pneumonia l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Pneumonia PowerPoint Presentation
Download Presentation
Pneumonia

Loading in 2 Seconds...

play fullscreen
1 / 71

Pneumonia - PowerPoint PPT Presentation


  • 274 Views
  • Uploaded on

Pneumonia. Mohammed Kaashmiri, M.D. Etiology. Birth through 3 months: Group B Strep E. Coli Listeria Monocytogenes Staph Epidermis Staph Aureus Herpes Simplex. Etiology. CMV RSV Influenza A Influenza B Parainfluenza Adenoviruses. Viruses. Most Common – Infants & Preschoolers

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Pneumonia' - liam


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
pneumonia

Pneumonia

Mohammed Kaashmiri, M.D.

etiology
Etiology
  • Birth through 3 months:
    • Group B Strep
    • E. Coli
    • Listeria Monocytogenes
    • Staph Epidermis
    • Staph Aureus
    • Herpes Simplex
etiology3
Etiology
  • CMV
  • RSV
  • Influenza A
  • Influenza B
  • Parainfluenza
  • Adenoviruses
viruses
Viruses
  • Most Common – Infants & Preschoolers
  • More mucous membranes involved
  • Gradual Worsening
  • RSV
  • Influenza A and B
  • Parainfluenza
  • Adenoviruses
bacteria
Bacteria
  • Abrupt onset
  • Lung usually sole affected organ
  • Strep Pneumonia
  • H. Influenza
  • Group a Strep
  • S. Aureus
bacteria6
Bacteria
  • M. Tuberculosis
  • Enteric Bacilli
  • Mycoplasma Sp.
  • Chlamydia Pneumonia

(School Age & Adolescent)

signs and symptoms
Signs and Symptoms
  • (Fever, Tachypnea, Cough) Pneumonia
  • Malaise
  • Apprehension
  • Chills or Rigors
  • Toxicity & Lethargy
  • Intercostal Retractions, nasal flaring
  • Wheezing
signs and symptoms8
Signs and Symptoms
  • Fine end – inspiratory crackles
  • Cyanosis, Grunting
  • Abdominal pain- Pleuritic chest pain
  • Asynchronous chest & abdominal movement
  • Diminished breath sounds
evaluation
Evaluation
  • 1. Chest X-Ray
    • Bacteria - Lobular, lobar consolidation
    • Viral – Perihilar infiltrates, Bilateral interstitial pattern
    • Mycoplasma – Patchy alveolar & interstitial infiltrates, single or contagious lobe
evaluation10
Evaluation
  • 2. CBC with Differential – Normal Count – Bacterial etiology unlikely
    • Thrombocytosis – 500K, Bacteria?
    • Thrombocytopenia – viral
  • 3. ESR – CRP
  • 4. Gram Stain
  • 5. Blood Culture
  • 6. Direct Fluorescent antibody test
  • 7. Cold agglutinin antibodies
bronchiolitis

Bronchiolitis

Mohammed Kaashmiri, M.D.

bronchiolitis14
Bronchiolitis
  • Inflammatory process primarily involving the small airways
  • Infants under one year at increased risk
  • Most commonly affects infants between the age of 2&6 month
  • Bronchiolitis = Tachypnea+ Retraction+ Wheezing
etiology15
ETIOLOGY
  • RSV- Responsible for majority of cases
  • Para influenza
  • Adenovirus
  • Influenza
  • M. Pneumonia
  • Incidence highest during the winter and early spring
  • Source: Usually a family member with minor URI
clinical manifestation
CLINICAL MANIFESTATION
  • History of exposure to sibling or adult with minor Respiratory illness within preceding week
  • Initial symptoms of sneezing, rhinorrhea and cough
  • Low grade fever
  • Irritability
  • Decreased appetite
clinical manifestation17
CLINICAL MANIFESTATION
  • Within 1-2 days: Tachypnea Retraction Wheezing
  • May progress to: Respiratory failure Apnea
diagnosis
DIAGNOSIS
  • Age of child
  • Clinical presentation
  • Epidemic of RSV in community
  • Viral identification on nasal secretions
  • Chest X Ray Peribronchial thickening, Patchy atelectasis, Segmental collapse Hyperinflation
differential diagnosis
DIFFERENTIAL DIAGNOSIS
  • Asthma
  • Croup
  • Salicylate poisoning
  • Congestive Cardiac failure
  • Foreign body aspiration
  • Pertusis
  • Pneumonia
treatment
TREATMENT
  • Mild Bronchiolitis- Treat at home
  • Mild Resp. distress- Careful observation and adequate hydration
  • Moderate to severe Resp. distress should be hospitalized- Supportive care
  • Administration of Oxygen- O2 Sats >95%
  • Monitoring to detect Hypoxemia, Apnea and Resp. Failure
treatment23
TREATMENT
  • Temperature regulation
  • Fluid administration
  • Bronchodilators
  • Steroids
  • Ribavirin
  • RSV Immunoglobulin
  • Mechanical Ventilation
treatment24
TREATMENT
  • Prevention of transmission of infection to staff and other patients
  • Careful hand washing
  • Limit child to child contact
  • Glove and gown
course complication and prognosis
COURSE, COMPLICATION AND PROGNOSIS
  • Most improve in 3-4 days with supportive care
  • By 2 weeks resp. rate, CO2, O2, and CXR resolve
  • 7% of hospitalized pts. Require mechanical ventilation
  • 30-50% with subsequent asthma
croup

Croup

Mohammed Kaashmiri, M.D.

croup acute laryngo tracheobronchitis
“Croup”Acute Laryngo Tracheobronchitis
  • Subglottic Laryngitis
  • Commonest cause of acute upper airway obstruction in childhood
  • Infants and young children have a smaller airway which predisposes to greater narrowing
epidemiology
Epidemiology
  • 3 cases per 100 children less that 6 years of age
  • Range 3 months to 6 years most cases between 1 & 3 years
  • Up to 1.3 % of affected children are hospitalized
  • Most commonly during the winter season
etiology majority viruses
EtiologyMajority --- Viruses
  • Para influenza type 1, 2 and 3- 2/3 cases
  • Influenza virus A & B
  • Adenovirus
  • RSV
  • 15% of patients have strong family history of croup
viral croup
“Viral Croup”
  • URI symptoms for few days prior to brassy cough
  • Intermittent inspiratory stridor
  • Prolonged exp. Phase
  • Temp 38-40 C
  • Symptoms worse at night
  • Hypoventilation > Hypoxemia
  • Hypercapnia > Dyspnea
  • Nasal Flaring > Retractions
viral croup32
“Viral Croup”
  • Most patients progress only as far as stridor and slight dyspnea
  • The duration of illness ranges from several days to several weeks
  • Recurrence > 3-6 Years

Decreases with growth of the airway

pathogenesis
Pathogenesis
  • Viruses primarily infect ciliated respiratory epithelium
  • Inflammatory response to the virus
  • Influx of PMN’s and mononuclears
  • Vascular congestion
  • Edema – Laryngospasm
  • Obstructive symptoms
diagnosis34
Diagnosis
  • History and physical exam
  • Radio graph – lateral neck
  • CBC – TLC < 10,000
  • Lymphomcytosis
  • Blood gas – hypoxia – CO2 retention
treatment35
Treatment
  • Approach in calm reassuring manner
  • Reduce anxiety – delay unnecessary lab work
  • Hot or cold steam - Oxygen
  • Racemic epinephrine
  • Cortico steroids
  • Artificial airway
urinary tract infection

Urinary Tract Infection

Mohammed Kaashmiri, M.D.

prevalence and etiology
Prevalence and Etiology
  • Varies with age and sex
  • Newborn infants 1.4/1000
  • School age female 1.2-1.9%
  • More common – uncircumcised male infants
  • Infancy – males more likely with anatomical basis
etiology38
Etiology
  • Hematogenous
  • Urinary tract abnormalities (VUR)
  • Most common causes:
    • E. Coli, Klebsiella, Proteus, Enterobacter, Pseudomonas, and Enterocci
  • Contributing factors:
    • Infrequent or incomplete voiding
    • Poor perineal hygiene
    • Older girls – sexual activity
    • Pinworms, constipation, bubble bath
clinical manifestation39
Clinical Manifestation
  • Newborn: Fever, Hypothermia
    • Poor feeding, jaundice
    • Sepsis, failure to thrive
    • Vomiting and Diarrhea
  • Pre-school children:
    • Abdominal pain
    • Vomiting, and Enuresis
    • Strong smelling urine
    • Increased frequency, dysuria, or urgency
signs and symptoms40
Signs and Symptoms
  • School age children:
  • “Classic” signs include: Enuresis, Increased frequency Dysuria, urgency, fever costovertebral angle tenderness
  • Some infections may be relatively asymptomatic
laboratory tests
Laboratory Tests
  • Urinalysis and urine culture
  • Microscopic analysis for bacteria, and white cells
  • Leukocytosis – neutrophilia
  • Increased ESR on C-reactive protein
  • 30% increase in serum creatinin
  • Blood cultures
diagnostic studies
Diagnostic Studies
  • Renal ultrasonography hydronephrosis/ pyoephrosis, renal/peri renal abscesses
  • Cystourethrography
  • CT – Diagnostic for Pyelo
  • DMSA Scan
  • Power Dopler Ultra Sound
  • MRI
treatment43
Treatment
  • “Treat promptly to prevent progression to pyelonephritis.”
  • Cystitis/Urethritis Bactrim, amoxil, or cephalosporin
  • Pyelonephritis Cefotaxime & amino glycoside

Subsequent changes according to culture sensitivity

treatment44
Treatment
  • Recurrence: Bactrim Nitrofurantoin
  • Obtain periodic urine cultures
  • Refer to Urologist: Uretral reflux Obstructive anomalies
gastroesophageal reflux

Gastroesophageal Reflux

Mohammed Kaashmiri, M.D.

gastroesophageal reflux46
Gastroesophageal Reflux
  • “Dysfunction of the lower esophageal sphincter (LES) mechanism with return of gastric contents into the esophagus”
pathogenesis47
Pathogenesis
  • Lower esophageal sphincter dysfunction
  • Transient relaxation of the sphincter
  • Increase intragastric pressure
clinical presentation
Clinical Presentation
  • Irritability (infantile heart burn)
  • Failure to thrive
  • G.I. Bleed, Hematemesis /occult blood in stool
  • Anemia
  • Esophagitis
  • Stricture
clinical presentation49
Clinical Presentation
  • Reflex bronchospasm
  • Reflex laryngospasm
  • Reflex central apnea
  • Reflex brady cardia
  • Aspiration / Aspiration pneumonia
  • Obstructive apnea
  • Stridor
diagnostic evaluation
Diagnostic Evaluation
  • History
  • Upper gastrointestinal series (UGI)
  • Upper GI endoscopy / biopsy
  • PH Probe Study
  • Radio nuclide scans
  • Bronchoscopy
treatment51
Treatment
  • Conservative

a. Positioning Prone, head elevation

b. Thickening 1 Tbsp. Cereal/oz formula

c. Fasting before Small frequent feeds

  • Pharmacologic
    • Prokinetic Metoclopramide
    • H2-Blockers-PPI’s
    • Antacids 0.5 – 1 ML/KG/Dose
  • Surgical Fudoplication/Gastrostomy
gastroenteritis

Gastroenteritis

Mohammed Kaashmiri, M.D.

diarrhea
Diarrhea
  • “Acute diarrhea is an increase in the number of stools and alteration in consistency in relation to the patient’s normal stooling pattern.”
epidemiology54
Epidemiology
  • Worldwide one billion episodes
      • 3-5 Million Deaths
  • USA
      • 20-35 Million cases
  • <5yr.
      • 2-4 Million office visits
      • 220,000 hospitalization
      • 400-500 deaths
etiology55
Etiology
  • Rota virus #1 virus
  • Predominantly effects infants between 3-15 months
  • Peak incidence in winter months
  • Transmission Fecal-oral
pathogenesis58
Pathogenesis
  • Interruption of normal cell transport process
  • Decrease in the surface area available for absorption
  • Increase in intestinal motility
  • Increased intestinal permeability
  • Increase in un-absorbable osmotically active molecules in intestinal lumen
diagnosis59
Diagnosis
  • Incubation period 24-48 hours
  • Vomiting first symptom in 80-90%, followed by low-grade fever and profuse diarrhea
  • Symptoms 4-8 days
  • Metabolic acidosis--Decreased lactase level
  • Positive rota-virus antigen in stool
treatment60
Treatment
  • Assess the degree of dehydration
  • Fluid and electrolyte replacement
  • Prevent spread of the enteropathogen
  • In select episodes determine the etiological agent—provide a specific therapy if indicated
treatment goals of therapy
Treatment Goals of Therapy
  • Maintain adequate perfusion
  • Restore fluid & electrolyte deficits
  • Replace ongoing losses
  • Meet nutritional needs
  • Oral re-hydration--appropriate in most cases
  • Anti-diarrheal medications ineffective
  • Anti-emetics? Antibiotics?
asthma

Asthma

Mohammed Kaashmiri, M.D.

asthma64
Asthma
  • Airway obstruction that is reversible spontaneously or with treatment
  • Airway inflammation
  • Increased airway responsiveness to a variety of stimuli
epidemiology65
Epidemiology
  • 15 million Americans
  • 4.8 million children
  • 10 million missed school days
  • 12.9 million physician contacts
  • 19 million days of hospital
  • Cost $12-15 billion/year
diagnosis66
Diagnosis
  • History --- History---History
  • Symptoms: Recurrent episodes of cough, wheeze, shortness of breath, and chest discomfort
  • Association with URI, allergens, irritants, exercise, weather change, and environmental pollutants
history
History
  • Pattern: severity, duration, diurnal variation, effect on sleep, and activity
  • Precipitating Events: URI, exercise, allergic factors, and weather changes
  • Associated Illnesses: Rhinitis, Polyp, sinusitis croup, and eczema
history68
History
  • Enviornmental History: Daycare, bedroom, pets, smoke and type of heating
  • Past History: hospitalizations, intubations, ICU, ER visits & number of school days missed
history69
History
  • Previous evaluations
  • Other illnesses : pneumonia, bronchiolitis and bronchitis
  • Family history: atopy, asthma, and eczema
physical examinations
Physical Examinations
  • Upper airways
  • Lower airways: resp. rate, work of breathing, retractions, breath sounds
  • Wheeze inspiratory/expiratory, chest configuration
  • Extrimities: urticaria, eczema, and clubbing
laboratory studies
Laboratory Studies
  • Spirometry
  • Chest X-Ray
  • Bronchial provocation test