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1、CASEREPORTANDDISCUSS 50 ofconsultationwithgeneralpractitionersoracuteillnessinyoungchildrenandathirdofconsultationsinolderchildren20 35 ofacutepediatricadmissionstohospital someofwhicharelife threateningAsthmaisthemostcommonchronicillnessofchildhood RespiratoryDisorders Respiratoryinfectionsareveryc
2、ommon Pathogens viruses bacterial mycoplasmaandotherpathogens InfectiousDiseases upperrespiratorytractinfection commoncold tonsillitis bronchitis bronchiolitis pneumonia etc Others Asthma foreignbodyaspiration etc RespiratoryDisorders CASE1 11months male sneeze runnynose lowtemperaturefor2daysoccasi
3、onalcough CASE1 physicalexamination throatcongestionlungauscultation clear CASE1 LABWBC4 0 109 LHb120g L PLT323 109 LNeutrophile0 30Lymphocyte0 55Monocyte0 10 Whatdoyoufindintheresults Diagnosis AcuteUpperRespiratoryTractInfection commoncold UpperandLowerRespiratoryTract cricoidcartilage upperrespir
4、atorytract nose nasalcavity rhinitissinus sinusitispharynx pharyngitispharyngotympanictube pharyngotympanicsalpingitistonsil suppurativetonsillitismiddleear otitismediaepiglottis epiglottitislarynx laryngitis 13years girlchiefcomplaint Pharyngalgiaandfeverforfourdays CASE2 CASE2 PhysicalexaminationT
5、39 5 pharynxwascongestive tonsilswereredandenlargedwhitepus filledspotsonthetonsils CASE2 physicalexaminationlungauscultation Noabnormalbreathsound Nowheezesandrales CASE2 LABWBC 12 9 109 L Hb 121g L PLT345 109 L N79 L12 CRP 30mg L Diagnosis suppurativetonsillitis tonsil 度 扁桃体有肿大但仍在咽腭弓范围内 度 扁桃体肿大超过咽
6、腭弓 但未达到咽后壁中线 度 扁桃体肿大达到或超过咽后壁中线 0 Tonsilsfitwithintonsillarfossa1 Tonsils75 ofspacebetweenpillars suppurativetonsillitis ThemostcommoncauseisbacterialinfectionofwhichthepredominantisGroupA hemolyticstreptococcus GABHS LowerRespiratoryTract trachea Trachitisbronchus bronchitisbronchiole bronchiolitist
7、erminalbronchiolesrespiratorybronchiolesalveolarducts pneumoniapulmonaryalveoli pneumonia 11months male sneeze runnynose lowtemperaturefor4days coughandwheezingfor2days CASE3 irritableandrestlessRR56breathsperminutesLungAuscultation rales rhonchus wheezing PhysicalExamination M 8个月 Hyperinflationinc
8、reasedlungmarkings ChestX ray Bloodtest WBC6 5x109 L N0 35Hb123g LPLT234x109 LCRP3mg L What supwithhim BRONCHIOLITIS Bronchiole bronchiolits 1 Trachea2 Mainstembronchus3 Lobarbronchus4 Segmentalbronchus5 Bronchiole6 Alveolarduct7 Alveolus BronchialTree Thehumantrachea windpipe dividesintotwomainbron
9、chi alsomainstembronchi theleftandtheright Therightmainbronchusiswider shorter andmoreverticalthantheleftmainbronchus BronchialTree Therightmainbronchussubdividesintothreelobarbronchi whiletheleftmainbronchusdividesintotwo Thelobarbronchidivideintotertiarybronchi Therearetensegmentsperlung Bronchial
10、Tree Thesegmentalbronchidivideintomanyprimarybronchioleswhichdivideintoterminalbronchioles eachofwhichthengivesrisetoseveralrespiratorybronchioles whichgoontodivideintotwoto11alveolarducts BronchialTree Theterminalbronchioleisthemostdistalsegmentoftheconductingzone Thebronchiolesorbronchioliarethepa
11、ssagewaysbywhichtheairpassesthroughthenoseormouthtotheairsacsofthelungsinwhichbranchesnolongercontaincartilageorglandsintheirsubmucosa BronchialTree BronchioleAnatomicstructure NarrowMucousmemberance tenderandthinrichinvascularityandlymphatictissuecontainnocartilageorglandsintheirsubmucosa DEFINITIO
12、N Bronchiolitisisanacute infectious inflammatorydiseaseofthelowerrespiratorytractresultinginobstructionofthesmallairways bronchioli Epidemiology Pathogen RSV respiratorysyncytialviruses Winterandearlyspringundertheageof2withapeakageof2to6monthsMale BronchioleAnatomicstructure NarrowMucousmemberance
13、tenderandthinrichinvascularityandlymphatictissueinfection obstructionClinicaldiagnosis CLINICALFEATURES premonitorysymptom common cold congestedorrunnynosesneezinglowgradefever CLINICALFEATURES Symptomscontinuouscoughparoxysmalwheezingfever variable irritabilityothers CASE4 male 8monthsfeveraccompan
14、iedbycoughandintermittentwheezingfor2daysrapid labouredbreathingandpoorfeeding T 39 5 RR 60breaths mincyanosisweakresponse PHYSICALEXAMINATION LungAuscultation cracklesandwheezes PHYSICALEXAMINATION WBC 6 11 109 L Neutrophils30 7 Lymphocytes69 3 CRP 22mg L LAB increasedlungmarkings sligntshadowinrig
15、htlowerlung CHESTX RAY Doyouhaveanycommentsorwhatdoyouconcludeanythingfromthiscase DIAGNOSIS Adenoviruspneumonia Adenoviruspneumonia PATHOGEN ADVWinterandspringandearlysummerundertheageof2Male Epidemiology ADV Forunexplainedreasons adenovirus3and7causesevereepidemicsofpneumoniainchildrenofnorthernCh
16、inaandKorea withmortalityratesof5 15 Clinicalmanifestation Highfever acontinuedfeverflu likesymptoms inflammationofthepharynx sorethroat inflammationofnasalmembranes oracongested runnynose Clinicalmanifestation cough Adenoviruscanalsoproduceadry harshcoughwheezingPaleWeakRale CASE5 an18 montholdinfant beatthehospitalwithatroublesomecough wheezeandbreathlessness Hismothersaidhedevelopedeczemaattheageof2months Fromtheageof8monthshehassufferedfromintermittentbutfrequentchestsymptoms CASE5 Hismother
