What Are the Symptoms of Bronchial Pneumonia?

It is the most common type of pneumonia in children, especially in infants and young children. The disease can occur all year round. It is more common in the north in winter and spring, and it is more common in the south in summer and autumn. Can be distributed or popular.

Overview of bronchial pneumonia

Various types in childhood

Children may be susceptible to this disease due to overcrowded living, poor ventilation, and cloudy air. Poor nutrition, vitamin deficiency, and congenital heart disease also increase the incidence of pneumonia, and the condition becomes more serious.

Overview of the causes of bronchial pneumonia

Pathogens are mostly bacteria and viruses. Bacteria are the most common bacteria. Staphylococcus aureus, hemolytic streptococcus, influenza B bacterium, E. coli, and E. coli are more common. The virus is most common among respiratory syncytial virus, adenovirus, influenza virus and parainfluenza virus. The disease is often secondary to bacterial infections on the basis of viral infections, so-called "mixed infections".

Overview Pathology of Bronchial Pneumonia

Alveolar inflammation is the main type, and bronchial wall and alveolar interstitial inflammatory lesions are relatively light. The alveolar capillaries are dilated and congested, the alveolar wall is edema, and there are a large number of neutrophils, red blood cells, cellulose exudates and bacteria in the alveoli. Inflammation spreads to adjacent tissues through the alveolar channels and bronchioles, and is a small piece of focal inflammation. Small lesions can be fused and enlarged. When inflammation occurs in the small bronchi and capillary bronchi, the lumen becomes narrower and the lumen is partially or completely blocked, causing emphysema or atelectasis. In viral pneumonia, there is edema in the bronchi and capillary bronchi walls and the alveolar septum, and mucus and damaged cells accumulate in the walls. Alveolar and alveolar ducts and interstitial cells showed monocyte infiltration.

Overview of Pathophysiology of Bronchial Pneumonia

() Overview of bronchial pneumonia (1) respiratory insufficiency

The main manifestation is hypoxemia, and severe cases may have carbon dioxide retention. Due to inflammation during pneumonia, on the one hand, the alveolar wall is thickened and the diffuse resistance is increased. On the other hand, bronchial mucosa congestion, edema, and secretion retention make the lumen of Pediatrics relatively narrow. As a result, the ventilation and ventilation functions are seriously impaired, and the body is deprived of oxygen and carbon dioxide retention. In the early stage of the disease, children can increase the minute ventilation by increasing the breathing rate and breathing depth. Because the ability of carbon dioxide to diffuse is greater than that of oxygen, there is often only mild hypoxia and no significant carbon dioxide retention.
As the disease progresses, effective gas exchange is seriously hampered, and the arterial oxygen pressure (PaO2) and blood oxygen saturation (SaO2) are significantly reduced, leading to hypoxemia. If SaO2 drops below 0.85, cyanosis can be seen when the reduced hemoglobin reaches 50g or more. When pulmonary ventilation is severely reduced, which affects the emission of carbon dioxide, the arterial blood carbon dioxide partial pressure (PaCOc) increases while Pa02 decreases. When Pa02 6.65kPa (50mmHg), PaC026.65kPa (50mmHg), Sa020.85, respiratory failure can occur.

() Overview of bronchial pneumonia (2) toxemia

Due to the action of pathogens, severe pneumonia is often accompanied by toxemia, which causes different degrees of infection and poisoning symptoms, such as high fever, lethargy, and convulsions. Hypoxia and carbon dioxide retention and toxemia not only affect respiratory function, but also impair systemic metabolism and vital organ function (Figure 1).
1. When the acid-base balance is imbalanced, the body's aerobic metabolism will be impaired during hypoxia, and the accumulation of acidic metabolites will be accompanied by high fever, hunger, dehydration, vomiting, and other factors, often accompanied by metabolic acidosis. In addition, carbon dioxide retention, PaCO2 increases, the concentration of carbonic acid and hydrogen ions increases, and the pH value decreases, which leads to respiratory acidosis. Due to hypoxia and carbon dioxide retention, renal arteriolar spasm causes water and sodium retention, and hypoxia causes increased secretion of ADH, resulting in dilute hyponatremia. When H + enters the cell during acidosis, K + is transferred to the outside of the cell, and blood K + increases or is normal. Blood Cl- in patients with diarrhea or malnutrition tends to be low due to compensatory respiratory acidosis; a small number of children may have respiratory alkalosis due to early rapid breathing and hyperventilation. In severe pneumonia, mixed acidosis often occurs.
2. Hypoxia and carbon dioxide retention in the circulatory system can cause reflex spasms in the pulmonary vessels, increase pulmonary circulation pressure, and cause pulmonary hypertension. Extensive lung lesions also increase pulmonary circulation resistance, resulting in increased right heart load. Myocardium is damaged by the pathogenic toxin, which is prone to toxic myocarditis. The above factors can lead to cardiac insufficiency. A few cases have microcirculation disorders due to severe toxemia and hypoxemia.
3 Hypoxia in the central nervous system can affect the sodium pump function on brain cell membranes, increase intracellular Na + and absorb water, coupled with hypoxia can expand capillaries, increase blood-brain barrier permeability and cause brain edema, which can cause central nervous system in severe cases Respiratory failure. Pathogenic toxins can cause toxic encephalopathy.
4 The gastrointestinal tract of the digestive system is prone to dysfunction due to hypoxia and toxins, and toxic intestinal paralysis may occur in severe cases. Increased gastrointestinal capillary permeability can cause gastrointestinal bleeding.

Overview of clinical manifestations of bronchial pneumonia

() Overview of bronchial pneumonia (1) general symptoms

Sudden or slow onset. There may be a few days before the onset of mild upper respiratory tract infections. Fever patients often have fever. Early body temperature is between 38 and 39 ° C, and can reach as high as 40 ° C. Most of them are relaxation or irregular fever. Most frail babies have a slow onset of illness, fever is not obvious or their temperature is lower than normal.

() Overview of bronchial pneumonia (2) respiratory symptoms

The cough is more frequent, with an irritating dry cough in the early stage, the cough in the extreme phase is slightly reduced, and the wet cough is restored in the recovery period. A severe cough often causes vomiting. Shortness of breath, breathing rate can reach 40 to 80 times per minute. Severe children may develop perioral, nasolabial folds, cyanosis of the toes, fanning of the nasal wings, and tri-concave signs.
Lung signs are not obvious early, and there may be rough or weakened breathing sounds. Later, wetting rales may be heard, more at the bottom of both lungs and near the spine, and more pronounced at the end of deep inhalation. Because most of the small lesions are scattered, percussion is generally normal. When the fusion of the lesions expands, and some or all of the lung lobes appear, the corresponding solid variant disease may appear. If percussion dullness and / or reduced breathing sounds are found on one lung, pleural effusion or empyema should be considered.

() Overview of bronchial pneumonia (3) circulatory system symptoms

Mild heart rate increases slightly, severe cases may have varying degrees of cardiac insufficiency or myocarditis. Patients with combined heart failure can refer to the following diagnostic criteria:
The heart rate suddenly exceeds 180 beats / min;
Suddenly accelerated breathing, more than 60 times / minute;
Sudden extreme irritability, obvious cyanosis, pale gray, prolonged microcirculation and refilling time of fingernails;
rapid liver enlargement;
The heart sound is dull, or there is a galloping rhythm, and the jugular veins are swollen;
Urinary oliguria or anuria, and facial, eyelid or lower extremity edema can be diagnosed as heart failure.
Patients with myocarditis are pale, tachycardia, dull heart sounds, arrhythmia, ECG manifested as ST-segment shift and T-wave low level, two-way and inverted.
Severe children may develop disseminated intravascular coagulation, which is manifested by decreased blood pressure, cold limbs, and bleeding from the skin and mucous membranes.
(D) Nervous symptoms often appear drowsiness, restlessness, or both. Severe cases may show signs of toxic encephalopathy such as convulsions, coma, or repeated convulsions.
(E) Digestive symptoms may include loss of appetite, vomiting, diarrhea, and bloating. Severe pneumonia often occurs with toxic intestinal paralysis and obvious abdominal distension, which causes the diaphragmatic muscle to increase further to make breathing difficult. Gastrointestinal bleeding can spit out coffee-like, blood in the stool, or tar-like stool.