BRONŞİOLİT

1. BRONŞİOLİT

2. BROCHIOLITIS • BROCHIOLITIS MEANS INFLAMATION OF THE BRONCHIOLES • IT OCCURS DURING THE FIRST YEAR OF • LIFE PEAK INCIDENCE AT 6 mo OF AGE • THE INCIDENCE IS HIGHEST DURING • THE WINTER AND EARLY SPRING

3. BROCHIOLITIS • IT OCCURS SPORADICALLY OR • EPIDEMICALLY • IT OCCURS IN MALE INFANTS WHO • HAVE NOT BEEN BREAST-FED AND • WHO LIVE IN CROWDED CONDITIONS

4. ETIOLOGY: • ACUTE BRONCHIOLITIS IS PREDOMINANTLY • A VIRAL ILLNESS • RSV IN 50% OF CASES • PARAINFLUENZA 3 • MYCOPLASMA • ADENOVIRUSES • THE SOURCE OF ILLNESS IS USUALLY A FAMILY MEMBER WITH MINOR RESPIRATORY ILLNESS

5. PATHOPHYSIOLOGY BY DROPLET ↓ INVASION OF THE SMALLER BRONCHIAL RADICLES BY VIRUS ↓ EDEMA, ACCUMULATION OF MUCUS, CELLULAR DEBRIS ↓ BRONCHIOLAR OBSTRUCTION ↓EVEN MINOR THICKENING OF THE BRONCHIOLAR WALL IN INFANTS PROFOUNDLY AFFECT AIRFLOW ↓ RESISTANCE IN THE SMALL AIR PASSAGES IS INCREASED DURING THE INSPIRATORY AND EXPIRATORY PHASES↓ THE BALL VALVE RESPIRATORY OBSTRUCTION LEADS TO EARLY AIR TRAPPING AND OVER INFLATION ↓ ATELECTASIS MAY OCCUR

6. PATHOLOGIC PROCESS ↓ IMPAIRS THE NORMAL EXCHANGE OF GOSES IN THE LUNG ↓ VENTILATION PERFUSSION MISMATCH ↓ HYPOXEMIA ↓ HYPERCAPNIA (CO2 RETENTION)

7. CLINICAL MANIFESTATION THE HISTORY OF A FAMILY MEMBERS WITH MINOR RESPIRATORY VIRAL ILLNESS SEROUS NASAL DISCHARGE SNEEZING DIMINISHED APPETITE FEVER 38,5-39 C PAROXYSMAL WHEEZY COUGH DYSPNEA IRRITABILITY VOMITING A MILD URTI

8. PHYSICAL EXAMINATION • TACHYPNE 60-80/min • R.DISTRESS • ALAE NASI FLARE • USE OF THE ACCESSORY MUSCLES • INTERCOSTAL AND SUBCOSTAL DISTENTION • HEPATO-SPLENOMEGALY (BY OVERINFLATED • LUNGS) • WIDESPREAD FINE CRACKLES • EXPIRATORY WHEEZING (USUALLY AUDIBLE)

9. LABORATORY • WBC: NORMAL LIMITS • LYMPOHOCYT • - VIRUS MAY BE DEMONSTRATED IN NASOPHARYNGEAL SECRETION BY ANTIGEN DETECTION OR BY CULTURE

10. DIFFERENTIONAL DIAGNOSIS ASTHMA FOREIGN BODY CONGESTIVE HEART FAILURE PERTUSIS ORGANOPHOSPHATE POISONING CYSTIC FIBROSIS BACTERIAL BRONCHOPNEUMONIA

11. COURSE AND PROGNOSIS • FIRST 48-72 HOUR IS MOST CRITICAL PHASE • AFTER THE CRITICAL PERIOD IMPROVEMENT • OCCURS RAPIDLY • RECOVERY IS COMPLETE IN A FEW DAYS • FATALITY RATE BELOW 1% • DEATH MAY RESULT FROM PROLONGED • APNEIC SPELLS, SEVERE UNCOMPENSATED • RESPIRATORY ACIDOSIS OR DEHYDRATION

12. COURSE AND PROGNOSIS • INFANTS WITH CONGENITAL HEART DISEASE, • BRONCHOPULMONARY DYSPLASIA, • IMMUNODEFICIENCY, OR CYSTIC FIBROSIS HAVE • A GREATER MORBIDITY

13. COURSE AND PROGNOSIS • A SIGNIFICANT PROPORTION OF INFANTS WITH • BRONCHIOLITIS HAVE HYPER-REACTIVE • AIRWAYS DURING LATER CHILDHOOD • THE INFANTS WITH BRONCHIOLITIS WHO • DEVELOPED REACTIVE AIRWAYS ARE MORE • LIKELY TO HAVE A FAMILY HISTORY OF ASTHMA • AND ALLERGY, A PROLONGED ACUTE EPIZODE • OF BRONCHIOLITIS AND EXPOSURE TO • CIGARETTE SMOKE

14. TREATMENT • INFANTS WITH RESPIRATORY DISTRESS • SHOULD BE HOSPITALIZED • PATIENT MUST BE PLACED IN AN ATMOSPHERE • OF COOL HUMUDIFIED OXYGEN TO RELIEVE • HYPOXEMIA AND REDUCE INSENSIBLE WATER • LOSS FROM TACHYPNEAPO2 90 • THIS TREATMENT RELIEVES THE DYSPNEA AND • CYNOSIS AND ALLAYS AXIETY AND • RESTLESSNESS • SEDATIVES SHOULD BE AVOIDED BECAUSE OF • POTENTIAL DEPRESSION OF RESPIRATION

15. TREATMENT • ORAL INTAKE MUST OFTEN BE SUPLEMENTED • OR REPLACED BY PARENTERAL FLUIDS • ELECTROLYTE BALANCE AND pH SHOULD BE • ADJUSTED BY SUITABLE INTRAVENOUS • SOLUTIONS • RIBAVIRIN (VIRAZOLE) AN ANTIVIRAL AGENT • FOR TREATMENT OF HIGH-RISK RSV PATIENTS. • IT SHOWED AN IMPROVEMENT IN OXYGENETION • AND DECREASED VIRAL SHEDDING • (CONGENITAL HEART DISEASE, • BRONCHOPULMONARY DYSPLASIA)

16. TREATMENT • ANTIBIOTICS HAVE NO THERAPEUTIC VALVE UNLESS THERE IS SECONDARY BACTERIAL PNEUMONIA • CORTICOSTEROIDS MAY BE EFFECTIVE IN SEVERE CASES • BRONCHODILATING AEROLIZED DRUGS (e-g ALBUTEROL) ARE FREQUENTLY USED EMPRICIALLY

17. TREATMENT • EPINEPHRINE OR OTHER ADRENERGIC AGENTS HAVE A THEORETICAL BASIS FOR USE AEROLIZED EPINEPHRINE PROVIDED SOME BENEFIT TO INFANTS WITH BRONCHIOLITS • IF RESPIRATORY FAILERE IS RAPIDLY DEVELOPED TRACHEOSTOMY IS NOT BENEFICAL BUT MECHANICAL VENTILATORY MAY BE EFFECTIVE

18. BROCHIOLITIS OBLITERANS IN BRONCHIOLITIS OBLITERANS THE BRONCHIOLES AND SMALLER AIRWAYS ARE INJURED AND THE ATTEMPED REPAIR PRODUCES LARGE AMONTS OF GRANULATION TISSUE THAT CAUSES AIRWAY OBSTRUCTION. AIRWAY LUMENS ARE OBLITARED WITH MODULAR MASSES OF GRANULATION AND FIBROSIS

19. ETIOLOGY: MEASLES INFLUENZAE ADENOVIRUS MYCOPLASMA PERTUSSIS INHALATION OF THE OXIDES OF NITROGEN OR OTHER CHEMICAL

20. CLINICAL MANIFESTATION COUGH R.DISTRESS CYNOSIS PROGRESSIVE DISEASE SHOWS INCREASING DYSPNEA COUGH SPUTUM PRODUCTION WHEEZING MAY OCCUR OR AFTER PERIOD OFAPPARENT IMPROVEMENT

21. ROENTGENOGRAPH FROM NORMAL TO A PATTERN THAT SUGGESTS MILIARY TUBERCULOSIS. JAMES SWYER SYNDROME UNILATERAL HYPERLUCENCY AND A DECRASE IN ABOUT 10% OF CASES. PULMONARY FUNCTION TEST: RESTRICTIVE OR A COMBINATION OF OBSTUETIVE AND RESTRICTIVE PATTERN

22. HRLT: BRONCHIECTASIS DIAGNOSIS: CAN BE CONFIRMED BY LUNG BIOPSY PROGNOSIS: SOME PATIENTS DETERIORATE RAPIDLY AND DIE WITHIN WEEKS OF THE ONSET OF THE INITIAL SYMPTOMS BUT MOST SURVIVE SOME WITH CHRONIC DISABILITY TREATMENT THERE IS NO SPESIFIC TREATMENT CORTICOSTEROID MAY BE EFFECTIVE