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LECTURE No. 17. Bronchial obstructive syndrome. Clinic, diagnosis, treatment. Respiratory failure. Clinic, diagnosis, treatment



Bronchial obstructive syndrome is a clinical symptom complex observed in patients with generalized obstruction of bronchial patency, its leading manifestation is expiratory dyspnea, asthma attacks. Diseases accompanied by airway obstruction.

The main causes of airway obstruction in children.

1. Obstruction of the upper respiratory tract:

1) acquired:

a) allergic rhinitis;

b) nasal polyps;

c) tonsil hypertrophy;

d) inflammation of the epiglottis;

e) viral laryngotracheitis;

e) laryngospasm (with spasmophilia);

g) a foreign body;

h) congenital stridor;

i) retraction of the tongue in an unconscious state;

j) mechanical compression of the trachea and bronchi;

2) congenital:

a) thymomegaly;

b) an increase in lymph nodes;

c) a tumor.

2. Obstruction of the large intrathoracic airways:

1) narrowing of the lumen (developmental anomaly, tumor, scar, foreign body);

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

3) excessive decline due to the weakness of the cartilage rings and (or) the membranous 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 deficiency.

The mechanisms of disorders in obstructive syndrome.

1.
Reversible:

1) inflammatory edema and mucosal infiltration and submucosal edema;

2) violation of mucociliary transport, obstruction of the lumen of the bronchi 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 the bronchi, the presence of emphysema.

Protective mechanisms of the respiratory apparatus.

1. Mechanical.

2. Biochemical.

3. Immunological.

Mechanical protective system of the breathing apparatus:

1) aerodynamic mechanism;

2) mucociliary escalator mechanism;

3) kinetic energy of exhaled air;

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

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

6) phospholipids of the cell membranes of the bronchi, alveoli, surfactant;

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

Immunological protective system of the respiratory apparatus.

1. Specific:

1) secretory IgA;

2) plasma IgM, G, E.

2. Non-specific:

1) alveolar macrophages;

2) lysozyme;

3) kallikrein;

4) lactoferrin;

5) interferon;

6) b-lysine.

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LECTURE No. 17. Bronchial obstructive syndrome. Clinic, diagnosis, treatment. Respiratory failure. Clinic, diagnosis, treatment

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