Acute bronchiolitis

Acute bronchiolitis

ACUTE BRONCHIOLITIS:

 IT is 1 of the common serious acute lower respiratory infections in infants.
- age bet^ 1 to 6 mnt.
- common in winter n spring.
- respirtory syncytial virus is common couse. Other r Parainfluenza virus 3,1 n 2, adenovirus, influenza.

PATHOGENESIS



- Inflammation of the bronchiolar mucosa lead to edema, thickening, formation of mucous pluge n cellur debris.
- lead to reduction of bronchia lumen
- causer increase in airway resistant n reduction of airflow.
- resistance during expiration causes traping of air n lead to emphysematous chenges.
- traped air mey absorb n lead to atelectasis.
- may causes respiratory acidosis.

C/F
- breathing become fast n respiratory distress develop.
- retraction of lower intercostal spaces n suprasternal notch become evident.
- infant may appear cyanosed.
- fever is moderatly high.
- accessory muscles are working.
- ronchi are ausculatated.
- air is trapped in d lungs leading 2 emphysema, liver n sleen pushed down.

INVESTIGATIONS
Chest x ray - shows hyperinflation n infiltrates.
- Diaphragm is pushed down.
- lung fields appear abnormally translucent.
Blood - leucocyte count is normal or slightly eleveted
A rapid test using monoclonal antibodies against RSV virus on nasophyrngeal aspirate cn identify RVS at bed side.

D/D
- Brochial asthama
- Congestive heart failure.
- Foreign bodies in trachea
- Bacterial pneumonia

TREATMENT
 essentially symptomatic.
- child shuld b nursed in a humid atmo. Preferably in siting position at angle of 30' to 40' wit head n neck evevated.
- oxygen remains the mainstay of reatment. It administered continuously even in the absence of cyanosis.
- fluids n electrolyte bal. Should be maintained.
- pulse oximetry should b perfomed regularly to keep an oxygen an saturation of more than 95%
- antibiotics hav no role. Ribavirin shrotens the course of illness.
- bronchodilators in bronchiolitis suggest that salbutamol wit iprotropium inhalation may provide some benefit.
- continuous positive airway pressure or assisted ventilatio may b required to control respiratotry failure.
- extracoporeal membrane oxyenation is effective, when respiratory is nt controlled by mechanical ventilation.
   
                           -by pam