonia,16,AcutePneumoniaProlongedPneumoniaChronicPneumonia,Basedontheprocessofpneumonia,17,MildPneumoniaSeverePneumonia,Basedontheseverityofpneumonia,18,CommunityAcquiredPneumonia(CAP)HospitalAcquiredPneumonia(HAP),Basedontheonsetsiteofpneumonia,19,Bronchopneumonia,20,Question,Whyarechildrenlikelyhavebronchopneumonia?,21,CharactersofchildhoodairwayanatomicstructureandtheirrespiratoryphysiologyImmunefunctionofchildhoodHighriskfactors:prematurebaby,underlyingdisorders,22,Question,Whatcausebronchopneumonia?,23,Bacteria:Streptococcuspneumoniae,HaemophilusinfluenzaeVirusesMycoplasma,CausesofBronchopneumonia,24,PathologyofPneumonia,25,Inflammaoryexudate,Inflammaoryexudate,PathologyofPneumonia,26,Question,Whatarethepathophysiologyofpneumonia?,27,Pathogens,URTI,Bronchitis,Pneumonia,Inflammatoryexudate,Obstructionofairway,Gasexchangeabnormal,Ventilationabnormal,hypoxemia,hypercapnia,toxinemia,tachypneacyanosis,rales,fever,cough,28,Question,Whatarethesignsandsymptomsofpneumonia?,29,Theclinicalsignsandsymptomsofpneumoniadependprimarilyontheageofthepatient,thecausativeorganism,andtheseverityofthedisease.,30,Fever,Cough,Cyanosis,Tachypenea,Rales,31,outbreathingin,Withinspiration,thesideofthenostrilsflaresoutwards,NasalFlaring,32,Withinspiration,thelowerchestwallmovesin,LowerChestWallIndrawing,outbreathingin,33,Fever,Cough,Cyanosis,Tachypenea,Rales,34,Classicfindingsofpneumoniathatoccurinadultsandolderchildren,suchasfever,coughandrales,areoftenabsentininfantsandtoddlers.Generallypresentwithnonspecificsignsandsymptomsincludinglethargy,irritability,poorfeeding,vomiting.Ifitappearrespiratoryfailureorotherabnormalityofothersystem-severepneumonia.,ImportantPoints,35,Complications,EmpyemaPyopneumothoraxPneumatoceleLungabscessesAtelectasis,36,LaboratoryExamination,WhitebloodcellcountandC-reactionproteinPathogensexamination:1)Sputumcultures2)Bloodcultures3)RapidscreeningtestsforvirusorbacterialBronchoscopyBloodgasanalysis:hypoxiaand/orhypercapnia,37,RadiographEvaluation,TypicalX-raymanifestationofbronchopneumoniaispatchyinfiltratesbilaterallyComplication:lungabscesses,empyema,pyopneumothorax,pneumatocele,atelectasisCT,38,39,Patchyinfiltrates,40,41,lungabscesses,42,pyopneumothorax,43,Question,Howtodiagnosispneumoniaclinically?,44,Accordingtothetypicalclinicalmanifestationofbronchopneumonia.AccordingtoX-raymanifestationPayattentiontotheatypicalmanifestationofinfantsEvaluatetheseverityofpneumoniaFindtheetiologyofpneumonia,45,DifferentialDiagnosis,BronchitisForeignBodyInspirationTuberculosis,46,Question,Howispneumoniatreated?,47,Management,SupportivecareAntimicrobialstherapyHospitalizationinselectedcases,48,SupportiveCareAdolescents.,Respiratorycaremayrangefromoxygenation,bronchodilatorsforwheezing,humidificationormist,suctioning,andposturaldrainage,intubationandmechanicalventilation.Hydration(sometimesintravenous)ControloffeverManagementofcomplications,49,AntimicrobialTherapyAdolescents.,Viruses,50,OrganismsCausingPneumoniaandEmpiricTherapyinPediatric,51,Question,Howabouttheclinicalcourseofpneumonia?,52,Withtreatment,pneumoniacausedbybacteriacanusuallybecuredin1or2weeksPneumoniacausedbyavirusoftenlastslonger,ClinicalCourseAdolescents.,53,SpecificPneumonias,54,Brochiolitis,BrochiolitisisthemostcommonseriousrespiratoryinfectionofinfancyTwotothreepercentofallinfantsareadmittedtohospitalwiththediseaseeachyearduringannualwinterepidemics.Ninetypercentareaged1-9monthsbronchiolitisisrareafteroneyearold.Respiratorysyncytialvirus(RSV)isthepathogenin75-80%cases,55,ClinicalFeatures,Coryzalsymptomsprecedeadrycoughandincreasingbreathlessness.Wheezingisoftenbutnotalwayspresent.Feedingdifficultiesassociatedwithincreasingdyspnoeaareoftenthereasonforadmissiontohospital.Recurrentapnoeaisaseriouscomplicationininfantsinthefirstfewmonthsoflife.Infantsbornprematurelywhodevelopbronchopulmonarydysplasiaandinfantswithcongenitalheartdiseasearemoreseverelyaffected.Thefindingonexaminationarecharacteristic:Sharp,drycoughTachypnoeaSubcostalandintercostalsrecessionHyperinflationofthechest,56,Investigations,RSVcanbeidentifiedrapidlyusingafluorescentantibodytestonnasopharyngealsecretions.ThechestX-rayshowshyperinflationofthelungsduetosmallairwaysobstructionandairtrapping.Bloodgasanalysis,whichisrequiredinonlythemostseverecases,showsloweredarterialoxygenandraisedCO2tension,57,Hyperinflationofthelungswithflatteningofdiaphragm,58,Management,Issupportive.Humidifiedoxygenisdeliveredintoahead-boxMist,antibioticsandsteroidsarenothelpfulNebulisedbronchodialatorsdonotreducetheseverityordurationoftheillnessTheantiviraldrugribavirinonlymarginallyshortensviralexcretionandclinicalsymptoms,andshouldbeconsideredonlyforinfantswithunderlyingcardiopulmonarydisordersorimmunodeficiencyFluidsmayneedtobegivenbynasogastrictubeorintravenouslyMechanicalventilationisrequiredinabout2%ofinfantsadmittedtohospital,59,Etiology：Respiratorysyncytialvirus(RSV)isthepathogenin75-80%casesClinicalfeatures:Age:3-6monthSeasonWheezingX-rayDuration:7-10daysManagement:,Bronchiolitis,60,Staphylococcusaureus.,S.aureusisanuncommonbutimportantcauseofpneumoniathatcanoccurinanyagegroup.S.aureusisarapidlyprogressivefulminantillnessS.aureuspneumoniaeasilyoccurscomplications.Bloodculturesarepositivein20-30%ofpatients.Thepleuraleffusionsshouldbedrainedbythoracentesisor,iflarge,byachesttube.Pneumatocelesarealsocommonandarefoundin45-60%ofpatientswithS.aureuspneumonia.Methicillinorvancomycinshouldbeadministeredfor3-4weeks.,61,MycoplasmaPneumonia,Mpneumoniaeisacommoncauseofsymptomaticpneumoniainolderchildren.Endemicandepidemicinfectioncanoccur.Theincubationperiodislong(2-3weeks),andtheonsetofsymptomsisslow.Althoughthelungistheprimaryinfectionsite,extrapulmonarycomplicationssometimesoccur.,62,ClinicalFeatures,Fever,cough,headache,andmalaisearecommonsymptomsastheillnessevolves.Ralesarefrequentlypresentonchestexamination,decreasedbreathsoundsordullnesstopercussionovertheinvolvedareamaybepresent.,63,Laboratoryfindings,Thetotalanddifferentialwhitebloodcellcountsareusuallynormal.Thecoldhemagglutinintitiershouldbedetermined,becauseitmaybeelevatedduringtheacutepresentation.Atiterof1:64orhighersupportsthediagnosis.,64,Imaging,Chestx-raysusuallydemonstrateintersititialorbronchopneumonicinfiltrates,frequentlyinthemiddleorlowerlobes.Pleuraleffusionsareextremelyuncommon.,65,Complications,Extrapulmonaryinvolvementoftheblood,CNS,skin,heart,orjointscanoccurDirectCoombs-positiveautoimmunehemolyticanemia,CoagulationdefectsandthrombocytopeniacanalsooccurAwidevarietyofskinrashesincludingerythemamultiformaandStevens-Johnsonsyndrome,66,Treatment,Antibiotictherapywitherythromycinfor7-10daysusuallyshortensthecourseofillness.Supportivemeasures,includinghydration,antipyretics,andbedrest,arehelpful.,67,ChlamydialPneumonia,PulmonarydiseaseduetoCtrachomatisusuallyevolvesgraduallyastheinfectiondescendstherespiratorytract.Infantsmayappearquitewelldespitethepresenceofsignificantpulmonaryillness.Appropriateage:2-12weeksInclusionconjunctivitis,eosinophilia,andelevatedimmunoglobulinscanbeseen.,68,ClinicalFeatures,About50%ofpatientswithchlamydialpneumoniahaveactiveinclusionconjunctivitisorahistoryofitRhinopharyngitiswithnasaldischargeorotitismediamayhaveoccurredormaybycurrentlypresentCoughisusuallypresent.ItcanhaveastaccatocharacterandresemblethecoughofpertussisTheinfantisusuallytachypenic.Scatteredinspiraotrtralesarecommonlyheard,butwheezesrarelySignificantfeversuggestsadifferentoradditionaldiagnosis,69,Laboratoryfindings,Althoughpatientsmayfrequentlybehypoxemic,CO2retentionisnotcommon.Peripheralbloodeosinphiliahasbeenobservedinabout75%ofpatients.Serumimmunloglobulinsareusuallyabnormal.IgMisvirtuallyalwayselevated,IgGishighinmany,andIgAislessfrequentlyabnormal.Ctrachomatiscanusuallybeidentifiedinnasopharyngealwashingsusingfluorescentantibodyorculturetechniques.,70,Imaging,Chestx-raysusuallyrevealdiffuseinterstitialandpatchyalveolarinfiltrates,peribronchialthickening,orfocalconsolidation.Asmallpleuralreactioncanbepresent.Despitetheusualabsenceofwheezes,hyperexpansioniscommonlypresent.,71,Treatment,Erythromycinorsulfisoxazoletherapyshouldbeadministeredfor14days.Oxygentherapymayberequiredforprolongedperiodsinsomepatients.,72,Summary,Pneumoniainpediatricpatientsencompassesawidespectrumofetiologiesandillnessfrommildtosevereandlifethreatening.Therapyshouldincludeanantibioticifabacteriaoratypicalbacteria(chlamydiaormycoplasma)issuspected.Noantibioticsarenecessaryforviralpneumonia.Supportivetherapyalsoincludesfevercontrol,maintenanceofhydrationandrespiratorycare.Closefollow-upisnecessaryinordertodetectanysecondarybacterialinfectionorthedevelopmentofcomplications.,73,KeyIssues,EtiologyofpneumoniaPathophysiologyofpneumoniaClinicalfeatureofpneumoniaDiagnosisanddifferentialdiagnosisofpneumoniaManagementofpneumoniaSeveralspecialpneumonias,74,Case-2,Hist