CHOANAL ATRESIA PPT

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CHOANAL ATRESIA EPISTAXIS TONSILITIS ASPIRATION PRESENTED BY: MS.SHIVANI M.SC(N)FINAL YEAR JINSAR :

CHOANAL ATRESIA EPISTAXIS TONSILITIS ASPIRATION PRESENTED BY: MS.SHIVANI M.SC(N)FINAL YEAR JINSAR

CHOANAL ATRESIA:

CHOANAL ATRESIA

DEFINITION:

DEFINITION Choanal Atresia is a congenital anomaly of the anterior skull base characterized by closure of one or both posterior nasal cavities (the back of the nasal passage called choana is blocked by abnormal bony or soft tissue formed during fetal development).

INCIDENCE:

INCIDENCE The condition occurs in 1 out of every 7,000 to 8,000 live births. Approximately 60% of reported cases are unilateral with a right-sided predominance. Bilateral choanal atresia is commonly associated with other congenital anomalies, such as coloboma (A congenital malformation (birth defect) in which part of the eye does not form due to failure of fusion of an embryonic feature ) , heart defects, choanal atresia, retarded growth, genitourinary abnormalities, and ear anomalies, which are present in approximately 50% of bilateral cases.

ETIOLOGY:

ETIOLOGY The cause of choanal atresia is unknown. It is thought to occur when the thin tissue separating the nose and mouth area during fetal development

RISK FACTORS :

RISK FACTORS Low birth weight and small stent size are potential risk factors for restenosis of choanal atresia .

PATHOPHYSIOLOGY :

PATHOPHYSIOLOGY Due to causes Persistence of the buccopharyngeal Failure of the bucconasal membrane to rupture Medial outgrowth of vertical and horizontal processes of the palatine bone Abnormal mesodermal adhesions forming in the choanal area Misdirection of mesodrmal flow due to local factors leads to sign and symptoms

SYMPTOMS:

SYMPTOMS Chest retracts unless the child is breathing through mouth or crying Difficulty breathing following birth, which may result in cyanosis (bluish discoloration), unless infant is crying Inability to nurse and breathe at same time Inability to pass a catheter through each side of the nose into the throat Persistent one-sided nasal blockage

SIGNS A physical examination may show an obstruction of the nose. :

SIGNS A physical examination may show an obstruction of the nose.

DIAGNOSIS:

DIAGNOSIS CT scan Endoscopy of the nose Sinus x-ray

TREATMENT :

TREATMENT The immediate concern is to resuscitate the baby if necessary. An airway may need to be placed so that the infant can breathe. In some cases, intubation or tracheostomy may be needed. An infant can learn to mouth breathe, which can delay the need for immediate surgery. Surgery to remove the obstruction cures the problem. Surgery may be delayed if the infant can tolerate mouth breathing. The surgery may be done through the nose ( transnasal ) or through the mouth ( transpalatal ).

* Bilateral choanal atresia requires airway support immediately after birth. In severe cases, longer term airway support with a tracheotomy may be needed until definitive repair can be performed safely.:

* Bilateral choanal atresia requires airway support immediately after birth. In severe cases, longer term airway support with a tracheotomy may be needed until definitive repair can be performed safely.

In cases where the skull base has a relatively normal shape and there are no cardiac contraindications to general anesthesia, bilateral choanal atresia should be repaired shortly after birth. Timing recommendations for repair of unilateral atresia vary in the literature. Repair at around 2 to 3 years of age is generally accepted. :

In cases where the skull base has a relatively normal shape and there are no cardiac contraindications to general anesthesia, bilateral choanal atresia should be repaired shortly after birth. Timing recommendations for repair of unilateral atresia vary in the literature. Repair at around 2 to 3 years of age is generally accepted.

Surgical procedures to correct choanal atresia can be broadly classified into transnasal and transpalatal approaches. The decision to use a transnasal versus a transpalatal approach rests on the surgeon's assessment of the choanal anatomy. The composition of the atretic plate, the depth and shape of the nasopharynx and the presence of other anomalies are the most important factors:

Surgical procedures to correct choanal atresia can be broadly classified into transnasal and transpalatal approaches. The decision to use a transnasal versus a transpalatal approach rests on the surgeon's assessment of the choanal anatomy. The composition of the atretic plate, the depth and shape of the nasopharynx and the presence of other anomalies are the most important factors

The transnasal approach requires less operative time and causes slightly less morbidity related to the incision. The transpalatal approach provides better exposure and more accurate bone removal. The palatal incision increases operative time and blood loss. The transpalatal approach probably reduces the risk of major vascular injury, intracranial complications, and restenosis. :

The transnasal approach requires less operative time and causes slightly less morbidity related to the incision. The transpalatal approach provides better exposure and more accurate bone removal. The palatal incision increases operative time and blood loss. The transpalatal approach probably reduces the risk of major vascular injury, intracranial complications, and restenosis.

EXPECTATIONS (PROGNOSIS) Full recovery is expected. :

EXPECTATIONS (PROGNOSIS) Full recovery is expected.

COMPLICATIONS Possible complications include: Aspiration while feeding and attempting to breathe through the mouth Respiratory arrest Renarrowing of the area after surgery :

COMPLICATIONS Possible complications include: Aspiration while feeding and attempting to breathe through the mouth Respiratory arrest Renarrowing of the area after surgery

PREVENTION There is no known prevention. :

PREVENTION There is no known prevention.

EPISTAXIS:

EPISTAXIS

DEFINITION:

DEFINITION Epistaxis, or bleeding from the nose, is a common complaint. It is rarely life threatening but may cause significant concern, especially among parents of small children. Most nosebleeds are benign, self-limiting, and spontaneous, but some can be recurrent. Many uncommon causes are also noted

TYPES::

TYPES: Epistaxis can be divided into 2 categories, anterior bleeds and posterior bleeds, on the basis of the site where the bleeding originates

The true prevalence of epistaxis is not known, because most episodes are self-limited and thus are not reported. When medical attention is needed, it is usually because of either the recurrent or severe nature of the problem. Treatment depends on the clinical picture, the experience of the treating physician, and the availability of ancillary services. :

The true prevalence of epistaxis is not known, because most episodes are self-limited and thus are not reported. When medical attention is needed, it is usually because of either the recurrent or severe nature of the problem. Treatment depends on the clinical picture, the experience of the treating physician, and the availability of ancillary services.

EPIDEMIOLOGY :

EPIDEMIOLOGY Frequency of epistaxis is difficult to determine because most episodes resolve with self-treatment and, therefore, are not reported. However, when multiple sources are reviewed, the lifelong incidence of epistaxis in the general population is about 60%, with fewer than 10% seeking medical attention. The age distribution is bimodal, with peaks in young children (2-10 y) and older individuals (50-80 y). Epistaxis is unusual in infants in the absence of a coagulopathy or nasal pathology ( eg , choanal atresia, neoplasm). Local trauma ( eg , nose picking) does not occur until later in the toddler years. Older children and adolescents also have a less frequent incidence. Consider cocaine abuse in adolescent patients.

PREVALENCE OF EPISTAXIS tends to be higher in males (58%) than in females (42%). :

PREVALENCE OF EPISTAXIS tends to be higher in males (58%) than in females (42%).

ETIOLOGY :

ETIOLOGY Causes of epistaxis can be divided into: Local causes ( eg , trauma, mucosal irritation, septal abnormality, inflammatory diseases, tumors) . Systemic causes ( eg , blood dyscrasias , arteriosclerosis, hereditary hemorrhagic telangiectasia ). Idiopathic causes. Local trauma is the most common cause, followed by facial trauma, foreign bodies , nasal or sinus infections , and prolonged inhalation of dry air. Children usually present with epistaxis due to local irritation or recent upper respiratory infection (URI).

Causes of epistaxis can be divided into: 1. Local causes (eg, trauma, mucosal irritation, septal abnormality, inflammatory diseases, tumors) . 2.Systemic causes (eg, blood dyscrasias, arteriosclerosis, hereditary hemorrhagic telangiectasia). 3.Idiopathic causes. Local trauma is the most common cause, followed by facial trauma, foreign bodies, nasal or sinus infections, and prolonged inhalation of dry air. Children usually present with epistaxis due to local irritation or recent upper respiratory infection (URI). :

Causes of epistaxis can be divided into: 1. Local causes ( eg , trauma, mucosal irritation, septal abnormality, inflammatory diseases, tumors) . 2.Systemic causes ( eg , blood dyscrasias , arteriosclerosis, hereditary hemorrhagic telangiectasia ). 3.Idiopathic causes. Local trauma is the most common cause, followed by facial trauma, foreign bodies , nasal or sinus infections , and prolonged inhalation of dry air. Children usually present with epistaxis due to local irritation or recent upper respiratory infection (URI).

Children usually present with epistaxis due to local irritation or recent upper respiratory infection (URI). Use of "blood thinning medications" called anti coagulants. Recurrent nosebleeds may be a symptom of an underlying disorder such as high blood pressure. Inflammation of the nose or sinuses and cold may cause a nose bleed. :

Children usually present with epistaxis due to local irritation or recent upper respiratory infection (URI). Use of "blood thinning medications" called anti coagulants. Recurrent nosebleeds may be a symptom of an underlying disorder such as high blood pressure. Inflammation of the nose or sinuses and cold may cause a nose bleed.

Deviated septum (when the partition between your nose is crooked), foreign objects in the nose, or other nasal obstruction may also cause nosebleeds. Symptoms Bleeding from one or both nostrils. Frequent swallowing. Sensation of fluid flow in the back of the nose and throat.   :

Deviated septum (when the partition between your nose is crooked), foreign objects in the nose, or other nasal obstruction may also cause nosebleeds. Symptoms Bleeding from one or both nostrils. Frequent swallowing. Sensation of fluid flow in the back of the nose and throat.

Trauma :

Trauma Self-induced trauma from repeated nasal picking can cause anterior septal mucosal ulceration and bleeding. This scenario is frequently observed in young children. Nasal foreign bodies that cause local trauma ( eg , nasogastric and nasotracheal tubes) can be responsible for rare cases of epistaxis. Acute facial and nasal trauma commonly leads to epistaxis. If the bleeding is from minor mucosal laceration, it is usually limited. However, extensive facial trauma can result in severe bleeding requiring nasal packing. In these patients, delayed epistaxis may signal the presence of a traumatic aneurysm. Patients undergoing nasal surgery should be warned of the potential for epistaxis. As with nasal trauma, bleeding can range from minor (due to mucosal laceration) to severe (due to transection of a major vessel).

Dry weather :

Dry weather Low humidity may lead to mucosal irritation. Epistaxis is more prevalent in dry climates and during cold weather due to the dehumidification of the nasal mucosa by home heating systems.

Drugs :

Drugs Topical nasal drugs such as antihistamines and corticosteroids may cause mucosal irritation. Especially when applied directly to the nasal septum instead of the lateral walls, they may cause mild epistaxis. Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) are also frequently involved

Septal abnormality :

Septal abnormality Septal deviations ( deviated nasal septum ) and spurs may disrupt the normal nasal airflow, leading to dryness and epistaxis. The bleeding sites are usually located anterior to the spurs in most patients. The edges of septal perforations frequently harbor crusting and are common sources of epistaxis.

Inflammation :

Inflammation Bacterial, viral, and allergic rhino sinusitis causes mucosal inflammation and may lead to epistaxis. Bleeding in these cases is usually minor and frequently manifests as blood-streaked nasal discharge. Granulomatosis diseases such as sarcoidosis , Wegener granulomatosis , tuberculosis, syphilis, and rhinoscleroma often lead to crusting and friable mucosa and may be a cause of recurrent epistaxis. Young infants with gastroesophageal reflux into the nose may have epistaxis secondary to inflammation.

Migraine :

Migraine Children with migraine headaches have a higher incidence of recurrent epistaxis than children without the disease. The Kiesselbach plexus, which is part of the trigeminovascular system, has been implicated in the pathogenesis of migraine.

Hypertension :

Hypertension The relationship between hypertension and epistaxis is often misunderstood. Patients with epistaxis commonly present with an elevated blood pressure. Epistaxis is more common in hypertensive patients, perhaps owing to vascular fragility from long-standing disease. Hypertension, however, is rarely a direct cause of epistaxis. More commonly, epistaxis and the associated anxiety cause an acute elevation of blood pressure. Therapy, therefore, should be focused on controlling hemorrhage and reducing anxiety as primary means of blood pressure reduction. Excessive coughing causing nasal venous hypertension may be observed in pertussis or cystic fibrosis .

Idiopathic causes The cause of epistaxis is not always readily identifiable. Approximately 10% of patients with epistaxis have no identifiable causes even after a thorough evaluation. :

Idiopathic causes The cause of epistaxis is not always readily identifiable. Approximately 10% of patients with epistaxis have no identifiable causes even after a thorough evaluation.

PATHOPHYSIOLOGY:

PATHOPHYSIOLOGY Bleeding typically occurs when the mucosa is eroded and vessels become exposed and subsequently break. More than 90% of bleeds occur anteriorly and arise from Little’s area, where the Kiesselbach plexus forms on the septum. The Kiesselbach plexus is where vessels from both the ICA (anterior and posterior ethmoid arteries) and the ECA ( sphenopalatine and branches of the internal maxillary arteries) converge. These capillary or venous bleeds provide a constant ooze, rather than the profuse pumping of blood observed from an arterial origin. Anterior bleeding may also originate anterior to the inferior turbinate. Posterior bleeds arise further back in the nasal cavity, are usually more profuse, and are often of arterial origin ( eg , from branches of the sphenopalatine artery in the posterior nasal cavity or nasopharynx ). A posterior source presents a greater risk of airway compromise, aspiration of blood, and greater difficulty controlling bleeding.

DIAGNOSIS OF NOSE BLEED :

DIAGNOSIS OF NOSE BLEED A thorough medical history for previous bleeding, high blood pressure, liver diseases, use of anticoagulants, nasal trauma, family history of bleeding etc. should be taken. Analysis of blood coagulation parameters. Measurement of the blood pressure and X-rays of the skull and sinuses maybe necessary. Treatment

FIRST AID IN NOSE BLEEDS - HOW TO STOP NOSE BLEED :

FIRST AID IN NOSE BLEEDS - HOW TO STOP NOSE BLEED Calm the patient if necessary with medication. The patient should sit with the upper part of the body tilted forward and the mouth open so that they can spit out the blood instead of swallowing. Check to see if there is an object inside the victim's nose and remove it if necessary. When medical attention is needed for epistaxis, it is usually because of the problem is either recurrent or severe. Treatment depends on the clinical picture, the experience of the treating physician, and the availability of ancillary services. In most patients with epistaxis, the bleeding responds to cauterization, nasal packing, or both. For those who have recurrent or severe bleeding for which medical therapy has failed, various surgical options are available. After surgery or embolization, patients should be closely observed for any complications or signs of rebleeding.

PowerPoint Presentation:

Medical approaches to the treatment of epistaxis may include the following: Adequate pain control in patients with nasal packing, especially in those with posterior packing (However, the need of adequate pain control has to be balanced with the concern over hypoventilation in the patient with posterior pack.) Oral and topical antibiotics to prevent rhinosinusitis and possibly toxic shock syndrome Avoidance of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) Medications to control underlying medical problems ( eg , hypertension, vitamin K deficiency) in consultation with other specialists.

TONSILITIS:

TONSILITIS

DEFINITION: :

DEFINITION: Tonsillitis is an inflammation (swelling) or infection of the tonsils. The tonsils are tissues on both sides of the back of child's pharynx (throat). Both the tonsils and the adenoids help child fight infections in his airway. Child's adenoids are above the tonsils and behind his nose. When child's tonsils are infected, often his adenoids are also infected. Children with tonsillitis often get better within a week. Some children have recurrent (comes back more often than once a year) tonsillitis.

CAUSES OF TONSILLITIS:

CAUSES OF TONSILLITIS Viruses: Tonsillitis in children is usually caused by germs called viruses. Viruses that cause a cold or influenza (the flu) may cause viral tonsillitis in children. Tonsillitis is common in teenagers with an illness called infectious mononucleosis (mono). With mono, the symptoms of tonsillitis can last up to a few weeks. Bacteria: Tonsillitis also can be caused by germs called bacteria. Group A streptococci often cause bacterial tonsillitis (strep throat).

SIGNS AND SYMPTOMS OF VIRAL TONSILLITIS :

SIGNS AND SYMPTOMS OF VIRAL TONSILLITIS Signs and symptoms of acute viral tonsillitis come on fast and do not last long. Your child may have any of the following: Cough Hoarseness Runny or stuffy nose Sore, watery eyes

PowerPoint Presentation:

Signs and symptoms of acute viral tonsillitis come on fast and do not last long. Your child may have any of the following: Cough Hoarseness Runny or stuffy nose Sore, watery eyes

*Diarrhea (loose, watery bowel movements) *Rash on his body or in his mouth :

*Diarrhea (loose, watery bowel movements) *Rash on his body or in his mouth

SIGNS AND SYMPTOMS OF BACTERIAL TONSILLITIS :

SIGNS AND SYMPTOMS OF BACTERIAL TONSILLITIS Signs and symptoms of acute bacterial tonsillitis occur fast and do not last long. Your child may have any of the following: Sudden pain in his throat and pain with swallowing Fever and bad breath Red, swollen throat and snoring

PowerPoint Presentation:

Sleep apnea (when your child's breathing stops for a short time during sleep) Whitish-yellow patches on the back of his throat Nausea (sick to his stomach), vomiting (throwing up), and stomach pain Painful, swollen lumps on the sides of his neck Rash that looks like sunburn with little bumps

SIGNS AND SYMPTOMS OF CHRONIC BACTERIAL TONSILLITIS OCCUR SLOWLY AND LAST LONGER. YOUR CHILD MAY HAVE ANY OF THE FOLLOWING:

SIGNS AND SYMPTOMS OF CHRONIC BACTERIAL TONSILLITIS OCCUR SLOWLY AND LAST LONGER. YOUR CHILD MAY HAVE ANY OF THE FOLLOWING Bad breath Long-lasting sore throat Red, swollen throat Painful, swollen lumps on the sides of his neck Open-mouth breathing Dark circles under his eyes Crooked teeth

DIAGNOSIS :

DIAGNOSIS History and physical exam: Your child's caregiver will look into your child's throat and feel the sides of his neck and jaw. He will ask your child about his signs and symptoms. The signs and symptoms that your child has can help caregivers learn if he has an infection. Throat culture: This is a test that may help caregivers learn which type of germ is causing your child's illness. A throat culture is done by rubbing a cotton swab against the back of your child's throat.

TREATMENT OF TONSILLITIS :

TREATMENT OF TONSILLITIS With treatment, your child may feel better faster. He may be able to return to school more quickly. Treating your child's tonsillitis may help prevent his spreading the infection to others. It also may decrease your child's risk of getting heart or kidney problems as a result of the infection. Your child may need any of the following: Medicines: Ibuprofen or acetaminophen: Ibuprofen or acetaminophen are over-the-counter medicines that may decrease your child's pain and fever. Ask your child's caregiver to tell you the right amount of medicine to give to your child, and how often to give it.

PowerPoint Presentation:

Do not give aspirin to children under 18 years of age: Your child could develop Reye syndrome if he takes aspirin. Reye syndrome can cause life-threatening brain and liver damage. Check your child's medicine labels for aspirin, salicylates , or oil of wintergreen. Antibiotics: Antibiotic (germ-killing) medicine may be needed if strep throat bacteria are the cause of your child's tonsillitis. Give your child this medicine as directed by his caregiver. Have your child take the antibiotics until they are gone, even if he feels better

PowerPoint Presentation:

*Steroids: Steroid medicine may be given to reduce swelling in your child's throat. Surgery: If your child has breathing changes when he sleeps, such as snoring, he may need to have his tonsils removed. This surgery is called a tonsillectomy. If he gets tonsillitis often, he also may need to have his tonsils removed. If his adenoids are swollen, they may be removed during a tonsillectomy. After a tonsillectomy, your child may not get sore throats as often.

NURSING MANAGEMENT: :

NURSING MANAGEMENT: If child complaints for sore throat adminster analgesic and acetaminophen should be given Patient should be advised to give warm saline gargles . Steam inhalation should also be recommended. Antibiotics should be administered as per order.

COMPLICATIONS: :

COMPLICATIONS: Complications may rarely include : dehydration and kidney failure due to difficulty swallowing, blocked airways due to inflammation, and pharyngitis due to the spread of infection. abscess may develop lateral to the tonsil during an infection rheumatic fever or glomerulonephritis can occur.

ASPIRATION IN CHILDREN:

ASPIRATION IN CHILDREN

DEFINITION:

DEFINITION Aspiration can be defined as the drawing of a foreign substance, such as the gastric contents, into the respiratory tract during inhalation.

INCIDENCE::

INCIDENCE : Children, especially those aged 1-3 years, are at risk for foreign body aspiration because of their tendency to put everything in their mouths and because of the way they chew. Young children chew their food incompletely with incisors before their molars erupt. Objects or fragments may be propelled posteriorly , triggering a reflex inhalation.

ETIOLOGY::

ETIOLOGY: Rattles Stuffed toys Food items Talcum powder

PATHOPHYSIOLOGY::

PATHOPHYSIOLOGY: Due to causes Irritation and edema can occur Obstruction in air passage causing inflammation Abscess, emphysema and atelacteasis

CLINICAL MANIFESTATION: :

CLINICAL MANIFESTATION: Inability to speak Cough Wheezing sound Dyspnoea Hoarseness Cyanosis

DIAGNOSIS: :

DIAGNOSIS: History Physical examination Chest X-ray bronchoscopy

TREATMENT OF ASPIRATION ::

TREATMENT OF ASPIRATION : Provide only sturdy , well construted rattles for infants Provide pacifier that has only one piece, durable construction Remove small parts that could be aspirated or swallowed from toys. Remove diapers or safety pins ,buttons, broken parts of toys . Do not permit infants to play with balloons. Remove small objects from floor before the infant is placed Do not give infants nuts , lozenges and hard candies

NURSING MANAGEMENT:

NURSING MANAGEMENT Suctioning of airway and administering oxygen Fluids can be given to children

PREVENTION: This can be prevented by keeping small objects such as toys , safety pins, candies and nuts out of the reach of children .   :

PREVENTION: This can be prevented by keeping small objects such as toys , safety pins, candies and nuts out of the reach of children .

CONCLUSION :

CONCLUSION As these more leading causes of illness in children . So we have to become aware about the diseases and provide the appropriate care and treatment to the child . It is necessary to educate the parents about these diseases and to cooperate with child.

BIBLIOGRAPHY:

BIBLIOGRAPHY 1.Marlow Dorothy.R (2002) , “A text book of paediatrics’ ’ 6ed. Philedelphia : Elsevier pub.,pp-447,1029 2.Wongs(2005) , ‘Essentials Of Paediatrics’ , 7ed. Philedelphia:Mosbys Pub.,pp-810,1106-1109 3. http://www.drugs.com/cg/tonsillitis-in-children.html 4. http://en.wikipedia.org/wiki/Tonsillitis 5.http:// emedicine.medscape.com /article/863220- overview#aw2aab6b2b7aa 6. http://www.atresia.info/choanal-atresia.htm 7. www.ncbi.nlm.nih.gov/ pubmed /19128709 8 . http://health.yahoo.net/adamcontent/choanal-atresia/2 9. http:// emedicine.medscape.com /article/863220overview#aw2aab6b2b6aa 10.http:// health.hpathy.com /nosebleed-symptoms-treatment- cure.asp

THANKYOU:

THANKYOU

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