bronchiolitis meu pleno.ppt

8/17/2019 Bronchiolitis MEU pleno.ppt

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Wisman Dr, Sp.A


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Bronchiolitis

Bronchioles infammation

Clinical syndromes:ast breathing, breathing diculties,retractions, wheezing, poor eeding, ,cough, irritability, (very young) apnoe

!redominantly " # years o age(# $ % months)

&icult to di'erentiate with pneumonia


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Holgate ST, et al. JACI 2003; 111(2):215


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&eense mechanisms orespiratory tract

– Aerodynamic filtering

– Airways reflexes

– Mucus

– Secreted substances

– Cilia

– Respiratory epithelium

• Non immune defenses

• Immune defenses – Cellular

– umoral


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Mucociliary system

Braga,


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…Bronchiolitis !athology

ecrosis o the resp epithelium &estruction o ciliated epithelial cells

!eribronchial inltration with lymphocites *neutrophils

+ub mucosal edematous o destruction o collagen, muscle, or elastic

tissue

!athophysiologydema - accumulation o mucous * cellulardebris narrow o peripheral airway partially .totally occluded over distention . atelectasis


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…Bronchiolitis

tiology !redominantly /+0 (/espiratory +yncytial

0irus) 1ther viruses : rhinovirus, adenovirus,

infuenza virus, parainfuenza virus, enterovirus, etc

+everity !rematurity 1/ 234

5nderlying medical condition 1/ #34 6roup 7 /+0 strain 1/ 8#% 7ge " 8 mo 1/ 489


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…Bronchiolitis

&iagnosis

tiological diagnosis

icrobiologic e;amination

Clinical diagnosis

+igns and symptoms7ge

/esource o inection epidemic o /+0


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…Bronchiolitis

Clinical aniestations : mild rhinorrhea,cough, cold, low=grade ever

2=# d ast breathing, chestretraction, wheezing, irritable, vomitus,poor inta>e

!hysical ;aminationstachypnea, tachycardia, retraction,

prolonged e;piration, wheezing,ever,pharyngitis, con?unctivitis, otitismedia, dehydration


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…Bronchiolitis

/adiologic e;aminationdi'use hyperinfation fat diaphragm, @ntercostal space A

retrosternal space A

peribronchial inltrates . thic>ening

patchy atelectasis segmental collapse

pleural e'usion (rare)


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…Bronchiolitis

alosis etabolic acidosis

7cute respiratory acidosis


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…Bronchiolitis

anagement ild treated at home

oderate . severe disease hospitalization

support : o;ygen

intra venous fuid drip(antibiotics)

detect * treat possible complication

prevent the spread o in

Controversial : bronchodilator

corticosteroid

antiviral

antibiotic


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…Bronchiolitis

atural history * complications /egeneration o bronchiolar epithelium

ater 8 or 4 d

Cilia ater 8 or 4 d

@mproved clinical ndings : in 8=4 days

@mproved radiological eatures: in 9 days

!ersistent respiratory obstruction : #DE

/espiratory ailure : # E


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…Bronchiolitis

Correlation with 7sthma 8D E = D E becomes asthmatic patients

+imilarity in : = pathogenicmechanisms

= pathologicdisorders


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bronchiolitis meu pleno.ppt

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