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BRONŞİOLİT
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
BROCHIOLITIS
• IT OCCURS SPORADICALLY OR
EPIDEMICALLY
• IT OCCURS IN MALE INFANTS WHO
HAVE NOT BEEN BREAST-FED AND
WHO LIVE IN CROWDED CONDITIONS
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
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
PATHOLOGIC PROCESS
↓
IMPAIRS THE NORMAL EXCHANGE OF GOSES IN THE LUNG
↓
VENTILATION PERFUSSION MISMATCH
↓
HYPOXEMIA
↓
HYPERCAPNIA (CO2 RETENTION)
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
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)
LABORATORY
- WBC: NORMAL LIMITS
- LYMPOHOCYT
- VIRUS MAY BE DEMONSTRATED IN
NASOPHARYNGEAL SECRETION BY
ANTIGEN DETECTION OR BY CULTURE
DIFFERENTIONAL DIAGNOSIS
ASTHMA
FOREIGN BODY
CONGESTIVE HEART FAILURE
PERTUSIS
ORGANOPHOSPHATE POISONING
CYSTIC FIBROSIS
BACTERIAL BRONCHOPNEUMONIA
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
COURSE AND PROGNOSIS
• INFANTS WITH CONGENITAL HEART DISEASE,
BRONCHOPULMONARY DYSPLASIA,
IMMUNODEFICIENCY, OR CYSTIC FIBROSIS HAVE
A GREATER MORBIDITY
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
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 TACHYPNEA PO2 90
THIS TREATMENT RELIEVES THE DYSPNEA AND
CYNOSIS AND ALLAYS AXIETY AND
RESTLESSNESS
• SEDATIVES SHOULD BE AVOIDED BECAUSE OF
POTENTIAL DEPRESSION OF RESPIRATION
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)
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
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
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
ETIOLOGY:
MEASLES
INFLUENZAE
ADENOVIRUS
MYCOPLASMA
PERTUSSIS
INHALATION OF THE OXIDES OF NITROGEN
OR OTHER CHEMICAL
CLINICAL MANIFESTATION
COUGH
R.DISTRESS
CYNOSIS
MAY OCCUR OR AFTER PERIOD
OF APPARENT IMPROVEMENT
PROGRESSIVE DISEASE SHOWS
INCREASING DYSPNEA
COUGH
SPUTUM PRODUCTION
WHEEZING
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
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