呼吸系统疾病英文

呼吸系统疾病英文第1页/共70页2ContentsUpperRespiratoryInfectionAcuteinfectiousLaryngitisAcuteBronchitisBronchiolitisPneumonia第2页/共70页3Anatomy

upperrespiratorytract(URT)CricoidCartilage

lower

respiratorytract(LRT)URT：Nose、pharynx、Uvula、Larynx、auditorytube、paranasalsinuses

LRT：Trachea、bronchia、bronchiole、therespiratorybronchiole、thealveolarductandthealveolus第3页/共70页4第4页/共70页5第5页/共70页6

Anatomy

characteristicsupperrespiratorytractNose:cilia↓,capillary↑Sinuses:mucousAuditorytubetonsilLarynx第6页/共70页7lower

respiratorytract：WeakCartilageSupporting,ciliaryfunctionimpairmentRightbronchus:straight,largeCollagenandelastinfibers，capillary，interstitialtissueThorax：chestwall,respiratorymuscle；diaphragm，mediastinum第7页/共70页8

Physiologicalcharacteristics

Thecompensatoryability↓Respiratoryrate↑

PatternofrespirationGas-exchangingmembrane:diffuserateCO2＞O2Resistanceofairway:child＞adult第8页/共70页9Arterialbloodgasexamination(1)pH↓acidosis；(2)PaO2↓SaO2↓hypoxemia；(3)PaCO2↑carbondioxideretentionmal-ventilation第9页/共70页10TheImmunologicalCharacteristics：ImpairedmucociliaryclearancefunctionSIgA↓、IgA↓、IgG↓subtypeofIgG↓Alveolarmacrophages↓,lysozyme↓lactoferrin↓、interferon↓complement↓第10页/共70页11UpperRespiratoryInfection(URI,orCommonCold)

1.

Etiology

90%

viruses,themajorityofcolds.rhinoviruses,coronaviruses.parainfluenzavirus,adenovirus,enterovirus,respiratorysyncytialvirus.

2.

season

fallandwinter

3.

Frequencythree

toeightcoldsayear.

第11页/共70页12

InoculationbyvirusInvasionofepitheliumofReleaseofnasopharynx,sinusesandURTcellulardamageInflammatoryofnasopharynxmediatorsinCholinergicnasalsecretionsstimulationIncreasedIncreasedvascularmucusPermeabilityproductionbronchialconstriction

NasalRhinorrheapostnasalStuffinessdripsorecoughthroat

Pathophysiologyofthecommoncold第12页/共70页13Theclinicalmanifestation

Commoncold

congestionarunnynosesneezingCough,sorethroatsometimesvomitinganddiarrheaFever,malaise,abdominalpain

第13页/共70页14

SpecifictypeofURIHerpangina:coxsackie-virusesgroupA.summer/fall.Highfever,sorethroat，

1-4mmvesicles/ulcersonanteriortonsillarpillars,softpalate,uvula,tonsilspharyngealwall.Pharyngoconjunctivalfever:type3,7adenovirus,spring/summer.Highfever,sorethroat，pharyngitis,conjunctivitis,cervicallymphadenopathy.第14页/共70页15ComplicationssinusitisotitismediacervicallymphadenopathyMesenterylymphadenopathyretropharngealabscesspneumoniarheumaticfeveracuteglomerulonephritis第15页/共70页16DifferentialdiagnosisFluAppendicitisEarlyphaseofacuteinfectiousdisease第16页/共70页17ColdFluLowornofeverHighfeverSometimesheadacheCommonlyheadacheStuffy,runnynoseSometimesstuffynose

Sneezing

SometimessneezingMild,hackingcoughCough,mayprogress

Slightachesandpains

severeachesandpainsMildfatigueFatigue,maypersistSorethroat

Sometimessorethroat第17页/共70页18

Treatment

increasedfluidintakeavoidanceofsecondhandsmokeSalinenosedropsbulbsyringeremovethemucuscoolmisthumidifierantipyretics,suchasacetaminophen,ibuprofen,decreasethediscomfortofcolds.Donotgiveaspirin(associatedwithReyesyndrome)第18页/共70页19

PreventionKeepyourchildawayfromapersonwithacold.Encourageyourchildtowashhis/herhandsfrequentlyandnottotouchhis/hermouth,eyes,ornoseuntiltheirhandsarewashed.Makesuretoysandplayareasareproperlycleaned,especiallyifmultiplechildrenareplayingtogether.第19页/共70页20AcuteinfectiousLaryngitisEtiologyVirusorbacteriaTypicalanatomy

第20页/共70页21ClinicalmanifestationsBarkingcough,hoarseness,inspiratorystridor,nasalflaring,suprasternal,infrasternal,intercostalretractionFever,dyspnea,cyanosisrestlessness,tachycardia.Worsenatnight.Congestionofpharynx,vocalcordedema

第21页/共70页22

GradeoflaryngicobstructionⅠ：inspiratorystridor,respiratorydifficultyonlyafteractivityⅡ：symptomsoccursatrest.tachycardia,rhonchiⅢ：Ⅱ+hypoxia,diminishedbreathsoundsⅣ：exhaustion,lethargy，pallor,breathsoundsdiminishordisappear.dullofheartsounds,arrhythmia第22页/共70页23Diagnosis&differentialdiagnosis

laryngealdiphtherialaryngealspasmbronchialforeignbodies第23页/共70页24treatmentMaintainingofairway：steaminhalation,clearingofsecretion.antibioticscorticosteroidoxygensupplysedatives(phenergan)Ⅲ↑tracheotomy第24页/共70页25AcuteBronchitis(tracheobronchitis)EtiologyVirusorbacteriaAllergy,climate,airpollution,chronicinfectionofURT,particularlysinusitis.Rickets,malnutrition第25页/共70页26Clinicalmanifestationsunproductivecough3~4days→productivecough,purulentsputum→5~10daysChestpain,shortnessofbreathVomitingPhysicalfinding:low-gradefever,rougheningofbreathsounds,rhonchi,coarsemoistrales.第26页/共70页27Asthmaticbronchitis：

﹤3yrsold,eczema,allergy

symptomsresembleasthma

recurrentepisodesreducedafter3~4yrsold.第27页/共70页28Treatment

increasedfluidintakefrequentshiftsofpositionantibioticscoughsuppressantsexpectorants,antihistaminesacetaminophen第28页/共70页29Bronchiolitis

Etiologyandepidemiology50％respiratorysyncytialvirus(RSV)parainfluenza3virus,mycoplasma,adenovirusesnorth——winterandearlyspringGuangdong——spring,summerandearlyautumn第29页/共70页302.PathophysiologyLesion:smallairpassages(diameter75～300um)Edema,accumulationofmucusandcellulardebris,spasmofsmoothmussle→↑resistanceofsmallairway→expiratorydifficulty→overinflationoratelectasis→hypoxemia,hypercapnia,acidosis第30页/共70页31ClinicalmanifestationInfant﹤2yrsold,peakat3~6moofage,male,nonbreast-feedURI3～4daysparoxysmalwheezycoughdyspneadeveloprapidlymildormoderatefever

第31页/共70页32PhysicalexaminationR60~80/minHR160～200/minNasalflare,intercostalandsubcostalretractionsPallor,cyanosisHyperexpandedchest，expiratoryphase↑wheeze，widespreadfinecracklesLiverandspleenpalpablebelowthecostalmarginCriticalphase48～72haferonsetofdyspnea;recoverduring5～15days第32页/共70页33LaboratoryexaminationWBCanddifferentialcellscountnormalVirusdetectedbyantigendetection,PCR,orculture.X-ray:hyperinflationofthelungs,emphysema,scatteredareasofconsolidation

第33页/共70页34DifferentialdiagnosisAsthmaCysticfibrosisHeartfailureForeignbodyinthetracheapertussis第34页/共70页35第35页/共70页36两侧肺纹理粗重。两肺中内带多数小斑片状及小结节病灶影。无病灶之肺部透过度增高。第36页/共70页37TreamentSupportivetreatment

cool,humidifiedoxygensupply,maintainSaO294%~96%;increasedfluidintake：oralintake,intravenoussolutionsheadandchestslightlyelevated

第37页/共70页38

RibavirinAntibioticscorticosteroids第38页/共70页39PneumoniaPneumoniaisresultsfromdirectinflammationofthelungtissueinfections(bacterial,viralorfungal)

chemicalinjury(gastricacid/aspirationoffood/hydrocarbonandlipoidpneumonia/radiationinducedpneumonia)

第39页/共70页40ClinicalmanifestationfevercoughDyspnea(Tachypnea,cyanosis)Localizedrales(finemoistrales)Abnormalchestx-ray第40页/共70页41ClassificationPathologicpathogeniccourseofdiseaseStateofdiseaseClinicalmanifestationWhereacquired第41页/共70页42Bronchopneumonia1.Etiologyviruses,bacteria,MP,CP.2~3yrsold2.pathology

edema,infiltration

第42页/共70页43第43页/共70页44第44页/共70页45第45页/共70页463pathophysiologyhypoxemia,hypercapnia,toxemiarespiratoryinsufficiencyacidosismyocarditis,heartfailure,shock,DICtoxicencephalopathytoxicintestinalparalysis第46页/共70页47

4.Clinicalmanifestation(1)mildpneumonia：

fevercoughdyspnea(tachypnea,cyanosis)ralesChestx-ray第47页/共70页48两肺纹理增粗。两肺中下野中内带见斑片状阴影，密度较均匀。部分病灶融合成范围稍大的片状影第48页/共70页49(2)Severepneumonia：

othersystemsinvolvedmyocarditis,heartfailuretoxicencephalopathytoxicintestinalparalysis

第49页/共70页505.ComplicationsEmpyemaPyopneumothoraxpneumatocele第50页/共70页51

6.Laboratoryfindings:

WBC,NBT,CRPPathogen(antigenand/orantibody)chestx-ray第51页/共70页527.diagnosisFever,cough,tachypnea,dyspnea,localizedfinemoistrales,chestx-ray8.differentialdiagnosisacutebronchitistuberculosisforeignbodiesoftrachea第52页/共70页53第53页/共70页54男2岁半。4个月前吃蚕豆后发生呛咳，经常发烧，左侧呼吸音低。胸片：左侧阻塞性肺气肿。心影稍右移，经支气管检查于左支气管取出蚕豆碎块。第54页/共70页55第55页/共70页56

9.treament

(1)generaltherapy(2)antipathogentherapyantibioticsantivirus

第56页/共70页57(3)symptomatictherapyoxygensupplyairwaymanagementabdominaldistentionfever(4)Corticosteroid(5)complications/underlingdisease

(6)Immunotherapy第57页/共70页58Characteristicsofpneumoniacausedbydifferentpathogen第58页/共70页59

1.respiratorysyncytialviruspneumoniaage:2~7monfever:mildormoderatemainsigns:acuteonset,wheeze,expiratorydifficulty,palpableliverandspleen.Pallor,cyanosis,restlessnessAuscultation:diffuserhonchi,fineralesChestX-ray:peribronchialthickeningorinterstitialpneumonia第59页/共70页602.Adenoviruspneumonia

Age:6mon-2yrsmainsigns:acuteonset,longdurationofhighfever，7~10daysor2~3weeksthenpelterSystemictoxicsymptomsareobviousFrequentcough，paroxysmalwheeze,dyspnea,cyanosis第60页/共70页61

lateappearanceofrales(3~7days)myocarditis,heartfailure,andencephalopathyX-raychangesearly第61页/