It's a medical College power point presentation of the respiratory system.

1. RESPIRATORY SYSTEM
DR. JASASHREE CHOUDHURY
PROFESSOR
DEPT OF PEDIATRICS
IMS & SUM HOSPITAL

2. Etiopathogenesis , clinical features,complications, investigations
Differential diagnosis and management of Acute URI,
Pneumonia with emphasis on bronchopneumonia
Bronchiolitis
Bronchitis
Bronchial asthma
Etiopathogenesis, c/f ,diagnosis, classification, management
t/t of Ac. Severe Asthma
Fb aspiration diagnosis ,management
Pathogenesis c/f & management of pneumothorax,
Pleural effusion, empyema

3. Etiology,C/F,diagnosis of
bronchiolitis
Management of bronchiolitis
Acute bronchitis-clinical
features,treatment

4. Common cause of hospitalization in young
children,<2yrs (severe in 2m-6m)
May be associated with future development
of bronchial hyper reactivity
May be associated with significant morbidity
though mortality is only 1 – 2%
INTRODUCTION

5. MICROBIOLOGY
Typically caused by viruses
RSV-most common
Parainfluenza
Human Metapneumovirus
Influenza
Rhinovirus
Coronavirus
Occasionally associated with Mycoplasma
pneumonia infection

6. RISK FACTORS OF SEVERITY
Prematurity
Low birth weight
Age less than 12months
Hemodynamically significant cardiac disease
Immunodeficiency
Neurologic disease
Anatomical defects of the airways

7. PATHOGENESIS
Viruses penetrate terminal bronchiolar cells—
directly damaging
also via inflammatory mediators
Pathologic changes begin 18-24 hours after
infection
Bronchiolar cell necrosis, ciliary disruption,
peribronchial lymphocytic infiltration
Edema, excessive mucus, sloughed epithelium
lead to airway obstruction and atelectasis

8. CLINICAL FEATURES
Begin with upper respiratory tract
symptoms: nasal congestion,
 rhinorrhea, mild cough, low-grade fever
Progress in 3-6 days to rapid respirations,
chest retractions, wheezing

9. CLINICAL FEATURES
Tachypnoea,low grade fever
Prolonged expiratory phase, rhonchi,
wheezes and crackles throughout
Severe distress,grunting
 Dehydration
 Conjunctivitis or otitis media
 Cyanosis or apnea(very young infants)

10. DIAGNOSIS
Clinical diagnosis based on history and
physical exam
Usually child is active alert apart from f/o
resp distress no toxic look
Supported by CXR:
hyperinflation, flattened diaphragms,
air bronchograms, peribronchial cuffing,
patchy infiltrates, atelectasis

11. Most useful in children with complicating
symptoms
CBC,Routine urine test--to help determine
bacterial illness
Blood gas--evaluate respiratory failure
CXR--evaluate pneumonia, heart disease
INVESTIGATION

13. DIFFERENTIAL DIAGNOSIS
Viral-triggered asthma
Bronchitis or pneumonia
Chronic lung disease
Foreign body aspiration
Gastroesophageal reflux or dysphagia leading to
aspiration
Congenital heart disease or heart failure,cardiac
asthma
Vascular rings, bronchomalacia, complete tracheal
rings or other anatomical abnormalities

14. RISK FOR SEVERE DISEASE
Toxic or ill-appearing
Oxygen saturation < 95% on room air
Age less than 3 months
Respiratory rate > 70
Atelectasis on CXR

15. HOSPITALIZATION
Children with severe disease
Toxic with poor feeding, lethargy,
dehydration
Moderate to severe respiratory
distress
(RR > 70, dyspnea, cyanosis)
Severe Hypoxemia,Apnea
Parent unable to care for child at
home

16. TREATMENT
Supportive care
Pharmacologic therapy

17.  Oxygen supplement,respiratory support
 Adequate fluid intake(Isotonic
fluid),antipyretics
 Hypertonic saline nebulization
 Adrenaline nebulization
 Saline nasal drop,bulb suctioning
 Aerosolised Ribavirin in special
situations
 Bronchodilators are controversial
 Aviod deep suctioning

18. Oxygen saturations to maintain above 90-
92%
Keep saturations higher in the presence of
fever, acidosis, Hemoglobinopathies
Wean carefully in children with heart
disease,
 chronic lung disease, prematurity
Mechanical ventilation for pCO2 > 55 or
apnea

19. ANTIBIOTICS
Not useful in bronchiolitis per se
Should be used if there is evidence of
concomitant
bacterial infection
Positive urine culture
Acute otitis media
Consolidation on CXR

20.  Follows upper respiratory infection
 Viral infection to bacterial invasion of upper
airways
 Inflammation of airways
 Increased mucus production

21. Clinical presentation
Fever
Tachypnea
Mild dyspnea
Cough with clear to purulent
sputum production
Diffuse ronchi & crepitation
X ray - rule out pneumonia
No evidence of lung infiltration

22. Management
Chest physiotherapy to mobilize secretion
Hydration to liquefy secretion
Pharmacologic intervention
1)Bronchodilators – reduce bronchospasm
and promote sputum expectoration
2) Oral antibiotics
3) Symptomatic treatment