respiratory Flashcards
(26 cards)
definition of congenital lobar emphysema
a neonatal condition associated with enlarged air
spaces in the lungs , The most affected is left upper lobe.
diagnosis of congenital lobar emphysema
xray, ct
Treatment of congenital lobar emphysema
Respiratory distress - emergency thoracotomy
Mild symptoms – delayed surgery
Resection of the affected lobe
clinical presentation of congenital lobar emphysema
respiratory and cardiovascular collapse ( hypotension and low pao2).-massive lobar overdistention cause compression of the normal lung and the mediastinum
definition of congenital cystic adenomatoid
malformations
(Defect in the development of the terminal bronchioles?)
and is a benign lung lesion appearing as a cyst or mass in the chest that can vary in size made from abnormal lung tissue.
classification congenital cystic adenomatoid
malformation
Based on size
I.Big cysts > 2cm;
II.Small cysts< 1 cm;
III.Solid, no cystic component
Anatomical
- Macrocystic > 5cm –favorable, no symptoms
- Microcystic < 5 cm – unfavorable, fetal hydrops ( fluid overload), respiratory distress
diagnosis of congenital cystic adenomatoid
malformations
Prenatal ultrasound- look for cysts, accumulation of amniotic fluid
respiratory distress
recurrent infections
treatment of congenital cystic adenomatoid
malformations
prenatal- thoracoamniotic shunt
postnatal- resection of cyst ( risk of infection or malignancy)
Asymptomatic newborn- lobectomy at 3-6 months
Symptomatic- emergency surgery
definition of Empyema
accumulation of infected fluid within the thoracic cavity
classification of Empyema
stage 1 - exudative phase. 1-3 days. Thin pleural fluid treated with thoracocentesis.
stage 2- fibro purulent 7-10 days. Invasion of organism to pleural space> fibrin deposition creates loculations ( pockets of fluid). decreases in the pleural fluid glucose and pH levels and increased protein and lactate dehydrogenase (LDH) levels
stage 3- organising stage 14-28 days. Fibroblast proliferation> thickening of the visceral and parietal pleura ( pleural peel)
etiology of Empyema
Most common is staphylococcus aureus, then streptococcus pneumonia
Signs and symptoms of Empyema
URT: cough, shallow rapid breathing, diminished breath sounds, dullness to percussion
Digestive : ( may spread to peritonitis to cause ileus) abdominal pain with distension
General: fever, lethargy
Diagnosis of Empyema
Lab- bloods ,
Imaging: ultrasound, chest xray, ct
Procedures: pleural fluid analysis obtained with thoracocentesis
Treatment of Empyema
Stage 1- drainage with thoracocentesis + antibiotics
stage 2- fibrinolytic therapy + antibiotics
stage 3- thoracotomy + antibiotics
Definition of congenital diaphragmatic hernia
Diaphragm doesn’t close properly during fetal development causing abdominal contents to go into the thoracic cavity ( mostly left side). The lungs will be smaller than expected (pulmonary hypoplasia)
Diagnosis of congenital diaphragmatic hernia prenatal and postnatal
prenatal ultrasound- stomach, intestine or liver in chest , absence of gastric bubble, polyhydramnios
postnatal: signs and symptoms ( respiratory distress, repeated pneumonia, scaphoid abdomen, bowel sounds in chest) xray
how to determine severity of congenital diaphragmatic hernia
Lung area to head circumference ratio (LHR)
Presence of liver ( and stomach) in chest is poor prognosis as there are smaller lungs
signs and symptoms of congenital diaphragmatic hernia postnatally
Signs of respiratory distress ( chest wall retractions, cyanosis, tachypnea, grunting)
Expanded chest, scaphoid abdomen
Bowel sounds in the chest, reduced breath sounds
Displacement of apex beat
Treatment of congenital diaphragmatic hernia
After birth- endotracheal intubation, NG tube ( for gastric decompression to allow space for lungs to expand)
extracorporeal membrane oxygenation (ECMO). ECMO provides temporary support for lung failure by circulating the baby’s blood through a heart-lung machine removes co2 and adds o2.
Surgery 1-2 days after stabilisation. Small hole- sewn, large hole- use muscle flap to close hole in diaphragm
Fetal surgery for congenital diaphragmatic hernia
Fetoscopic endoluminal tracheal occlusion
a surgical procedure to treat the most severe cases
Normally fluid produced in the lungs escapes through the trachea. FETO blocks the trachea using a balloon to build up pressure in the trachea and stimulate development of lungs
definition of esophageal atresia
incomplete formation of the esophagus, esophagus ends in a blind pouch rather than connecting to the stomach, frequently forms a tracheoesophageal fistula
classification of esophageal atresia
type A - Esophageal atresia without fistula
Type B - Esophageal atresia with proximal TEF (< 1%)
Type C - Esophageal atresia with distal TEF (85%)
Type D - Esophageal atresia with proximal and distal TEFs (< 1%)
signs and symptoms of esophageal atresia
excess salivation with bubbles ( baby cannot swallow spit)
respiratory distress
abdominal distension - baby cries, air from the trachea is forced through the fistula into the lower esophagus and stomach.
cough, cyanosis after feeding ( trachea is weak and may collapse)
associated features of esophageal atresia
VACTERL (vertebral defects, anorectal malformations, cardiovascular defects, tracheoesophageal defects, renal anomalies, and limb deformities)
