Respiratory system

Fifth stage

Pediatric
Lec 1 p2
د.فارس

2/11/2016

Respiratory diseases
wheezing
Bronchiolitis:
Common wheezy infection.
Occur in few months up to 2 years. Most serious age 3-6 month
Above 5 years rare.
Usually its Viral infection (RSV) other virus also can play a roll but less common "parainfluenza virus ..adenovirus poor prognosis because it may cause bronchiolitis obliterance . .rhinovirus " . And bacteria has no roll no AB in TX
Rarely super infection by bacteria
More in boys.
Breast feeding is protective.


Neonate (1 month) rarely have bronchiolitis and rarely have viral infection.


Pathophysiology:
Compliant chest wall
Narrowing obstruction
Immunological factor

Clinical feature :

There is exposure to adult with upper RTI before one week.
Rhinorrhea
, cough,
sneezing,
common cold,
low grade fever,
respiratory distress
, cyanosis,
tachypnea (120/min),
wheezing,
flaring ala nasi, recession,
tired, hyperinflated chest
, air trapping
By examination :
, auscultation (wheezingprolong expiratory sound,
, fine bilateral crackles), may feel liver and spleen (due to hyperinflation), poor appetite refuse eating because apnea .


Diagnosis clinically.

CXR hyperinflationwide ,more than 8 ribs , narrow mediastinum.

No need for complete blood.
Viral diagnosis: immunoflurecnet of secretions, viral culture (slow process), serology (antibodies).
Course of Bronchiolitis 1-stormy course 2-3 days // 2-plateau course 7-10 days. // 3-good condition after 10 days

DDX of Wheezing :

Bronchiolitis
Bronchial Asthma
Foreign body aspiration
GERD
heart failurecardiomegaly compress the trachea
trance esophageal fistula
immune deficiency
allergy
Cystic fibrosis \bronchiectasis should mention them lastly


Treatment:
Mild cases
Can manage at home
monitor,
semi-setting position (30 degree),
good hydration.
Can give humidified O2.
Indication for hospital admission:
Cannot eat give nasogastric tube.
Less than 6 months age.
Severe respirotary distress.
Need O2.
Baby with high risk factors CHD, chronic lung diseases (broncho-pulmonnary dysplasia),
immune deficiency,
neuromuscular weakness.
Home condition is bad.
Vomiting
Toxic appearance
Carless parents.
In hospital:
Give humidified O2.
Fluids (nasogastric)
Monitoring.
Head up.
Nebulizer one of the following ( B agonist salbutamol, epinephrine adrenaline, hypertonic saline, anti cholinergic ipratrubium , steroid)
No antibiotics only in superadded or secondary infection or fever or high patchy in CXR for pneumonia.
Antiviral agent.
Prevention: breast feeding, no vaccine for RSV, give annual vaccine for influenza, monoclonal antibody (Palivizumab) for RSV given monthly in high risk and premature.

Complication :

Apnea
Respiratory failure
Hemothorax
Hemomediastinum
Cardiopulmonary collaps
Death

Prognosis :4%continue wheeze with other viral infection and 1\3 of baby develop later asthma
Notes :
More than 2 week not diagnose it as bronchiolitis first
In bronchiolitis birth cycle may reach 120\min or 80\min
Not diagnose H.F without radiological evidence of cardiomegaly.
Avoid sedation in tx of bronchiolitis cause respiratory distress


دغوح فهّم حجي احمد أغا---------------------------ولهذا المثل قصة وهي يحكى ان إمرأة كان لها ولداً عاقاً فأرادت ان تشتكيه الى الوالي العثماني حجي احمد اغا فذهبت الى السراي وحينما دخلت شاهدت بعض افراد الشرطة يقومون بضرب بعض الصبية المذنبين فتضجرت وقالت في نفسها إذا جاء ولدي الى هنا فسوف ينال من الضرب كما ينال هؤلاء الصبية ، اذن ما العمل وهي قد سجلت دعوى بحق ولدها ارسل الوالي شرطياً مع هذه المرأة لتدلهم على ولدها واثناء سيرها في الطريق رأت شباباً جالسون ويتحدثون فأشارت الى احدهم وقالت هذا ولدي فما كان من الشرطي الاان يلقي القبض عليه ليقتاده الى الوالي وبالتالي فقد حكم عليه الوالي ان يحمل امه على كتفيه ويدور بها في شوارع وطرق المدينة وبينما هو على هذا الحال مرّ بالشارع الذي دارهم فيه وكان اخوه واقفاً على باب الدار ليشاهد هذه الحالة كما يشاهدها جميع ابناء المدينة فدهش من هذا الموقف وقال له يا اخي يا فلان من تكون هذه المرأة التي تحملها فقال له امي فقال له اخيه وكيف تكون امك وهي قد ماتت قبل عامين0 قال له اعغف بس غوح فهم حج احمد اغا فأصبحت مثلاً