Supprative lung disease 11\11 Flashcards
Enumerate suppurative lung disease
- purulent pleurisy ( empyema
- lung abscess
- bronchiactsis
Define empyema
accumulation of pus in the pleural spaces
causes of empyema:4
- complication of bacterial pneumonias: pneumococci, staph, H.influenza
- contamination introduced from chest trauma or surgery
- mediastinitis
- rupture of lung abscess or sub diaphragmatic abscess
keyword of causes of empyema
bacterial pneumonias
chest trauma or sugery برا
mediastinits جوه
rupture abscess جوه
CP: what are the symptoms of empyema 4
- fever 2. dyspnea 3. chest pain: +++ exaggerated by what?? de breath, cough, straining
4.. the child often lies on the affected side
IN which side does the child with empyema will lie
affected
CP: signs of empyema:3 inspection palpation, percussion , auscultation
- Diminished movement of affected side, inspection
shift of trachea and mediastinum to the opposite side, palpation - Dullness on percussion
- Diminished breath sounds
complications of empyema2
bronchopleural fistula
pleural fibrosis:chronicity
investigations of empyema2
1.chest X ray : uni or bi Massive homogenous opacity ,,
obliterated costophrenic angle
mediastinal shift of the opposite side
2. Thoracocentesis and culture of pus
what is the treatment of empyema3
- Immediate closed drainage of pus by an underwater seal or continuous suction
- systemic antibiotic : 3-4 weeks according to culture and sensitivity
- surgical decortication: of chronic cases
Define lung abscess
it is a suppurative process resulting in destruction of the pulmonary parenchyma with formation of a cavity containing purulent material.
may be acute less than 6 weeks or chronic more than 6 weeks
what is the duration to differentiate of acute and chronic lung abscess
6 weeks
what is the etiology or causes of lung abscess:AB:4
A: aspiration of infected material or foreign body
B: secondary: 1. pueumonia 2. TB and bronchiectasis
3. Amebic abscess: rare in child 4. metastatic abscess: uncommon as from septic emboli
or thrombophlebitis
CP:symptoms of lung abscess5
dyspnea and pain
1. insidious onset of fever 2. anorexia 3. weight loss
4. cough often with hemoptysis and copious amounts of foul smelling purulent sputum
5. followed by marked relief of symptoms
what are the signs of lung abscess:3 auscultation
- respiratory distress 2.diminshied air entry 3. localizing bronchial breathing
what are the complications of lung abscess3
the other topics of the lecture
- empyema or pneumothorax
- bronchiectasis
- spread of infection local or systemic
what are the investigations for lung abscess 3
- chest x ray or CT BETTER: a cavity with or without air fluid level surrounded by consolidation
- sputum culture and sensitivity
- bronchoscopy and BAl culture
what is the treatment of lung abscesse3
- prolonged antibiotic therapy : for 6 weeks: 3 IV and then 3 oral according to culture and
- bronchscopy : only to identify and remove a foreign body
3, resection of the affected lobe : in children with recurrent severe hemoptysis or chronic
Define Broncheicatasis
obstruction + chronic inflammation
it is a condition characterized by dilatation of the bronchi with destruction of the bronchial and peribronchial tissues and accumulation of exudative material inside bronchi
etiology of bronchiatsis AB
A: congenital
B; acquired : usually due to chronic pulmonary infection as:
1.foreigh body 2. enlarged broncho-pulmonary nodes due to TB
3. lung abscess or localized cysts 4, immotile cilia syndrome
5. cystic fibrosis 6. asthma 7. immunodeficiency
8. gastroesophageal reflux.
what are the affected lobs parts of bronchiectasis
bassal segments of the lower lobes……… right middle lobe……. lingular segment of left upper lob
what is the classification of bronchiectasis
Anatomical: localized or diffuse
Etiological: cystic fibrosis and Non- cystic
CP: symptoms of bronchiectasis3
- fever, anorexia, poor weight gain are common
- chronic cough : with expectoration of copious fetid mucopurulent sputum, usually changing with posture
- hemoptysis may occur
what are the signs of bronchiectasis3
- chest signs: musical rales may heard over the affected area as well signs of consolidation and fibrosis
- clubbing of fingers is usually seen
3, if extensive there is : persistent dyspnea and delayed physical growth
what are the complications of bronchiectasis2
- pulmonary hypertension may comp…. cor-pulmonale
- respiratory failure
what are the investigations of bronchietasis2
- chest x ray: may show honeycomb or soap bubble appearance
- CT scan of the chest confirms the diagnosis. GOLD STAND: DIAGNOSTIC
what is the treatment of bronchiectasis 4
- Effective postural drainage and chest physiotherapy
- antibiotic accordign to culture
- bronchodilators and symptomatic
- in localized cases : lobar resection
what is the primary infection with TB 3
- the lung is the portal for 98% of cases
- the local infection constitutes the primary complex: gohns foucs, lymphang, lymphadeni
- most lesions heal slowly by fibrosis and may calcify
what are the TB complications5: spread ……. pleura
- local spread 2. bronchial spread 3. hematogenous causing miliary TB
- pleural effusion : in older children as hypersensitivity reaction
- empyema , caseation and cavitation : more in malnourished children
pleural effusion common in which children……older
empyema as compl of tb common in which child ……. malnutri
tell about secondary infection of TB
mostly seem in adults as a reactivation or reinfection
CP; of pulmonary TB3
- general : loss of appetite , weight , night sweat , night fever
- chronic cough: MAIN SYMPTOM
A.sputum may be mucoid , purulent or blood B. may complain of localized wheezing
C. recurrent colds or pneumonia for months before diagnosis, with response to routine treatment - chest signs:
what is the main symptom of pulmonary TB
chronic cough
what are the chest signs of TB4 : according to the lesion
- IN pneumonic : may be signs of consolidation
- IN pleural effusion : physical signs of effusion may be detected
- IN fibrosis : deviation if the trachea and mediastinum to the same side
- IN compression of the trachea and bronchi by tb lymph nodes: wheezes may be noticed
Should be differentiated from asthma
what are the diagnostic investigations :8
- CBC: lymphocytois 3. Tuberclin test: Mantoux test MOST important diagnostic tool
- esr: very high above 100 4, culture: sputum or gastric aspirate, directZN, on LS media 4 weeks, bactic 10 days
5, quantiferon tb test: GOOD negative : IFN release from T cell
6, biopsy of nodes or pleura 7. radiology: x ray or CT - ELISA and PCR
other name of tuberculin test
mantoux
what is the most important diagnostic tool for TB
Tuberculin test
what is an 5mm induration
Negative tuberclin
5-9 mm induration
doutful repeat
10 mm induration or more
positive
false positive tuberclin
BCG vaccin
infection with atypical myobacteria
false negative test tuberclin5
subcutaneous injection or outdated
recent use fo corticosteroids or immunosuppressives
intercurrent viral infections
recent antiviral vaccines; measles and mumps
advanced disseminated TB………..
prevention of TB2
- general :
- BCG : early in 1st month, live attenuated , left deltoid muscle , intradermaly, reaction after 3-6 weeks, subsides 2-6 mon, booster 6 year
chemoprophylaxis: isoniazid 15mg\kg\day for 6 months
what is the treatment of TB
it usually consists of combined drug therapy to delay the emergence of drug resistant strains
what are the 1st line antituberculous drugs and their doses
isioniazid , rifampicin , pyrazinamide, ethambutol orallllllll
dose of isonazide
10-15mg\kg\day oral
rifampicin dose
10-20 mg\ kg\day oralllll
pyrazinamide
20-40 mg oral
ethambuto
15-20 oralllllllllll
alterative drugs
strptomycin , thionamide, other as kanamycin amikacin para amion
streptomycin dose
20 -40 IMMMMMMMMMMM
ethionamide
15-20 aoral
allll drugs of TB oral ex
strepto
what is the antitubirculas regimen
1st 2 mont : all the 1st line
next 4mot: isoniazid and rifampicin only
what are the indications of corticosteroids in TB 5
- Allergy to antituberculous drugs
- TB serositis: pleurisy, pericarditis , asictic pertiontis
3, miliary TB affect the suprarenal
4, endobronchial TB after removal of the glands to avoid postoperative stricute - after surgical removal of cervical TB lymph nods to avoid fibrous tissue formation
what are the areas of extra TB5
- lymphadenitis 2. skeletal : potts disease… arthritis
- abdominal: enteritis……peritonitis………tabes mesentrica of the mesentry…..urogenital
- TB of cns: meningitis …..tuberculoma
- other: pericardittis ….. skin lupus vulgarus…………….eye and ear as chronic otitis media and mastoiditis
Define cystic fibrosis
Autosomal recessive mutation …..of cystic fibrosis transbembrane regulator CFTR gene……..
leading to abnormal ion transport across the epithelial cells of the exocrine glands……………
resulting in increased viscosity if secretions.
what are the most common affected lymphnodes in lymphadenitis
cervical…..intialy …then ….with cold abscess formation
what are the characters of potts or TB of spine
more in lower thoracic and descends less in cervical
pain , kyphosis, compression paraplegia
x ray: rarefaction and destruction of vertebrae
TB arthirits
affect large joints from ankle to elbow
limitation of movements and pain
what is the most unique thing when examining urine of TB patient
sterile pyuria
TB meningitis
headache , irritability , disorientatiion due to ++ICT
convulsions, CSF: ++protein and lymphocytes……..— glucose
what is the pathogenesis of cystic fibrosis
LUNGS…Panceriase….Sweat glands
pathogenesis of CF the 1st one
- viscid mucus in the smaller airways predisposes to chronic infection. initially with staph and H influenza and subsequently with pseudomonas aeruginosa.
leads to damage of the bronchial wall. bronchiectasis and abscess
2nd pathogenesis of CF and 3
over 90 of children have malabsorption and failure to thrive from birth ….because of pancreatic insufficiency exocrine
abnormal function of the sweat glands results in excessive concentrations of Na and Cl in sweat
reach 60-125ml mol\L
what is the normal concentrations of Na and Cl in children
10-30 mmol\L
clinical presentation of CF in newborn
can be diagnosed through screening
CP of CF in infancy 4
- meconium ileus in newborns is delayed up to 72 h
- failure to thrive
- recurrent chest infections
4, malabsorption, steatorrha
CP in young child of CF 4
- bronchiectasis 2. sinusitis 3, nasal polyp
- rectal prolapse
CP of older child and adolescent of CF 7
- Allergic bronchopulmonary aspergillosis ABPA
- diabetes mellitus often not insulin dependent
- liver or biliary cirrhosis and portal hypertension
- distal intestinal obstruction
- pneumthorax or recurrent hemoptysis
- sterility in males
- psychological problems
symptoms of CF : chest , Git
recurrent or persistent chest infection with purulent sputum
frequent large pale very offensive and greasy stools steatorrhea
signs o f CF 5
- hyperinflation o f the chest due to air trappign
- coarse inspiratory crepitations and expiratiory wheeze
- finger clubbing
- failure tto thrive
- ultimately 95 of patients with CF will die of respiratory failure
diagnositc investigations of CF 1
sweat chloride test
how to confirm the diagnosis of CF
by testing for gene abnormalities in the CFTR protein where AF508 is the commonest gene mutation
what is the commonest gene mutation in CF
AF508
what is the aim of CF management 2
prevent progression
maintain adequate nutrition and growth
what are the systems that are involved in CF management 4
1.respiratory 2. nutrition, git and hepatic
3. psychological 4. gene therapy
what is the major problem with CF
recurrent and persistent chest infection
enumerate the respiratory management of CF 6
- anti inflammatory : appear to be beneficial 2. antibiotcs: prophylactic oral are recommended
usually flucloxacillin hg
what is the usually used prophylactic anibiotic in CF
flucloxacillin
4 rest respiratory ttt of CF
- physiotherapy: at least twice a day aiming to clear airway
- bronchodilators: may reverse the obstruction
- lung transplant: in end stage
what are the nutritional , git….management 6
regular assess of nutri
High calorie diet is essential
oral enteric coated pancreatic enzymes replacement therapy taken with meals and snacks
4, oral bile acid therapy may improve biliary secretion
5. fat soluble vitamin supplements
6. supplement with salt staring at diagnosis as oral rehydration is essential
what is gene therapy
CFTR potentiators and correctors may improve
high cost …. not yet proven
what are the pediatric allery 5..1…2 =7
asthma, allergic rhivitis, conjunctivitis, eczema
5, urticaria and hypersensitivity to food , drugs and insects
allergy is common 40 of asth… 8 of food
increasing in prevlance throughout developed world
are majore cause of emergency and morbidity and can be fetal aller
in which age does eczema and food allergy present
infancy
in which age dose the asthma and allergic rhinitis present
toddler and chilhood
whaat do you called the progression from eczema , food in infancy and then asthma which is predictive and allergic rhinitis in later chilhood
allergic march
what are the possible preventations of allergy under trial 4
pre and pro biotics 1. prebiotics: microorganisms
2. pro: active oligosaccaride
3, environmental and 4. nutritional
