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1、 Respiratory System Disorders vPediatric pulmonary diseases account for almost 50% of deaths in children under age 1 year and 20% of all hospitalization of children under age 15 years. Bryce et al. WHO estimates of the causes of death in children. Lancet 2005vRespiratory tract infections represent t
2、he most common infections of childhood and range from trivial to life threatening illness. Other diseases of this system include asthma, disorders of pleura or pleura cavity, lung tumor, congenital abnormality.vThe knowledge of basic respiratory physiology and anatomy is one of the basic requirement
3、s for correct interpretation of symptoms and physical signs and in the attainment of an age appropriate differential diagnosis. There are a number of significant anatomic and physiological differences between children and adults that have impact on assessment and management. The child is not only ph
4、ysically smaller but also has immature respiratory systems with fewer reserves than those of the adult.vNormal anatomyvRespiratory system is divided into upper respiratory tract and lower respiratory tract by cricoid cartilage.vupper respiratory tract: nose, nasal sinuses, pharynx, pharyngotympanic
5、tube , epiglottis , larynx vlower respiratory tract: trachea, bronchus, bronchiole , respiratory brochiole, alveolar ductules , alveolus vNasal passage is shorter, no vibrissa , mucosa has a rich vascularity-liable to infectionvNasal passage is narrow-liable to obstruction, resulted dyspnea.vNasal s
6、inus ostia is large-nasosinusitis.vpharyngotympanic tube is broader, straighter, shorter and horizontal-otitis media .vpharyngeal tonsils :start to enlarge at the end of 1 year, peak at 4 to 10 year-old, degeneration at 1415 years old-tonsillitis rarely occurs in infants.vLarynx is in a shape of fun
7、nel and narrow, cartilage is flexible, mucosa is tender and rich of vessel-laryngeal edema and narrowvTrachea and bronchus are narrower than those of adult; cartilage is flexible, lack of elasticity tissue, supporting action is weakvAirway wall account for 30% of Airway wall area in children, 15% in
8、 adult. mucosa is tender and rich of vessel. vThe right main bronchus is more vertical and broader than the left and it offers an easier passage for aspirated foreign bodiers.vBronchiole has not cartilage- easy to collapse, result to retention of gas and effect the exchange of gas.vThe amount and si
9、ze of alveolus is less and small.vChest is shorter and in a barrel shape, has a smaller scope of activities vThe airway are lined with an epithelial membrane that gradually changes from ciliated pseudostratified columnar epithelium in the bronchi to a ciliated cuboidal epithelium near the gas-exchan
10、ging units. The three lobes (upper, middle and lower) of right lung has separated by the horizontal and oblique fissures, respectively.vThe left lung has two major lobes (upper and lower) separated by an oblique fissure, and the upper lobe is itself divided into upper and lingular lobes. The right l
11、ung and the left lung project low down behind the dome of the diaphragm and peak behind the clavicles.vNormal physiologyvThe principal function of the lung is to carry through gas exchange, which is to enrich the blood with oxygen and cleanse it of carbon dioxide. An essential feature of normal gas
12、exchange is that the volume and distribution of ventilation are appropriate.vThe extrathoracic components of the respiratory tree trend to collapse inwards during inspiration and open during expiration. Therefore, if the extrathoracic airway is obstructed, the obstruction is first evident during ins
13、piration and, as the airway further narrows, obstruction occurs during both phases of breathing. vBy the action of respiratory muscles the intrathoracic airways are actively opened during inspiration. In addition, surfactant reduces the surface tension of the alveoli, thereby reducing the effort to
14、keep the alveoli open during inspiration. During expiration, the airways tend to collapse because of the natural elasticity of the lung. Therefore, partial obstruction of the intrathoracic airways causes earlier closure of the airways during expiration and results in air-trapping with eventual over
15、inflation of the lung.vAcute upper respiratory tract infectionvThe upper respiratory tract comprises the nose, throat, tonsils, pharynx, and sinuses. Acute upper respiratory infection (also called common cold syndrome) is very common in all paediatric age groups. The nose and pharynx are the most co
16、mmon sites of infection.vViruses: respiratory syncytical virus, rhinovirus, adenovirus, parainfluenza virus, and influenza virus.vBacterial: streptococcusvThe commom cold :running nose, nasal congestion, sore throat, lacrimation, cough, and sneezing, low grade fever vomiting, diarrhea, abdomen pains
17、 convulsion vSpecial types of AURI:1)herpangian: cause by coxsackievirus fever, extreme irritability, poor appetite small blister , ulcers on the lips, gums and tongue. 2) pharyngo-conjunctival fever: caused by adenovirus type 3 or type 7. fever, pharyngitis, conjunctivitis swollen lymph nodes/gland
18、 gastrointestinal symptomsvOtitis mediavInfectious laryngitisvPeritonsillar abscessvPneumonia vPost-streptococcal glomerulonephritisvRheumatic fevervVirus: white blood cell count is usually normal to low; virus isolation and serum test can confirm the agent.vBacteria: white blood cell count may incr
19、ease. Pathogenic bacteria can also be cultured from pharyngeal swabs or throat washings. ASO titer is increased after streptococcus infection.vDiagnosis is made by clinical manifestation. But the following may be considered for differential diagnosis:1.Influenza: influenza infection is easiy recogni
20、zed during epidemics. In older children produces a syndrome of sudden onset of high fever, severe myalgia, headache, and chills. Parainfluenza virus or influenza virus could be found.2. Earlier period of acue infectious disease: Epidemics, clinical manifestations, and laboratory findings may be arri
21、ved at the diagnosis. Pay attention to state of the illness.3.Acute appendicitis: Abdominal pain may present before fever. Localization of pain to the hypogastric region. Abdominal muscle is tense with fixed tenderness. White blood cell counts may increase.vGeneral therapy: rest, ensure an adequate
22、fluid intake, and prevent complication.vPathogenic therapy: Antivirus: Clinically used anti-virus drugs include virazole (ribavirin), persantine and interferon. The drug could be used for 3 to 5 day. If it is caused by hemolytic streptococci, penicillin should be used for 10 to 14 days.vSymptomatic
23、management: Fever is controlled by antipyretics, such as compound aminopyrine, and paracetamol. Alcohol sponging also is used. Some oral laryngopharynx drug could be given to control sore throat.vChinese herb: banlan gen, daqing ye and so on can antivirus and relieve toxicity symptom.vAcute bronchit
24、is is an infection of he bronchial mucous membranes. It may be complication of acute upper respiratory infection, or clinical situation of acute infection disease. Because trachea is usually involved at the same time, so it is also defined as acute tacheobronchitis. This disorder appears to be more
25、common in younger children.vEtiology bacteria Virus Rhinitis, sinusitis, rickets, malnutrition can promote the illness progress.vClinical manifestations cough sputum production, vomiting, malaise, fever, diarrhea. dyspnea and cyanosis are rare.vInfant: tachypnea, recession, apnea.v physical sign: in
26、termittent cyanosis, crepitation, wheeze, dehydration, hepatomegalyvAsthmatic bronchitis:(1) most patients had suffer from eczema or other allergic illness before 3 years old.(2) symptoms like asthma.(3) repeated episode.vChest X-rayNormalLung markings thickenHyperinflationvTreatmentv1.gerneral therapy: rest, inhalation oxygen and adequate hydrationv2.control infection anti-virus therapy or antibiotics.v3.symptomatic management: control cough, dilute sputum; control asthma, aminophylline, bricanyl, inhaled steroids, B2-adrenoceptor agonists. prednisone