15呼吸系統(tǒng)疾病英文

TheSecondAffiliatedHospitalofSunYat-senUniversityTanWei-pingInfectionsoftheRespiratoryTract1ContentsUpperRespiratoryInfectionAcuteinfectiousLaryngitisAcuteBronchitisBronchiolitisPneumonia2Anatomy

upperrespiratorytract(URT)CricoidCartilage

lower

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

LRT：Trachea、bronchia、bronchiole、therespiratorybronchiole、thealveolarductandthealveolus345

Anatomy

characteristicsupperrespiratorytractNose:cilia↓,capillary↑Sinuses:mucousAuditorytubetonsilLarynx6lower

respiratorytract：WeakCartilageSupporting,ciliaryfunctionimpairmentRightbronchus:straight,largeCollagenandelastinfibers，capillary，interstitialtissueThorax：chestwall,respiratorymuscle；diaphragm，mediastinum7

Physiologicalcharacteristics

Thecompensatoryability↓Respiratoryrate↑

PatternofrespirationGas-exchangingmembrane:diffuserateCO2＞O2Resistanceofairway:child＞adult8Arterialbloodgasexamination(1)pH↓acidosis；(2)PaO2↓SaO2↓hypoxemia；(3)PaCO2↑c(diǎn)arbondioxideretentionmal-ventilation9TheImmunologicalCharacteristics：ImpairedmucociliaryclearancefunctionSIgA↓、IgA↓、IgG↓subtypeofIgG↓Alveolarmacrophages↓,lysozyme↓lactoferrin↓、interferon↓complement↓10UpperRespiratoryInfection(URI,orCommonCold)

1.

Etiology

90%

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

2.

season

fallandwinter

3.

Frequencythree

toeightcoldsayear.

11

InoculationbyvirusInvasionofepitheliumofReleaseofnasopharynx,sinusesandURTcellulardamageInflammatoryofnasopharynxmediatorsinCholinergicnasalsecretionsstimulationIncreasedIncreasedvascularmucusPermeabilityproductionbronchialconstriction

NasalRhinorrheapostnasalStuffinessdripsorecoughthroat

Pathophysiologyofthecommoncold12Theclinicalmanifestation

Commoncold

congestionarunnynosesneezingCough,sorethroatsometimesvomitinganddiarrheaFever,malaise,abdominalpain

13

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

1-4mmvesicles/ulcersonanteriortonsillarpillars,softpalate,uvula,tonsilspharyngealwall.Pharyngoconjunctivalfever:type3,7adenovirus,spring/summer.Highfever,sorethroat，pharyngitis,conjunctivitis,cervicallymphadenopathy.14ComplicationssinusitisotitismediacervicallymphadenopathyMesenterylymphadenopathyretropharngealabscesspneumoniarheumaticfeveracuteglomerulonephritis15DifferentialdiagnosisFluAppendicitisEarlyphaseofacuteinfectiousdisease16ColdFluLowornofeverHighfeverSometimesheadacheCommonlyheadacheStuffy,runnynoseSometimesstuffynose

Sneezing

SometimessneezingMild,hackingcoughCough,mayprogress

Slightachesandpains

severeachesandpainsMildfatigueFatigue,maypersistSorethroat

Sometimessorethroat17

Treatment

increasedfluidintakeavoidanceofsecondhandsmokeSalinenosedropsbulbsyringeremovethemucuscoolmisthumidifierantipyretics,suchasacetaminophen,ibuprofen,decreasethediscomfortofcolds.Donotgiveaspirin(associatedwithReyesyndrome)18

PreventionKeepyourchildawayfromapersonwithacold.Encourageyourchildtowashhis/herhandsfrequentlyandnottotouchhis/hermouth,eyes,ornoseuntiltheirhandsarewashed.Makesuretoysandplayareasareproperlycleaned,especiallyifmultiplechildrenareplayingtogether.19AcuteinfectiousLaryngitisEtiologyVirusorbacteriaTypicalanatomy

20ClinicalmanifestationsBarkingcough,hoarseness,inspiratory

stridor,nasalflaring,suprasternal,infrasternal,intercostalretractionFever,dyspnea,cyanosisrestlessness,tachycardia.Worsenatnight.Congestionofpharynx,vocalcordedema

21

GradeoflaryngicobstructionⅠ：inspiratorystridor,respiratorydifficultyonlyafteractivityⅡ：symptomsoccursatrest.tachycardia,rhonchiⅢ：Ⅱ+hypoxia,diminishedbreathsoundsⅣ：exhaustion,lethargy，pallor,breathsoundsdiminishordisappear.dullofheartsounds,arrhythmia22Diagnosis&differentialdiagnosis

laryngealdiphtherialaryngealspasmbronchialforeignbodies23treatmentMaintainingofairway：steaminhalation,clearingofsecretion.antibioticscorticosteroidoxygensupplysedatives(phenergan)Ⅲ↑tracheotomy24AcuteBronchitis(tracheobronchitis)EtiologyVirusorbacteriaAllergy,climate,airpollution,chronicinfectionofURT,particularlysinusitis.Rickets,malnutrition25Clinicalmanifestationsunproductivecough3~4days→productivecough,purulentsputum→5~10daysChestpain,shortnessofbreathVomitingPhysicalfinding:low-gradefever,rougheningofbreathsounds,rhonchi,coarsemoistrales.26Asthmaticbronchitis：

﹤3yrsold,eczema,allergy

symptomsresembleasthma

recurrentepisodesreducedafter3~4yrsold.27Treatment

increasedfluidintakefrequentshiftsofpositionantibioticscoughsuppressantsexpectorants,antihistaminesacetaminophen28Bronchiolitis

Etiologyandepidemiology50％respiratorysyncytialvirus(RSV)parainfluenza3virus,mycoplasma,adenovirusesnorth——winterandearlyspringGuangdong——spring,summerandearlyautumn292.PathophysiologyLesion:smallairpassages(diameter75～300um)Edema,accumulationofmucusandcellulardebris,spasmofsmoothmussle→↑resistanceofsmallairway→expiratorydifficulty→overinflationoratelectasis→hypoxemia,hypercapnia,acidosis30ClinicalmanifestationInfant﹤2yrsold,peakat3~6moofage,male,nonbreast-feedURI3～4daysparoxysmalwheezycoughdyspneadeveloprapidlymildormoderatefever

31PhysicalexaminationR60~80/minHR160～200/minNasalflare,intercostalandsubcostalretractionsPallor,cyanosisHyperexpandedchest，expiratoryphase↑wheeze，widespreadfinecracklesLiverandspleenpalpablebelowthecostalmarginCriticalphase48～72haferonsetofdyspnea;recoverduring5～15days32LaboratoryexaminationWBCanddifferentialcellscountnormalVirusdetectedbyantigendetection,PCR,orculture.X-ray:hyperinflationofthelungs,emphysema,scatteredareasofconsolidation

33DifferentialdiagnosisAsthmaCysticfibrosisHeartfailureForeignbodyinthetracheapertussis3435兩側(cè)肺紋理粗重。兩肺中內(nèi)帶多數(shù)小斑片狀及小結(jié)節(jié)病灶影。無病灶之肺部透過度增高。36TreamentSupportivetreatment

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

37

RibavirinAntibioticscorticosteroids38PneumoniaPneumoniaisresultsfromdirectinflammationofthelungtissueinfections(bacterial,viralorfungal)

chemicalinjury(gastricacid/aspirationoffood/hydrocarbonandlipoidpneumonia/radiationinducedpneumonia)

39ClinicalmanifestationfevercoughDyspnea(Tachypnea,cyanosis)Localizedrales(finemoistrales)Abnormalchestx-ray40ClassificationPathologicpathogeniccourseofdiseaseStateofdiseaseClinicalmanifestationWhereacquired41Bronchopneumonia1.Etiologyviruses,bacteria,MP,CP.2~3yrsold2.pathology

edema,infiltration

424344453pathophysiologyhypoxemia,hypercapnia,toxemiarespiratoryinsufficiencyacidosismyocarditis,heartfailure,shock,DICtoxicencephalopathytoxicintestinalparalysis46

4.Clinicalmanifestation(1)mildpneumonia：

fevercoughdyspnea(tachypnea,cyanosis)ralesChestx-ray47兩肺紋理增粗。兩肺中下野中內(nèi)帶見斑片狀陰影，密度較均勻。局部病灶融合成范圍稍大的片狀影48(2)Severepneumonia：

othersystemsinvolvedmyocarditis,heartfailuretoxicencephalopathytoxicintestinalparalysis

495.ComplicationsEmpyemaPyopneumothoraxpneumatocele50

6.Laboratoryfindings:

WBC,NBT,CRPPathogen(antigenand/orantibody)chestx-ray517.diagnosisFever,cough,tachypnea,dyspnea,localizedfinemoistrales,chestx-ray8.differentialdiagnosisacutebronchitistuberculosisforeignbodiesoftrachea5253男2歲半。4個月前吃蠶豆后發(fā)生嗆咳，經(jīng)常發(fā)燒，左側(cè)呼吸音低。胸片：左側(cè)阻塞性肺氣腫。心影稍右移，經(jīng)支氣管檢查于左支氣管取出蠶豆碎塊。5455

9.treament

(1)generaltherapy(2)antipathogentherapyantibioticsantivirus

56(3)symptomatictherapyoxygensupplyairwaymanagementabdominaldistentionfever(4)Corticosteroid(5)complications/underlingdisease

(6)Immunotherapy57Characteristicsofpneumoniacausedbydifferentpathogen58

1.respiratorysyncytialviruspneumoniaage:2~7monfever:mildormoderatemainsigns:acuteonset,wheeze,expiratorydifficulty,palpableliverandspleen.Pallor,cyanosis,restlessnessAuscultation:diffuserhonchi,fineralesChestX-ray:peribronchialthickeningorinterstitialpneumonia592.Adenoviruspneumonia

Age:6mon-2yrsmainsigns:acuteonset,longdurationofhighfever，7~10daysor2~3weeksthenpelterSystemictoxicsymptomsareobviousFrequentcough，paroxysmalwheeze,dyspnea,cyanosis60

lateappearanceofrales(3~7days)

myocarditis,h