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Lecture number 17. Bronchoobstructive syndrome. Clinic, diagnosis, treatment. Respiratory failure. Clinic, diagnosis, treatment



Bronchoobstructive syndrome is a clinical symptom complex observed in patients with generalized impairment of bronchial pathways, leading manifestation of it is expiratory dyspnea, attacks of suffocation. Diseases accompanied by obstruction of the respiratory tract.

The main causes of airway obstruction in children.

1. Obstruction of the upper respiratory tract:

1) purchased:

a) allergic rhinitis;

b) polyps of the nose;

c) hypertrophy of the tonsils;

d) inflammation of the epiglottis;

e) viral laryngotracheitis;

e) laryngospasm (with spasmophilia);

g) foreign body;

h) congenital stridor;

i) tongue twisting with unconsciousness;

j) mechanical compression of the trachea and bronchi;

2) congenital:

a) thymomegaly;

b) enlarged lymph nodes;

c) tumor.

2. Obstruction of large intrathoracic airways:

1) narrowing of the lumen (developmental abnormality, swelling, scar, foreign body);

2) compression from the outside (tumor, abnormal vessel);

3) excessive collapse due to the weakness of the cartilaginous rings and (or) the membrane part (tracheomalacia).

III. Obstruction of the lower respiratory tract:

1) viral bronchiolitis;

2) bronchial asthma;

3) aspiration of vomit;

4) foreign bodies;

5) cystic fibrosis;

6) a1-antitrypsin insufficiency.

Mechanisms of disorders in obstructive syndrome.

1.
Convertible:

1) inflammatory edema and infiltration of the mucosa and submucosal edema;

2) violation of mucociliary transport, obturation of bronchial lumen with a viscous secret;

3) bronchospasm.

2. Irreversible:

1) fibroplastic changes in the walls of the bronchi.

2) stenosis, deformation and obliteration of the lumen of the bronchi.

3) expiratory collapse of bronchi, the presence of emphysema of the lungs.

Protective mechanisms of the respiratory apparatus.

1. Mechanical.

2. Biochemical.

3. Immunological.

Mechanical respiratory protection:

1) aerodynamic mechanism;

2) mucociliary escalator mechanism;

3) the kinetic energy of the exhaled air;

4) cough push, biochemical protective system of the respiratory apparatus;

5) bronchial secretion of the respiratory apparatus (sialomucines, fucomucins, glucosaminoglycans, etc.);

6) phospholipids of bronchial cell membranes, alveoli, surfactant;

7) BAS (serotonin, histamine, etc.).

Immunological respiratory system.

1. Specific:

1) secretory IgA;

2) plasma IgM, G, E.

2. Nonspecific:

1) alveolar macrophages;

2) lysozyme;

3) kallikrein;

4) lactoferrin;

5) interferon;

6) b-lysine.

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Lecture number 17. Bronchoobstructive syndrome. Clinic, diagnosis, treatment. Respiratory failure. Clinic, diagnosis, treatment

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