RESPIRATORY SYSTEM
1. The nose, like the whole front part of the skull of early age the child is
small. Moves narrow lower nasal passage is absent, it becomes clear to 4 years of
age, mucosa delicate structure of the nose.
2. The sinuses are formed to 2 years and is fully developed in the prepubertal
period.
3. Throat - at an early age is relatively short and narrow. Pharyngeal
lymphatic ring in the newborn developed inadequate
but; tonsils at an early age are deep between the arches, to 4-10 years in the
lymphatic tissue grows, starting with 13-14 almonds start to regress.
4. Larynx - relatively short and wide, funnel-shaped, with a thin pliable
cartilage and muscles. The angle of inclination of the epiglottis in children less than
adults. Especially intensively growing at 1 year of age. Sex differences in its
structure appear to 3 years. In the wall of the throat a large number of lymphatic
tissue.
5. The trachea - at an early age has a elliptical shape, the soft cartilage, the
mucosa is rich in blood vessels and mucous glands. tracheal length increases with
the growth of the body.
6. The bronchi - right bronchus is wider and shorter, continues trachea. Left -
a long and narrow. The angle of discharge of the same. Neonates
glubokovetvyaschayasya bronchi system, ie large bronchial branches reach the lung
cortical layer. branching type is gradually changing, and ends finally to 7 years.
Distinguish right and left main bronchus, equity, subdolevye, lobular, subdolkovye,
segmental, subsegmentary and terminal bronchi.
7. Light grow continuously by increasing the alveolar volume. lung mass
biggest increases in the first 3 months of life, and in 13-16 years. The histological
structure of lung tissue in infants is characterized by the number of loose
connective tissue in the interlobular septa and poverty elastic fibers. The basic
structural unit of the lung - acinus consisting of respiratory bronchioles I, II, III
order. In young children, they have wide gaps, but low in the alveoli. The roots of
the lung on chest radiograph also look like an adult to 10 years.
Children pneumonic process is most often localized in certain segments, due
to the characteristics of the data segments aeration, drainage function of bronchi,
the evacuation of them secret and the possibility of getting infections. The most
common pneumonia is localized in the lower lobe, namely in the apical-basal
segment (Figure 5). This segment is isolated to some extent from the other
segments of the lower lobe; its segmental bronchus departs above the other
segmental bronchus and is at a right angle straight back. This creates conditions for
poor drainage, since an early age, children usually are long time in the supine
position. Along with the defeat of the 6th segment of pneumonia often localized in
verhnezadnem segment of the upper lobe and the basal posterior segment of the
lower lobe. This explains the common form of the so-called paravertebral
pneumonia. A special place is occupied by the middle lobe lesion. With this type of
localization is acute pneumonia. There is even the term "srednedolevoy syndrome".
Fig.27.A chest radiograph.
Right-upper lobe pneumonia.
When viewed from the oral cavity is necessary to pay attention to the state of
the pharynx and tonsils. In infants tonsils usually do not go beyond the front bow.
Children of preschool age there is hyperplasia of the lymphoid tissue and tonsils
out when viewed from the front of the bow.
A healthy child has a synchronous part in the breath of both halves of the rib
cage. When pleurisy can be seen that one of the halves of the thorax (ipsilateral)
behind during breathing.
On examination, it draws attention to the type of breathing. In young
children there is abdominal breathing. In boys, it remains unchanged, the girls from
5-6 years of age appears thoracic type of breathing. Restriction of chest rise
observed in acute swelling of the lungs, asthma, pulmonary fibrosis,
subdiaphragmatic abscess, intercostal neuralgia.
Figure 34. Chest radiograph in a patient with cystic fibrosis.
Counting the number of breaths is best done in a minute, when the baby
sleeps.
In children with respiratory lesions observed a change in the ratio between
the frequency of breathing and pulse. In healthy children in the first year of life on
one breath has to 3-3.5 shock pulse in children older than one year on one breath -
4 stroke. In lesions lungs (pneumonia) and vary the ratio becomes 1: 2, 1: 3, since
the breathing rate increases more and pulse - to a lesser extent.
Fig.36. Bronchopulmonary dysplasia.
For respiratory distress syndrome, the child's cry at the birth of weak or even
absent. A marked hypotonia, decreased reflexes, pallor or cyanosis. Noteworthy is
that the breath of a child with a groaning breath, but without stenotic souffle,
shallow.
Palpation. Feeling the chest with both hands, which put her hands on his
chest studied areas symmetrically on both sides.
On palpation can reveal tenderness of the chest. It is necessary to distinguish
between superficial pain associated with superficial and deep tissues - pleural.
Pleural pain is usually aggravated by breathing in and out, often give in the
epigastric and hypochondrium, weaken if compress the chest (lungs decreases
mobility).
Voice tremor (fremitus vocalis) - the feeling that happens when put hands on
symmetrical portions of the chest of the patient cells on both sides, and the patient
at this time utters the words, which would provide greater vibration voice
(containing a large number of vowels and the sound of "p" For example, "thirty-
three", etc. in infants studied voice trembling while screaming or crying baby.
Strengthening the voice of jitter due to the sealing of the lung tissue (dense bodies
conduct sound better), in the presence of cavities in the lungs.
Voice jitter is attenuated by occlusion bronchus (lung atelectasis), and
pushing off from bronchial chest wall (exudate, pneumothorax, pleural tumor).
Percussion.Distinguish percussion indirect and direct. Indirect percussion -
percussion finger on the finger. When percussion great importance is the correct
patient position (symmetric position of both halves of the thorax). Percussion begin
with the comparative method to detect the change in the sound more clearly.
When percussion lung health is not always determined by the same lung
sounds. Right in the lower divisions of the proximity of the liver it is shorter than
the left because of the stomach close - tympanic shade (so-called space Traube
delimited from above the lower boundary of the heart and left lung, right - the liver
edge to the left - the spleen, from the bottom - costal arch, with fluid accumulation
in the pleural cavity it disappears).
Fig.38. Methods of indirect Fig.39. Methods of direct
percussion apex. percussion of the clavicle.