This document provides an overview of the respiratory system and common respiratory ailments in children. It discusses the anatomy of the respiratory system and covers topics like acute upper respiratory infections, allergic rhinitis, bacterial sinusitis, otitis media, pneumonia, bronchiolitis, bronchitis, asthma and foreign body aspiration. For each topic, it addresses etiology, clinical features, diagnosis, management and potential complications. The goal is to educate about important respiratory illnesses and how they are evaluated and treated in pediatric patients.

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

2.  To know important respiratory ailments to be
covered
 To know the normal anatomy of respiratory
system
 To understand pathology clinical features and
management of acute URI , allergic rhinitis
 To learn the c/f , management of bacterial
sinusitis and otitis media

3. 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
Foreign body aspiration diagnosis ,management
Pathogenesis c/f & management of pneumothorax,
Pleural effusion, empyema

4. What makes up the resp. system

6.  Up to ½ of all
symptomatic illness
 Significant
morbidity and
health care costs
 Occasionally leads
to fatal illness
 Excessive use of
antibiotics a major
issue

7.  Children average 8 per year, adults 3
 Rhinoviruses 30 to 35%, coronavirus – 10%
 miscellaneous known viruses about 20%
 undiscovered viruses up to 35%
 group A beta hemolytic streptococci 5% to 10%

8. ACUTE URI
COMMON COLD
SINUSITIS
RHINITIS
TONSILLITIS
PHARYNGITIS
LARYNGITIS
AOM

9.  Direct contact is the most efficient means of
transmission
 Droplet infection
 Brief exposure (e.g., handshake) transmits in
less than 10% of instances

11.  Symptomatic
o Paracetamol
 Saline Nasal drop
 Antihistaminic

12.  Ig E mediated allergic reaction to specific allergens
in predisposed children
 May be seasonal or perennial/family history
 Common agents – house dust mite, spores, pollen
 Co existing – atopic dermatitis,asthma

13.  C/F –Sneezing,nasal itch,nasal
obstruction,clear rhinorrhoea
 O/E –Inf turbinate hypertrophy , pale nasal
mucosa,allergic shiner,allergic salute
 Diagnosis – clinical , eosinophilia on nasal
smear, increase total IgE ,Skin test – specific
allergen
 Trt – avoidance of allergen , topical steroid
nasal spray,short course antihistaminic
 Avoid topical decongestants

16.  Mostly viral pathgens
 Predisposing factors – adenoid H,Allergic
rhinitis,ciliary dyskinesia,cystic fibrosis
 Viral infection -- obstruction of ducts --
compromise of mucocilary blanket–
bacterial invasion
 S.pneumoniae and
H.influenzae(nontypable),moraxella
 Complicates 0.5% of common URI,More
common in adults than in children

18.  Persistent,purulent nasal discharge >7days
 Fever,nasal congestion,earache and fullness
 Swelling around eye
 Tenderness over sinuses
 Headache
 Halitosis,hyposmia
 Headache,vomiting in complicated cases
Diagnosis
o Clinical
o X-Ray PNS,CT is preferred
o Rarely – MRI(in complicated cases)

26.  Antibiotics
 Amoxycillin -10 – 14 days
 Clarithromycin
 Cefuroxime
 Paracetamol
 Mucolytic agents
 Oral decongestants
 Saline nasal decongestant
 Steam inhalation

27. (Chronic sinusitis >12weeks)
Maxillary: usually uncomplicated
Ethmoid:orbital cellulitis, cavernous
sinus thrombosis (40% mortality)
Frontal: osteomyelitis of frontal
bone(pott puffy tumor),cavernous
sinus thrombosis; epidural, subdural,
or intracerebral abscess; orbital
extension,proptosis

28.  Critical role of
eustachian tube
 conduit between
nasopharynx, middle
ear, and mastoid air
cells
 Children have shorter,
wider eustachian
tubes,collapsible
 Adenoids as a source

29.  Acute otitis media is an inflammation of the
middle ear that can result in accumulation of
infected fluid
 Viral infection,S. pneumoniae,nontypable H
influenzae,Moraxella,Streptococci
 Otitis media is a common childhood infection
 91% of children had at least one episode by age two

30.  Symptoms of otitis media can include:
 Ear pain (otalgia)
 Discharge from the middle ear (otorrhea)
 Difficulty hearing
 Nonspecific symptoms include: fever, irritability,
headache, apathy, anorexia, vomiting and diarrhea
 Tragus sign,pink inflammed tympanic membrane
 Bulged t.membrane,pus discharge

34. DIAGNOSIS/TREATMENT
Diagnosis is clinical,otoscopy
Antibiotic-Amoxycillin(80-90mg/kg) for 10days
Prompt antibiotics in less than 2years
Paracetamol
Dry ear ( no ear drops )
Reassess after 5 days
Complications
Hearing loss,mastoiditis,meningitis
Brain abscess,sigmoid sinus thrombosis,
Facial nerve palsy

35. CHRONIC OTITIS MEDIA
Persistent or recurrent ear discharge
more than 6weeks
Etiology – pseudomonas aeruginosa
S.aureus
proteus
E. coli
Treatment – topical antibiotics
avoid water entry in that ear
antibiotiocs