SKENARIO

A boy with the age 1 years and 1

month, getting to the hospital with
the problems healthy the symptomps
dyspneau since 3 days before getting
to the hospital, beside that, he has
more problems productive cough and
fever (febris), the children born
weight 3 kg, born with spontan and
enough month.Before that there is
nothing about problem health that is
dyspneau.

Key Words
A

boy with the age 1 year and 1

month
Dyspneu since 3 days ago
The productive cough
Fever (febris)
The normal partus
There is no dyspneu history

Patomekanisme Productive Cough

Inflammation of the airway

mucous production

Afferent (vagus nerve)

Medullar cough center

Efferent (glossopharyngeal)

Stimulation of laryngeal,ICS muscle, diafragm

Deep inspiration and closure of glotis

Contraction of abdominal muscle

Pushes Diafragm

Increased inthatoracic pressure

Glottis open suddenly

Expulsion of mucous and other desquamated cell

Patomekanisme Dyspneau
There is Problems Respiration system

Obstruksi of the airway

O2

Stimulation of the receptor

Afferent (nerve vagus)

Medullar center respiration

Respiration muscle must to doing hard

Patomekanisme Febris
Inflammation of the airway

Stimulation makrofaq release IL1,

IL2, IL6,IL12

Sintesis Prostaglandin

Stimulation reseptor termoregulator

body temperature

Pneumonia
Is an inflamation of the lung(s),
caused by microorganism
(bacteria, fungus, virus, parasite),
chemical material, radiation,
aspiration and drugs.

Epidemiology
About

1.2 Million people hospitalized

per year for pneumonia
Woman > Man

Ethiology
Infection

(bacteria, fungus, virus,

parasite)
Chemical exposure (ex. Berillium)
Alergen inhalation (ex. Aktinomisetes
termofilik spore)
Drugs usage (nitrofurantoin,
busulfan, metotreksat)
Radiation

Clinical Signs & Symptoms

Fever,

chills, temp. > 40 C

Cough, mucoid or purulent sputum
rust color blood
Dyspneu
Thoracal pain

Physical Examination
Inspection:

Fixation of painful part of

lung during breathing.
Palpation : Increasing fremitus
Percussion: Dull sound
Auscultation: broncovesicular
bronchial

Pathomechanism
Most

often, organisms that cause

pneumonia enter the lungs after being
inhaled into the airways.
Sometimes the normally harmless bacteria
present in the mouth may be aspirated
into the lungs, usually if the gag reflex is
suppressed.
Pneumonia may also be caused from
infections that spread to the lungs through
the bloodstream from other organs.

Pneumonia Pneumokok Phase

Congesti (First 4 12 hours): Serosa exudate
enters alveoli trough dilatated blood vessels
2. Red Hepatization (next 48 hours): red
granulated lung because red blood cell, fibrin
and leukocyte polymorfonuclear fill alveoli.
3. Gray hepatization (3 8 days): gray lungs
because of leukocyte and fibril consolidation
4. Resolution (7 11 days): lytic exudate
reabsorbed by macrofag.
1.

Medical Treatment
Antibiotic

infection (ex. Penicillin)

Broncodilator dyspneu
Oxygen therapy Hipoxia

Prevention
Lifestyle

Habits : Good Hygiene,

Healthy Diet, Low Stress boost
immune system
Vaccines

Supporting Test
Sputum

Tests (bloody, opaque and

colored yellow, green, or brown)
Blood Tests (White blood cell count,
Blood cultures)
Thoracal X-ray (infiltrates, plural
efusion)

Complication
Pleural

Effusion
Empyema
Pulmonary Abscess
Pneumothorax
Breathing Failure

BRONCHIOLITIS
An

inflammatory obstruction of the

small wall airways or bronchioles
Occurs in infants and toddlers
The most associated pathogen is
Respiratory Syncytial Virus ( RSV )
Also may be associated with
adenoviruses, influenza,
parainfluenza and mycoplasma

Pathophysiology
Viral infection

Infiltration + lymphocytes around

bronchioles

Inflammation + activation of
eosinophils, neutrophils and
mycoplasma

Submucosa becomes edematous

Narrowing of peripheral
airways

Cell-mediated hypersensitivity +
release of lymphokines

Cellular debris + fibrin form plugs

within the bronchioles

Necrosis of the bronchial

epithelium + destruction of
ciliated epithelial cells

Clinical Manifestation
Breathlessness
Tachypnoea
Cough
Mild

fever
Expiratory wheezing
Rhinorrhea

Investigations
Respiratory

snycitial virus ( RSV ) can be

identified rapidly on nasopharyngeal
secretions demonstrating binding of a
fluorescent antibody
Chest X-ray : hyperinflation of the lungs
due to small airways obstruction
Blood gas analysis : lowered arterial
oxygen + raised CO2 tension

Treatment and Management

Humidified

oxygen is delivered via nasal

cannulae
Antiviral drug ( Ribavirin ) shortens viral
excretion and clinical symptoms.
Fluids may need to be given by nasogastric
tube or intravenously
Mechanical ventilation is required in about
2% of infants admitted to hospitals.
Nebulised bronchodilators, antibiotics and
steroids have been not validated for
effective therapies but may be tried on a
case by case basis.

Prognosis
Most

infants recover from the acute

infection within 2 weeks
As many as half will have recurrent
episodes of cough and wheeze over
the next 3-5 years
Rarely, the illness is very severe and
results in permanent damage to the
airways ( Bronchiolitis obliterans )

Prevention
A

monoclonal antibody
( Palivizumab ) to RSV is given
monthly by intramuscular injection

ACUTE BRONCHITIS

DEFINITION
Sudden

inflammation of the main airways

to the lungs called the bronchi.
Typically associated with a viral upper
respiratory tract infection.
Common virus - Influenza virus type A &
B
- Rhinovirus
- Parainfluenza
- Coronavirus

 Bacterial

infection with :
- Mycoplasma pneumoniae
- Chlamydia pneumoniae
- Bordetella pertussis (whooping
cough)

AETIOLOGY
Viruses

are transmitted when they

are expelled through coughing,
sneezing and talking.
Transmitted through contact with
infected drinking glasses and eating
utensils.

SIGNS & SYMPTOMS

Cough

- stays steady or gets increasingly

worse for + 10 days 2 weeks
- worse at night
- may cough up mucous
- lasts for less than 6-8 weeks
Shortness of breath, dyspnea
Burning pain, wheezing and crackling in
the chest
Chest pain
Low-grade fever
Malaise

RISK FACTORS
Air

pollutants
Allergies
Chronic sinusitis
Lack of pertussis immunization
Malnutrition (particularly in children)
Exposure to chemicals, fumes and
dust
Smoke inhalation

INCIDENCE & PREVALENCE

Frequently

affects people who suffer

from allergies, other respiratory
illnesses, chronic sinusitis, chronic
tonsillitis, infected adenoids and
smokers.

PATOMECHANISME
Viral/ bacterial infection
Inflammation of the mucous membrane of the
bronchial tubes
Produce thick sticky mucous
Mucous reduces the normal defensive function of
the cilia, which is responsible for moving
secretions and debris out of the lungs
Inflammation & accumulated mucous narrow the
airways, restrict respiration & promote bacterial
infections

TREATMENT
Medical tretment
Antibiotics
Bronchodilators Albuterol
Decongestants Pseudoephedrine
Non-medical treatment
Rest
Increase humidity
Increase fluid intake

PREVENTION
Good

hygiene
Immunization against influenza and
pertussis
Avoid cigarettes, second hand smoke
Avoid heavy fumes

COMPLICATIONS
Pneumonia
Chronic

bronchitis

PROGNOSIS
Symptoms

usually abate within 7-14

days in the absence of prior chronic
pulmonary disease.
Patients with asthma or other lung
conditions may have a worsening of
symptoms.

BRONCHIECTASIS

1.
2.
3.
4.
5.

Dilatation of the bronchial tree proximal

to the terminal bronchiole leading to
fibrosis and destruction of the lung.
Aetiology
Congenital : Pulmonary sequestration
Acquired : infection or obstruction
Immunodeficiency (eg ;HIV) recurrent
infection
Mucociliary defect Kartegeners
syndrome
Mucoviscidosis & Cystic fibrosis thick
mucuos

 Signs

and Symptoms
1. Cough
2. Haemoptysis
3. Fever
4. Sputum is esp in large amount in the
morning
5. Clubbing finger
6. Crackles
7. Dyspnoea

 Patogenesis
Multiple aetiologies
Mucuos stagnation
Bacterial infection
Acute inflammation

pneumonia
Fluid filled lung

Stiff lung
Dyspnoea
Mucosal bleeding
Bronchial irritation
and
macrophage
Haemoptysis
cough
IL-1, IL-6. TNF-a
sputum
anterior hypothalamus
superinfection
termoregulatory center
foul smelling sputum
fever

Stimulate monocyte

1.
2.
3.
4.
5.

Investigations
Chest X-Ray ; Honey Comb appearance
Bronchography ; rarely required
CT scan ; investigation of choice
Sputum ; culture
Treatment
Postural drainage
Antibiotics
Bronchodilators
Anti-inflammatory agents
Surgery (recurrent haemoptysis,
pneumonia, bronchitis)

- Honey comb
appearance
-Ring-like
shape

 Prognosis

With antibiotic intake / operation prognosis

improved
- Middle lobe syndrome : bronchiectasis of
right middle lobe
- Kartegeners syndrome ; a) situs inversus
b) sinusitis
c) bronchiectasis
Complication
-Sepsis, lung abscess, cerebral abscess,
empyema, cor pulmonale
-