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Sindromul bronsitic si sindromul de obstructie bronsicaBronsita acuta Bronsita cronica Astmul bronsic
Infectii comune virale respiratorii si SARS (severe acute respiratory synd)Raceala comuna Faringita Crup (laringotraheobronsita ) Traheita Bronsita Bronsiolita Pneumonie SARS - ARDS (adult respiratory distress synd)
Infectii virale respiratorii Cele mai frecvente boli infectioase din bolile acute Incidenta 3 -5 cazuri/persoana/an la copii 6-8 cauri/p/an Anumite virusuri- un tablou clinic Un virus mai multe sindroame Numai pe baze clinice-nu dg exact virus
Rinovirus: RC- acutizare Bcr, astm-P Coronavirus:RC- ac Bcr,astm-P-bronsiolita-SARS V sincitial resp:P-bronsiolita RC-P Paragripal:crup-faringita-traheobronsita Adenovirus :RC-faringita P Gripal: gripa-P-rinita-faringita Enterovirusuri:boala febrila nedif-rinita faringitaP
Tablou clinic Rinoree Stranut Congestie nazala Dureri in git Raguseala tuse-crup-stridor hipoxie Tuse dispnee-polipnee-weezing-raluri bronsice expir prelungit Alterarea starii generale-dispnee-cianoza Rx infiltrate pulm interstitiale ,consolidare pneumonica (SARS ) asociere disfunctie multiorgan : ARDS
Bronsia cronica
Bronsita acuta nu se cronicizeaza
Definitie bronsita cronica Anamneza: tuse si expectoratie (3 luni pe an 2 ani la rind )
Emfizem pulmonar Dg anatomo patologic :
Dilatatia spatiilor aeriene distal de bronhiola terminala
Boala de cai aeriene mici
Bronhiolele mici sunt ingustate
BPOC (bronhopneumopatia obstructiva cronica ) Definitie GOLD (Global initiative for cronic Obstructive Lung Disease ): boala pulmonara caracterizata prin disfunctie ventilatorie obstructiva incomplet reversibila Asociere : Bronsita cronica emfizem pulmonar boala de cai aeriene mici
Factori risc BPOC Fumatul- relatie VEMS nr pachete /an Hiperreactivitatea bronsica in BPOC/ astm
ipoteza daneza : varietati ale aceleiasi boli Ipoteza britanica : astmul alergic/BPOC inflamatie legata de fumat (boli complet diferite ) Infectii resp : acutizare B cr
Factori risc BPOC Factori profesionali:praf mina carbune,aur cadmiu Poluare : nu e clar dovedit Pasiv second hand smoking Genetic : deficitul alfa 1 antitripsina (1% din pop caucaziana )
Istoric BPOC
tuse sputa dispnee efort
Examen fizic Stadii incipiente normal Fumatorii :miros tigara coloratie nicotina unghii Torace : butoi diafragm coborit Raluri bronsice weezing expirator Expir prelungit: cuantificare (t expir fortat>4s) auscultatie anterior expir fortat Obstructie severa:pozitie sprijinit coate musculutura resp accesorie : scm ,ic
Tipuri BPOC Pink puffers (roz pufaitor ) Nu cianoza Folosire m resp accesor Buzele punga Domina emfizemul Murmur vezicular diminuat
Tipuri BPOC Blue bloaters (albastru buhait ) retentie lichid ( insuficienta card dr , cpc,)j-h-e Cianoza Domina bronsita cr Forme avansate: scadere G semn Hoover misc paradox c toracica
Paraclinic in BPOC Gaze sang (sat o2 ) :o2 scazut= insuf resp co2 cresc= hipoventilatie alveolara (hiperemie conjunctivala ) Hct crescut ECG: HVD Rx pulm-emfizem Alfa1 antitripsina spirometrie : VEMS/CV Ecocardiografie
Criteriile de severitate GOLD pt BPOCBronsita cr simpla nu BPOC (stadiul 0 /la risc ) BPOC= +/- tuse sputa VEMS/CV 80 %p 2moderat 50% < VEMS < 80 %p 3sever 30% < VEMS < 50% p
4f sever
VEMS < 30 % p VEMS 2 .z/sapt.
> 2 n. /luna
VEMS >80%
Moderat Persistent
Zilnic
> 1 n. / sapt
60%