Escolar Documentos
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Cultura Documentos
Respiratory system
a. Introduction, Respiratory Function Test
b. Clubbing.
c. Nose,Larynx,Pharynx,Sudden Infant death.
d. Pulmonary edema.
e. Congital Lung Lesion.
f. Pulmonary hemorrhagic hemoptysis
g. Atelectasis
h. Pulmonary hemosiderosis
i. Pulmonary embolism
j. Aspiration $.
k. Inhalation Hypersesitivity Pneumonia.
l. Esinophilic Pneumonia(Loffler $)
m. Causes of recurrent Pneumonia.
n. Pleurisy pleural effusion empyema.
o. Pneumothorax,tension pneumothorax, Pneumomediastinum.
p. Bronchopulmonry dysplasia.
q. Interstitial lung disease
r. Bronchiectasis
s. Pulmonary abscess
t. Cystic fibrosis,primary ciliary dyskinesia.
u. Chest wall anomalies.
v. Neuromuscular disease of chest
w. Pulmonary hypertension
x. Vascular ring pulmonary A-V fistula
RESPIRATORY SYSTEM
(VT): Tidal volume: Amount of air move in and out each breath.
(VC): Viral capacity: Amount of air move in and out after
maximum insp. And max expiration.
(TIC): Total lung capacity: Amount of air left in lung after max
respiration
N.B.: Functional residual capacity:
During insp. Alveolar PO2 (PAO2) as fresh atmosphere gas enter lung.
During exp. alveolar PCO2 (PACO2) as Capillary Blood put CO2 to
alveoli and take O2..
FRC act as buffer minimize shanges in PAO2 &PACO2.
Respiratory
Function Test
Insp. capacity
VC
TLC TV(Vt)
FRC
Tidal volume
(TV)
PCO2 50 mmHg.
N.B. Clubbing:
1. Chronic hypoxia with chronic lung disease
2. Cardiac: cyanotic heart disease. Cong. Heart failure, bacterial
endocarditis.
3. GIT: Crohns disease, ulcerative colitis, liver cirrhosis, intistinal
lymphoma
4. Other: Hypothyroidism, fabry, reaynaund disease
5. Unilat. Clubbing: vac. Disease: Subclavian A. aneurysm, Brachial
AV fistula.
Window angle
To detect clubbing
1. In N. if we put 2 finger opposite each
other window appear in clubbing this
window disappear
2. Phalangeal depth ratio
finger
Normal
With disappear this window
IPD >DPD
Normal:
InterPhalangeal depth
distal phalangeal depth.
In Clubbung: reverse
appear: IPD DPD
Disappear of window
NB.
1. Fluoroscopy: useful in evaluation of strider.
2. Barium swallow: TOF, vascular ring, GE reflux.
In patient with Rec. pneumonia, Strider, persistent wheezes of
unknown origin.
Milk Scan for GE Reflux.
3. CT with contact, CT, MRI of chest: Has replaced bronchography
also pulm. Atriography and lung scan
NB. Sudden infant death $:
Cardiac, CNS (AV malformation), Metabolic disease.
Immunodef. Can be the causes of rec. sudden infant death also
Pulm. Hypertention & flaccid child is a cause.
Investigation: Echo, ECG for long QT interval , Metabolic screen,
CT.
Pacifier, supine position sleep, No soft bed or comfort, no
smoking, no sharing bed all effective.
4. Res. Function test: Only to D.D. restrictive from obstructive
lung disease
N.B. Choanal atresia: Can be with CHARGE $
(Cloboma, Heart, Atresic choana, Retarted Growth or CNS,
Genital anomalies (hypogonadism), Ear anomalies (deafness)
Unilateral: Can be asymptomatic for long period unilat.
Discharge.
Bilateral: Cry relieve cyanosis
CT best diagnostic
PULMONARY EDEMA
Cardiogenic
Non-cardiogenic
(ARDS)
Acute resp. distress syndr.
Heart size:
Greater than N
Edema distribution:Central or even
Pleural effusion:
present
Air bronchogram :not present
Auscultation: Gallop rhysm
Generalised edema:usually present
Normal
Patchy or peripheral
Not usually
usually present
Not present
No
N.B.:
Brochiolitis Obliterance:
serious condition complicate viral bronchiolitis
CT : patchy area of translucency and bronchiectasis.
The only definitive diagnosis is lung biopsy.
Treatment: Steroid treatment esp.in Bronchiolitis obliterance organizing
pneumonia (BOOP) but relapse can occure.So better treatment with
steroid for 1 year to prevent relpse.
Focal
Bronchitis or bronchietasis
TB
Trauma Tumor
Pulm. A.V. malformation
Pulm. Embolism
Diffuse
Idiopathic infency
Cow milk hypereson. (Heiner $)
Good Pasteur $
Collagen vascular
Henoch scheten
Wegner granuloma
Treatment:
1. Volume resuscitation & blood transfusion.
2. Mechanical ventilation.
3. Corticosteroid treatment.
4. If not stopped bronchoscopy or embolization or lobectomy
5. Treatment of cause
ATELECTASIS
Indication of Bronchoscopy:
1. Foreign body.
2. Massive both lung collapse
3. Isolated area of atelectasis
persist several weeks.
4. Lobar atelectasis persist
for 7 days after supp.
Treatment.
Causes:
1.
2.
3.
4.
5.
Pulmonary hemosiderosis:
Must be diffuse alveolar hemorrhage & chronic course
Triad of:
1. Iron def. anemia :Microcytic hypochromic with iron and
TIB capacity with retics & bilirubin
2. Chronic Hemoptysis .
3. Alveolar infiltration on chest X-ray & CT.
May be primary as:
1. Good Pasteur: hematuria, hemoptysis (anti-basent memb. Ab).
2. Cows Milk allergy.
Or Secondary: Autoimmune disease, cardiac cause,
henoch. Schonlein Purpra.
C/P: Hemoptysis+ anemia + evidence of alveolar Infiltration.
Investigation: For autoimmune disease, good poster
Treatment: Steroid treatment 2-5 mg/kg/day
Then taper & then alternative day therapy.
N.B.: Good posteur disease is the commonest causes of pulm.
Hemosiderosis.
PULMONARY EMBOLISM
Prepared by Dr. Amr Malash
Causes:
ASPIRATION SYNDROME
Gastric content: After anesthesia, gastroenteritis.
Hypoxia, hemorrhagic pnemonitis, pulm. Edema
Treatment: O2 therapy esp. mechanical ventilation,
Bronchodilator steroid therapy
Antibiotic prophylactic: should cover anerobic bacterial &
pseudomonas in hosp. patient.
Resolution usually 2-3 weeks,prolonged lung damage can appear.
Hypersensitivity pneumonia:
Secondary to inhation: farmer lung pigeon breeder lung,
Humidifier lung (contaminates humidifier)
C/P: Interstitial lung disease, +ve history of exposure
BA lavage: Lymphocytosis
Treatment: Prednisone treatment 1-2 mg./kg/day may be up to 6
months.
6. Bronchiectasis.
Pleural effusion
Transudate
Exudate
Complicated empyema
clear
cloudy
purulent
>1000
Cell type:
lymphocyte
polymorph.
Gram stain:
Negative
Colour:
Usually +ve
Common
>5000
Polymorph.
80% positive
Common
LDH :
<200
>200
PH :
7.4
7.2-7.4
> 1000
<7.2
Chest tube placement required
Hydrothorax:
Hemothorax:
1.
2.
3.
4.
5.
Traumatic
TB. Empyema
Intrathoracic neoplasm or metastasis
Cong. Lung sequestration, A.V. malformation.
Patent ductus arteriosis blood disease
Chylothorax:
Pneumothorax:
May be spontaneous or follow staph pneumonia, asthmatic bronchitis
Spontaneous: Usually in teenage & young adult
Secondary: Staph pneumonia, asthmatic. Cyst fibrosis
Diag: Chest X-ray especially in Expiration views: accentuate contrast
bet. lung marking & pnuemothorax (exp. film)
Tension pneumothorax mean : shift of mediastinum.
However,in RDS bilat pneumothorax without shift , so better diagnosis
on basis of evidence of circulatory compromise or hearing (hiss) on
chest tube.
Pneumomediastinum:
Bronchiectasis:
Irreversible abnormal dilation of bronchial tree.
Cystic fibrosis is the commonest cause. Other ciliary dyskinesia,
pertussis infection, T.B. immunodeficiency right middle lobe $ by ext.
compression by lymph nodes.
Prepared by Dr. Amr Malash
Pulmonary abscess:
Aspiration of infected material or FB is commenest cause (posttonsillectomy or adenoidectomy),
Immune deficiency, pneumonia, blood porn infection.
Diag: CT chest is most sensitive
D.D: Pneumatocele from abscess:
Abscess thick wall with low density center progress to air fluid level.
Pneumatocele: Thin wall with or without fluid level.
Cystic fibrosis:
$: Respiratory, meconium ileus, meconium plug $ in infancy,
maldigestion & steatorrhea (pancreatic), liver dysfunction.
Pectus evacuation:
Funnel chest:((
females
exercise intolerance, recurrent chest infection, recurrent asthmatic
bronchitis
Sternal cleft:
life.
Scoliosis:
Neuromuscular disease:
Butulism, Guillian barri, polio, myasthenia, spinal muscle dystrophy.
Rec. infection lead to lung fibrosis and further accelerate loss of function
of lung parenchyma lead to hypoxia
Pulmonary hypertension corpulmonale.
NB.: Change in voice and speech, use of ala-nasi, use of acc. Muscle at
rest is serious manifestation.
Prepared by Dr. Amr Malash
Pulmonary hypertension
Primary pulmonary
disease
Hypertension
Prepared by Dr. Amr Malash
pulmonary vascular
Eisenmenger $
Avoid hypoxia
Avoid hypoglycemia & treatment
Avoid hypothermia
Proper treatment of iron deficiency anemia