Penyakit Respirasi Pada Anak

7/21/2019 Penyakit Respirasi Pada Anak

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%. A&ute +ron&'itis

Acute inflammation of themucous membranes of the

trachea and bronchi (duration < 4

weeks)

productive cough

upper respirator tract smptoms

general smptoms (in !0 " #0$)

2%.&.20!!



20.6.2000



20.6.2000

2

Aetio!ogy of a&ute +ron&'itis

'ommon resp. tract viruses (&0$) RS3

4Respiratory Synsitia! 3irus5

acteria (in about 20$ of cases) *neumococci ( in 2 " +0$),

-aemophilus ( in 2 " &$),

coplasma (in 0.# " !!$)

'hlamdia (in 0 "!&$)

(*ertussis (in 0 " /$))



20.6.2000

6

Diagnosis of a&ute +ron&'itis

7'e aim is to diffn&iated ari semua pasien g BATUK 1 dentifikasi *en.

3ain g memerlukan pengobatan spesifik ( ump

pneumonia, sinisitis, asthma)(identif1 among all patients with cough1 those with ot'er i!!nessesot'er i!!nesses

needing spe&ifi& treatmentneeding spe&ifi& treatment (e.g. pneumonia1 sinusitis1 asthma)

ari semua pasien g BRONCHITIS 1

dentifikasi *en. g memerlukan Antibiotika(identif1 among all patients with bronchitis, those 8'o 8ou!d8'o 8ou!d

+enefit from anti+ioti&s)+enefit from anti+ioti&s)



20.6.2000

1

(Differentia!) diagnosis

-istor (e.g. asthma) ada mengiik5

-ealth status (general conition, auscultation)

!"ra# (to e$clue %neumonia&

CR' (high CR' reers to bacterial aetiolog# or

%neumonia&

inus ultrasound (to e7clude sinusitis)

Antibod testing (of a few representative patientsif needed to establish an e%iemic )

8as access to a follow"up visit (inform our

assistants9)



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9

Kapan per!u di :#ray

;'en is &'est <#ray needed=

patient is particularl un)ell (Kurang sahat& patient is particularl %rone to %neumonia due

(menjurus ke pneumonia)

to underling disease1 age or alcoholism histor of pneumonia within the preceding ear upper respirator tract smptoms absent patient re:uests 7"ra (%neumonia can not be

e7cluded on clinical smptoms and findingsonl)



20.6.2000

>

7reatment of a&ute +ron&'itis

"irst &'oi&e?"irst &'oi&e? no anti+ioti&s@

"a&tors supporting anti+ioti& treatment?"a&tors supporting anti+ioti& treatment?

CR' * + mg-l patient is particularl un)el ! or becoming so %#re$ia of over week5s duration or patient

pre7ial following a period of apre7ia epidemio!ogi&a! state %atient is immunocom%romise



20.6.2000

Antimi&ro+ia! t'erapy of a&ute +ron&'itis %

"irst &'oi&e?"irst &'oi&e? in most cases good effect on pneumococci is sufficient penicillin resistance in pneumococci in ;inland is low

( < !$) (A)

peni&i!!in 3peni&i!!in 3 !"!.# mega units & hourl for # = / das > ! tab? 2#0 mg ? 400.000 unit@ osis

< !2 thn 2#"#0 mgBgda dibagi 6"& Cam 7

D !2 thn1 adult !2# = #00 mgBgda =E"

for patients with penicillin allerg a first #generationa first #generation

&ep'a!osporin&ep'a!osporin



20.6.2000

%0

Antimi&ro+ia! t'erapy of a&ute +ron&'itis

Ot'er &'oi&es?Ot'er &'oi&es?

probable mcoplasma or chlamdia infection doxycyclinedoxycycline !00"!#0 mg dail for # = / das a ma&ro!idea ma&ro!ide erthromcin #00mg + " 4

times dail1 ro7ithromcin !#0 mg twicedail1 klarithromcin 2#0mg twice dail oraFithromcin 2#0 mg dail for # =/ das

underling chronic lung disease

amo<i&i!!in, su!p'atrimet'oprimamo<i&i!!in, su!p'atrimet'oprim



20.6.2000

%%

Symptomati& treatment of a&ute +ron&'itis

No benefit is gained on cough with codeine,salbutamol or dextromethorphan as compared

with a placebo,

...but cough improves considerably even during aplacebo-treatment

patient often presents with additional symptoms,

which can be eased with antihistamines,

anticholinergic and/or sympatomimetic

agents, but their benefit remains controversial benefit remains controversial !!



TKS. Bersambung As%irasi

%nm/nia

20.6.2000

%



. Aspirasi Pneumonia

*ada anak ai sering ter

sedak1 masuk susu A

atau benda asing (corpus

aliena) kedalam Alveoli. edema1 cairan adang



Pada anak Besar ?

#Ka&ang tojin#8ang &oin

# Benda asing# d!!



anagemen Aspirasi Pneumonia

Dpt dikethui dengan Anamnesis yang teliti

Konsultkan ke Bgn !

Benda asing yang padat "ndoskopy

#usu $ A#% sama dgn pengobatan

&neumoniaHarus dirawat di RS



20.6.2000

%1

+.!.'hronic bronchitis

+.2.8mphsema

+.+. Asthma

. O+stru&tiCe and nf!amtory

-ung Disease



20.6.2000

%9

.%. *'roni& Bron&'itis

ecurrent or chronic productive

cough for a minimum of +

months for 2 consecutive ears. isk factors

'igarette smoke Air pollution



20.6.2000

%>

*'roni& Bron&'itis

Pat'op'ysio!ogy 'hronic

inflammation

-pertroph Ghperplasia of

bronchial glands

that secrete mucus

ncrease number of

goblet cells

'ilia are destroed



20.6.2000

%

*'roni& Bron&'itis

Pat'op'ysio!ogy .. Bronchospasm often occurs

"nd result

!ypoxemia !ypercapnea

&olycythemia 'increase (B)s*

)yanosis )or pulmonale 'enlargement of right side of

heart*



20.6.2000

0

Harrowing of airwa tarting w bronchi

smaller airwas

airflow resistance

work of breathing

-poventilation G 'I2

retention hpo7emiaG hpercapnea

*'roni& Bron&'itis

Pat'op'ysio!ogy ..



*'roni& Bron&'itis?

Diagnosti& 7ests

*;Js (*ulmonar ;unction Jests) ;K' ;orced vital capacit ;8K! ;orcible e7hale in ! second ;8K!;K' ? </0$

ALs (Arterial lood Las analsis) *a'I2

*aI2 '' ('ell lood 'ounts) -ct



20.6.2000

..mp'ysema? Pat'op'ysio!ogy

tructural changes

-perinflation of

alveoli estruction of alveolar

G alveolar"capillar

walls

mall airwas narrow

3ung elasticit

decreases



20.6.2000

Abnormal distension

of air spaces

Actual cause is

unknown ungkin ok ada

Pores of Kohn (ada

hubungan dari alvke alv g lain)

mp'ysema? Pat'op'ysio!ogy



.. Ast'ma

(eversible inflammation +obstruction

%ntermittent attacks #udden onset

aries from person to person #everity can vary from shortness of

breath to death



Ast'ma

riggers Allergens

"xercise

(espiratory infections

Drugs and food additives

ose and sinus problems "(D /astro "sophageal (eflux Disorder

"motional stress



20.6.2000

1

!. welling of mucus

membranes

(edema)

2. pasm of smoothmuscle in

bronchioles ncreased airwa

resistance

+. ncreased mucus

gland secretion

Ast'ma? Pat'op'ysio!ogy



Ast'ma? ar!y *!ini&a! anifestations

"xpiratory + inspiratory whee0ing Dry or moist non-productive cough

)hest tightness

Dyspnea

Anxious +Agitated

&rolonged expiratory phase %ncreased respiratory + heart rate

Decreased &"1( /&ulmo. "xpi2tory 1low (ate3



Pencetus Asthma



20 6 2000

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Penyakit Respirasi Pada Anak