Professional Documents
Culture Documents
Dr LEAH GITHINJI
PAEDIATRICIAN PULMONOLOGIST
Less than 1 week up to 2 months: 60 or more 2 months up to 12 months: 50 or more 12 months up to 5 years: 40 or more. Hypoxaemia Pulmonary oedema Parenchymal inflammation Restricitve/obstructive diseases
Pathophysiology:
Apnoea > 20 second or associated with pallor, cyanosis, convulsion or limpness. Prematurity Sepsis Meningitis/encephalitis Drugs Abnormal muscle tone
Aetiology:
Cough
Commonest respiratory symptom. Physiological to remove excess secretions or foreign body. Cough receptors in the posterior pharynx and large bronchi. Vagus/ glossopharyngeal: afferent to cough centre pons /medulla. Efferent to - larynx/ diaphragm/ chest wall/abdominal wall/pelvic Acute: lasts less than 2 weeks. Chronic: lasts more than 2 weeks.
During or after feeding: aspiration Night: asthma/ post nasal drip Morning: bronchiectasis With exercise: asthma Absence during play: psychogenic Seasonal: allergen Cold: hyperreactivity
Infants:
Children
Infections
Infectious
Pneumonia Croup Post nasal drip/sinusitis Asthma Foreign body Tropical eosiniphilia Environmental irritants
Non infectious
Non infectious
Asthma Domestic smoke pollution/passive smoke Gasro-eso. Reflux Foreign body Tracheo-eso. fistula
Psychogenic
Congenital anamolies
Propped up position at 30 degree. Treat accordingly for Allergic/non allergic rhinitis; Sinusitis
Macrolides: if Mycoplasma / chlamydia suspected. Nasal steroids/ decongestant Bronchodilators/ steroids Specific treatment
Psychogenic Cough
School aged children. The child is often a high achiever; family stress Fixed timing but disappears during sleep and when distracted. Diagnosis by observation and exclusion of other causes. Treatment: Counseling, Normal saline gargle
Noisy Breathing
Snoring
Inspiratory harsh sound irregularly Associated with: large tonsils and adenoids; micrognathia, macroglossia, palatal palsy, pharyngeal hypotonia, obesity Diagnostic test:
Sleep study, flexible bronchoscopy, lateral x-ray neck Sleeping difficulty; daytime somnolence, enuresis, growth failure, morning headache.
Stridor
Common causes:
Infective: epiglottitis, laryngotracheobronchitis, tracheitis, retropharyngeal abscess (rare) Malignancy: tumor compression, papilloma Allergic: angioneurotic oedema. Congenital: laryngomalacia, laryngeal web, vascular ring, Aspiration: foreign body. Neuronal: paralysis of vocal cord.
Blood count; Lateral neck X-ray; flexible bronchoscopy.
Investigation
Grunting
Low pitched expiratory sound. Protective phenomenon to prevent collapse of alveoli: PEEP Causes:
Respiratory distress syndrome Severe pneumonia, ARDS, severe sepsis CXR; O2 saturation, blood gas
Investigations:
Cough could be the only symptom. Triggering factor Worse at night History of repeated problem. Symptomatic improvement with bronchodilator. Gastro-esophageal reflux: Prokinetic.
Causes of Wheeze/Ronchi
Bilateral
Unilateral
Asthma Bronchiolitis Mycoplasma Cystic fibrosis Alpha 1 antitrypsin deficiency Severe pneumonia
Infective
Chest in drawing:
Cyanosis:
Increased airway resistance. Contraction of diaphragm and pulling of ribs inside. Negative pressure inside Breathing in and lower chest wall goes in. Supra sternal, inter costal recession.
Vasomotor instability in acrocyanosis. Defective perfusion. Defective ventilation. Defective diffusion. Methhaemoglobinemia Hyperoxia test
Bronchiectasis. Severe cough Pneumonia Foreign body Severe measles Haemangioma/ AV malformation