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Sinusitis

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Sinusitis

  1. 1. Sinusitis Xavier Robledo López 91153 Palmira Carreño Antonio 91188Víctor Armando Barajas Juárez 91200 1
  2. 2. • Mejor conocida como Rinosinusitis• Es la inflamación de la mucosa de las fosas nasales y senos paranasales, secundaria a causas infecciosas y no infecciosas.Componente viral o Componente bacteriano Alergico 80% 20% 2
  3. 3. Revisión Anatómica 3
  4. 4. 4
  5. 5. Correcto Funcionamiento• Adecuado drenaje de secreciones• Integridad del aclaramiento mucociliar• Calidad de las secreciones mucosas★ Permeabilidad de cada ostium del seno★ Función inmune normal 5
  6. 6. Factores que afectan Fn. Mucociliar✴ Humo del cigarro✴ Contaminantes ambientales✴ Fallas inmunes 6
  7. 7. Epidemiologia 7
  8. 8. Clasificación• <4 semanas de • 4-8 semanas drenaje nasal de duración purulento Aguda Subaguda Aguda Crónica recurrente? • 8-12 semanas• Episodios recurrentes, • 3 subtipos: con periodos -Sin poliposis nasal. libres de -Con poliposis nasal enfermedad. -Rinosinusitis fúngica alérgica Dykewickz MS, Hamilos DL. Rhinitis and Sinusitis. J Allergy Clin Inmunol. 2010; 125(2): S103-S115. Tomás-Barberan M, Ortega del Álamo P, et.al. Diagnóstico y Tratamiento de las Rinosinusitis Agudas. Segundo Consenso. Rev Esp Quimioter.2008;21(1):45-59
  9. 9. Fisiopatología Función inmune local y sistémica. Función mucociliar normal Permeabilidad de cada ostiumDykewickz MS, Hamilos DL. Rhinitis and Sinusitis. J Allergy Clin Inmunol. 2010; 125(2): S103-S115
  10. 10. Fisiopatología de sinusitis aguda Infección viral de VAS Inflamación de Sinusitis aguda la mucosa de bacteriana los senos paranasales > Engrosamiento Obstrucción del de la mucosa y ostium < aclaramiento . Disminución de la presión dentro del seno Anzai Y, Paladin A. Diagnostic imaging in 2009: update on evidence-basedpractice of pediatric imaging. What is the role of imaging in sinusitis?. Pediatr Radiol . 2009 : 39 (Suppl 2):S239–S241
  11. 11. Agentes causalesVirus BacteriasRinovirus S. PneumoniaeInfluenza H. InfluenzaeParainfluenza M. catarrhalisAdenovirus S. aureus Del Río-Navarro BE, Mitsutoshi F, Zepeda-Ortega B. Rinitis, Sinusitis y Alergia. Revista Mexicana Alergia. 2009; 56 (9): 204-16.
  12. 12. Manifestaciones Clínicas Obstrucción Rinorrea Secreción nasal purulenta retronasal Cefalea grave Dolor frontal oque se proyecta facial Fiebre a SPN localizado. Del Río-Navarro BE, Mitsutoshi F, Zepeda-Ortega B. Rinitis, Sinusitis y Alergia. Revista Mexicana Alergia. 2009; 56 (9): 204-16.
  13. 13. Fisiopatología de Sinusitis crónica Proliferació n bacteriana Obstrucción primaria o del ostium secundaria Disminución de la Estasis de presiónsecreciones parcial de O2 Disminución Aumento de del la presión movimiento parcial de ciliar CO2 Hipertrofia polipoide de la mucosa nasal Eloy P, Nollevaux MC, Bertrand B. Fisiología de los senos paranasales. EMC- Otorrinolaringología. 2005; 34 (issue 3): 1-11.
  14. 14. Características específicas de la RSC • -60% de los casos. -Factores alérgicos, anomalías estructurales e infecciones virales o bacterianas.Sin pólipos • Dolor facial, sensación de presión o llenado • Presencia de neutrofilos, monocitos y pocos eosinófilos. Con • 20-33% de los casos • Síntomas similares a la anterior + anosmia/hiposmia. • Polipos generalmente bilaterales y localizados en el pólipos meato medioRS fúngica • Moco espeso, hifas en la mucina y evidencia de alergia a hongos mediada por IgE. • Pólipos alérgica • Pacientes inmunocompetentes Dykewickz MS, Hamilos DL. Rhinitis and Sinusitis. J Allergy Clin Inmunol. 2010; 125(2): S103-S115
  15. 15. Diagnóstico• HC – Infecciones virales anteriores o recurrentes – Exposición a cambios bruscos de temperatura – Exposición a agua infectada – Tiempo de evolución relativamente corto – Alergias
  16. 16. Exploración física
  17. 17. Criterios mayores• P ain Dolor facial, sensacion de opresión• O bstrucción nasal• D escarga postnasal, purulenta• S mell Hiposmia-anosmia Desrosiers et al. Canadian clinical practice guidelines for acute and chronic rhinosinusitis Allergy, Asthma & Clinical Immunology 2011, 7:2
  18. 18. • “2 o mas hallazgos positivos proporcionan una sensibilidad del 95% y una especificidad del 77% para sinusitis”Desrosiers et al. Canadian clinical practice guidelines for acute and chronic rhinosinusitis Allergy, Asthma & Clinical Immunology 2011, 7:2
  19. 19. Imagenologia • Nivel líquido • Velamiento • TAC?
  20. 20. Tratamiento• Médico• Quirúrgico• Aliviar dolor• Disminuir edema• Controlar la infección
  21. 21. • Codeína• Calor húmedo• Vasoconstrictores – Efedrina 2% – Fenilefrina 0.25%
  22. 22. Antibióticos• Amoxicilina/clavulanato – 375-1500 mg/dia• Levofloxacino – 500mg/dia• Drenaje
  23. 23. Complicaciones• Cefalea intensa persistente• Convulsiones• Fiebre alta• Edema palpebral• Diplopía• Celulitis orbitaria• Absceso orbitario
  24. 24. Referencias1. McMahon N, Cooper M, Iorember F and English R. Just Chronic Sinusitis. Clinical Pediatrics. 2012; 51(11): 1099-1103.2. Hawthorne MR and Ahmad N. Acute sinusitis: Pitfalls in diagnosis and management. Clinical Risk. 2010; 16: 209-212.3. Harvard Women’s Health Watch. What to do about sinusitis. Harvard Health Publications. 2009; 16(7): 1-4.4. Dykewickz MS, Hamilos DL. Rhinitis and Sinusitis. J Allergy Clin Inmunol. 2010; 125(2): S103-S115.5. Tomás-Barberan M, Ortega del Álamo P, et.al. Diagnóstico y Tratamiento de las Rinosinusitis Agudas. Segundo Consenso. Rev Esp Quimioter.2008;21(1):45-596. Anzai Y, Paladin A. Diagnostic imaging in 2009: update on evidence-based practice of pediatric imaging. What is the role of imaging in sinusitis?. Pediatr Radiol . 2009 : 39 (Suppl 2):S239– S241
  25. 25. Referencias7. Del Río-Navarro BE, Mitsutoshi F, Zepeda-Ortega B. Rinitis, Sinusitis y Alergia. Revista Mexicana Alergia. 2009; 56 (9): 204-16.8. Eloy P, Nollevaux MC, Bertrand B. Fisiología de los senos paranasales. EMC-Otorrinolaringología. 2005; 34 (issue 3): 1-11. (http://www.sciencedirect.com/science/article/pii/S163 234750544285X)9. Desrosiers et al. Canadian clinical practice guidelines for acute and chronic rhinosinusitis Allergy, Asthma & Clinical Immunology 2011, 7:2 26

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