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1、呼吸疾病,1,Respiratory Tract Disease,Zhang Jin Division of Respiratory Disease Childrens Hospital of Fudan University,呼吸疾病,2,Divided from ring gristle Upper respiratory tract nose, nasal sinus, pharynx, epiglottis, larynx,OVERVIEW,呼吸疾病,3,OVERVIEW,Lower respiratory tract,trachea bronchus bronchiole termi
2、nal bronchiole respiratory bronchiole alveolar ducts alveolar sac alveolus,气管,支气管,软骨,终末细支气管,肺泡管,肺泡囊,腺泡,呼吸疾病,4,The total number of alveoli increases from 24 million to 250 million by 4 years of age,and most in the first 2 years After 4 year,growth is primarily by increase in size of individual alveol
3、i,Development of pulmonary structure,呼吸疾病,5,Several mechanical properties-increased risk of infant respiratory compromise,Smaller and less firm in airway more likely obstruction in response to infection inflammation, foreign body Greater compliance of chest wall more likely collapse or labored breat
4、hing when respiration obstructed Fewer fatigue-resistant diaphragmatic muscle fibers earlier respiratory muscle fatigue in response to an increased load,呼吸疾病,6,Nasal obstruction: infant ( nasal stenosis, mucosa tender) Sinusitis: 2y (nasal mucosa sinus mucosa) Otitis media: infant and young children
5、 ( eustachian tube : short, wide, straight, horizontal) Tonsillitis:1y(developing after 1yr) Throat edema: infant and young children (short, cartilage soft, mucosa tender) Expiratory dyspnea, Emphysema: less elastic tissue Respiratory failure: less number of alveoli Atelectasis: no Kohn Inadequate l
6、ung expansion: diaphragm, greater compliance of chest wall Mediastinal shift: loose support tissue,Clinical Significance,URT,LRT,Thoracic,呼吸疾病,7,Physiological Characteristic,Respiratory Rate: fast slow Breathing Pattern: abdominal thoracoabdominal Tracheal Caliber: small large Airway Resistance: hig
7、h low,呼吸疾病,8,Physical examination signs,respiratory rate breathing pattern breath sounds cyanosis Thoracic depression stridor , wheezing groaning clubbing,呼吸疾病,9,呼吸疾病,10,Pneumonia,呼吸疾病,11,Inflammation of the alveoli or interstitial spaces of the lung Caused by microorganisms or noninfectious agents,
8、Definition,呼吸疾病,12,bronchial pneumonia lobar pneumonia interstitial pneumonia,Classification,Pathology,呼吸疾病,13,Etiology,Infection Non-infection viral pneumonia aspiration pneumonia bacterial pneumonia food mycoplasmal pneumonia gastric acid chlamydial pneumonia foreign bodies fungi pneumonia hyperse
9、nsitivity Protozoa pneumonia drug or radiation-induced,Classification,呼吸疾病,14,Classification,Community-Acquired Pneumonia (CAP) Hospital-Acquired Pneumonia (HAP) 48 Hrs,Approach,呼吸疾病,15,Classification,Typical-Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Gram-negative baci
10、lli Untypical- mycoplasmal pneumonia, chlamydial pneumonia, Legionella, Novel coronavirus,Manifestation,呼吸疾病,16,Fever Coughing Dyspnoea intercostal, subcostal, suprasternal retractions, nasal flaring cyanosis Fixed Rales, decreased breath sound,Clinical manifestation,Common type of pneumonia,呼吸疾病,17
11、,Viral pneumonia Upper respiratory infection prodrome (fever, coryza, cough,hoarseness) Myalgia, malaise, headache Wheezing Bacterial pneumonia Sign of generalized toxicity Dullness to percussion Decreased breath sound Pleural involvement,Clinical manifestation,呼吸疾病,18,Severe pneumonia,Accompanied b
12、y cardiac failure RR60b/min HR180r/min Irritable, Cyanosis heart sound reduced, gallop liver enlarged Oliguria/anuria, edema,Clinical manifestation,呼吸疾病,19,Severe pneumonia,CNS（toxic encephalopathy) mild: agitation, sleepiness severe: coma, seizure headache, fontanelle, pupil conjunctival congestion
13、, changes in breathing,Clinical manifestation,Brain dysfunction,Increased intracranial pressure,呼吸疾病,20,Severe pneumonia,Digestive system toxic paralytic ileus gastrointestinal bleeding Other DIC,Clinical manifestation,呼吸疾病,21,empyema: streptococus, G- dyspnea limited in respiratory movement dullnes
14、s to percussion decreased breath sound,Complication,呼吸疾病,22,pyopneumothorax： Aggravation Severe cough dyspnea cyanosis Drum sound/dullness Decreased breath sound or disappear,Complication,呼吸疾病,23,pneumatocele： Staphylococcus aureus Asymptomatic acute respiratory distress,Complication,呼吸疾病,24,Chest x
15、-ray,Viral pneumonia hyperinflation increased interstitial markings peribronchial cuffing patchy bronchopneumonia Bacterial pneumonia Lobar consolidation with lobar volume expansion Pneumatoceles Pleural effusion Abscesses,呼吸疾病,25,Laboratory Findings,Blood routine test and CRP(C-reactive protein) Vi
16、ral pneumonia Normal or slightly elevated WBC with lymphocyte predominance Normal or slightly elevated CRP Bacterial pneumonia Elevated WBC with granulocyte predominance Elevated CRP,呼吸疾病,26,呼吸疾病,27,呼吸疾病,28,1. Bacterial stain and culture nasopharyngeal secretion tracheal aspiration, bronchial brushi
17、ng , lung puncture pleural fluid, blood 2. Viral detection Rapid viral diagnosis fluorescent antibody test or ELISA on nasopharyngeal secretions serologic technique 3. M.pneumoniae Cold agglutinin titers 1:64 serologic technique,Special examination,Laboratory Findings,呼吸疾病,29,Diagnosis and Different
18、ial diagnosis,Diagnosis Symptom sign chest x-ray etiology Differential diagnosis Pulmonary tuberculosis Bronchial foreign body,呼吸疾病,30,1.General Treatment： humidified oxygen: to achieve SaO292% hydration and electrolyte supplementation nutrition,Treatment,呼吸疾病,31,2. Etiological Treatment: Local epid
19、emiologic information Community-acquired or hospital-acquired Age Radiograohic findings Basic condition Gram stain and bacteria culture, antibiotic sensitivity,Treatment,呼吸疾病,32,Pathogen 5 years Streptococcus pneumoniae + + + Viruses + + + Enteric bacilli + + + Group B streptococci + - - Chlamydia t
20、rachomatis + + Staphylococcus aureus + + + Haemophilus influenzae + + + Group A streptococci - + + Mycoplasma pneumoniae + + Chlamydia pneumoniae - + + +, very frequent; +, moderately frequent, +, rare, , very rare; -, absent,Pathogeny in CARTIs,呼吸疾病,33,3. Application of adrenal cortical hormone： 4.
21、 Symptomatic Treatment： Endotracheal intubation or mechanical ventilation Early chest tube drainage of empyema fluid,Treatment,呼吸疾病,34,5. Treatment for cardiac failure Digoxin / Cedilanid Diuretic (Furosemide) Vasodilator (ACE-enzyme inhibitors) Sedation,Treatment,呼吸疾病,35,Mycoplasma Pneumonia,The se
22、cond most common cause of CAP Affecting patients over 5 years Prominent headache is an early sign. A persistent, nonproductive cough become the dominant feature with time Physical findings are often totally absent initially,呼吸疾病,36,Chest x-ray： 1) patchy or confluent bronchopneumonia 2) unilateral m
23、arked infiltrate in the lower lobe Cold hemagglutinin titer 1:64 a fourfold or greater rise in acute and convalescence antibody titer for M.pneumoniae Treatment is by erythromycin for 7-10 days,呼吸疾病,37,呼吸疾病,38,呼吸疾病,39,呼吸疾病,40,Bronchiolitis,Caused by the respiratory syncytial virus (RSV) Annual winte
24、r epidemics occur in babies aged 1-9 months Cough, wheezing, Sign: breathe rapidly and shallowly; nasal flaring retraction ,cyanosis,呼吸疾病,41,Management of bronchiolitis,呼吸疾病,42,Most infants make a full recovery within 2 weeks Some have recurrent episodes of cough and wheeze over the subsequent few y
25、ears infants with chronic lung disease and congenital heart disease are at particular risk of being severely affected,呼吸疾病,43,呼吸疾病,44,Staphylococcal Pneumonia,The organism is necrotizing, producing bronchoalveolar destruction Severe, rapidly progressing pneumonia with formation of abscesses, pneumat
26、oceles, and empyemas in typical of S. aureus Fever, tachypnea, dyspnea, tachycardia,cyanosis Beginning with a focal infiltrative lesion, progressing to patchy consolidation Most often only one lung involved(80%), more often the right,呼吸疾病,45,Penicillin-sensitive: 90%, use -lactamase-resistant penici
27、llin Methicillin - resistant: use vancomycin,呼吸疾病,46,呼吸疾病,47,13hr later,呼吸疾病,48,Adenoviral pneumonia,Over 45 types accounting for 2-10% of all respiratory illnesses Severe infection are most likely due to type3,7, 21 Severe pneumonia may occur at all ages, especially common in young children(age 3 y
28、ears) Adenoviral pneumonia can be necrotizing. Chest x-ray show peribronchial and interstitial infiltrate Mortality as high as 10%, causing permanent lung damage: bronchiectasis, COPD,呼吸疾病,49,2008/8/26,呼吸疾病,50,2008/9/5,呼吸疾病,51,2008/9/9,呼吸疾病,52,lung,mediastinum,2008/9/9,lymph nodes,Low lobe lesion,at
29、electasis,呼吸疾病,53,lung,mediastinum,pleural effusion,呼吸疾病,54,2008/9/18,呼吸疾病,55,Comparison of pneumonia in different pathogens,呼吸疾病,56,Case Study,6 Unwell 10 days Cough Fever Progressive dyspnoea,Temperature 39oC Heart rate 125 Respiratory rate 36 Hypoxic Oxygen saturation 89% in air, 97% in 30% oxyge
30、n intercostals recession,History,Examination,呼吸疾病,57,investigation,Blood routine test WBC 19*109/L ; N 87% CRP100mg/l,呼吸疾病,58,Right pleural effusion,呼吸疾病,59,What do you think? What should be done?,呼吸疾病,60,Imaging techniques,CXR Ultrasound C.T.,size of collection echogenicity of collection location g
31、uided thoracocentesis/tube drainage,呼吸疾病,61,large pleural effusion on ultrasound,echogenic pleural collection,Fibrinous strands,呼吸疾病,62,Make the child well Control the infection Reestablish a normal pleural circulation,safe effective prompt minimal mortality,Treatment aims,requirements,呼吸疾病,63,Antibiotics,Best guess - based on age,underlying disease etc. High dose Intravenous,呼吸疾病,64,Admission,Post drain insertion,At discharge,At 8-week follow-up,呼吸疾病,65,Thanks,