Name: Christine P.

Salimbagat Group K

ANATOMY AND PHYSIOLOGY

Overview of Pediatric Community-Acquired Pneumonia

Pneumonia causes the lungs to fill with pus, which causes them to stiffen. As a result, the patient's lungs are
stiff and he breaths quickly. As pneumonia progresses, the lungs stiffen even more and fail to expand
adequately. Severe pneumonia patients have a lot of pus in their lungs, which makes their lungs rigid.
Pneumonia is a serious respiratory infection that affects the lower respiratory tract (distal bronchi and alveoli).
The accumulation of oedema and purulent secretions within the airspaces is caused by host-pathogen
interactions and the resulting inflammatory response; these alterations are important to the pathophysiology
of pneumonia.

What is a Community-Acquired Pneumonia?

Acute inflammation of the lower respiratory tract and lung parenchyma is referred to as pneumonia.
Pneumonia obtained outside of hospitals or long-term care institutions in people without known genetic or
acquired immunodeficiency, active malignancy, or within 48 hours after hospital admission is referred to as
community-acquired pneumonia (CAP). This is in contrast to nosocomial pneumonia (hospital-acquired
pneumonia), which occurs after a hospital stay of more than 48 hours and involves a separate set of germs.

How does a child’s lung work?

A child's lung anatomy is fairly similar to that of an adult. The lungs are a pair of air-filled organs made up of
lung parenchyma, a spongy tissue. The right lung has three lobes or portions, while the left lung has two. The
lungs are placed on either side of the thorax or chest and are responsible for allowing the body to accept
oxygen and expel carbon dioxide, which is a waste gas produced during metabolism. It is necessary to examine
the entire respiratory system in order to comprehend the architecture of the juvenile lung and lung illness in
children.

What are the two main features of the normal anatomy of the pediatric respiratory system?

Pediatric Airway Anatomy

Outside of the thorax (chest cavity) includes the supraglottic (epiglottis), glottic (airway opening to the trachea),
and infraglottic (trachea) regions. The intrathoracic airway includes the trachea, two mainstem bronchi,
bronchi and bronchioles that conduct air to the alveoli.

Pediatric Lung Anatomy

Lung anatomy includes the lung parenchyma are subdivided into lobes and segments that are mainly involved
in the gas exchange at the alveolar level.

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 Parts

Mouth and Nose

Pharynx – cavity located behind the mouth
Larynx – part of the windpipe that contains the vocal cords
Trachea – also referred to as the windpipe, conducts into and out of the lungs
Lungs – a pair of spongy air filled organs.
Bronchial tubes – passages that carry the air and divide and branch as the travel through the lungs
Bronchioles – tiny passages surrounded by bands of muscle that transport air throughout the lungs.
Bronchioles continue to divide into smaller and smaller units until they reach microscopic air sacs called
alveoli
Lung Alveoli – clusters of balloon-like air sacs
Lung Interstitium – Thin layer of cells between alveoli that contain blood vessels and help support the alveoli
Pulmonary Blood Vessels – tubes that carry blood to the lungs and throughout the body
Lung Pleura – thin tissue that covers the lungs
Lung Pleural Space – area lined with a tissue called pleura and located between the lungs and the chest wall
Diaphragm – a muscle in the abdomen that assist with breathing
Lung Mucus – sticky substance that lines the airways and traps dust and other particles inhaled
Lung Cilia – microscopic hair-like structures that extend from the surface of the cells lining the airway.
Covered in mucus, cilia trap particles and germs that are breathed in.

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 What are the differences in Pediatric Pulmonary Anatomy?

❖ While the basic anatomy of the pediatric lung and the adult lung are the same, there are some
important differences that should not be overlooked. These differences can increase the occurrence
and severity of lung disease and respiratory issues in young children and impact treatments and
techniques that are most effective.
❖ The ribs in infants and young children are oriented more horizontally than in adults and older children
lessening the movement of the chest.
❖ Rib cartilage is more springy in children making the chest wall less rigid. This can allow the chest wall
to retract during episodes of respiratory distress and decrease tidal volume.
❖ The intercostal muscles that run between the ribs are not fully developed until a child reaches school
age. This can make it difficult to lift the rib cage especially when lying flat on the back.
❖ The back of a child’s head is typically larger than in adults. This can cause the neck to flex when a
child is lying on his or her back and result in a partially obstructed airway.
❖ Infants and children tend to have a proportionally larger tongue in relation to the space in the mouth.
❖ Younger children are typically nose breathers.
❖ The internal diameter of the airways in a child is smaller. Any inflammation or obstruction may cause
more severe distress.
❖ In general, pediatric airways are smaller, less rigid, and more prone to obstruction.
❖ Children also have higher respiratory rates than adults making them more susceptible to agents in
the air.

Pediatric Community-Acquired Pneumonia

Even though inhalation of infected droplets is the most prevalent cause of CAP, around 10% of cases can be
caused by aspiration of oropharyngeal or stomach secretions. Lobar pneumonia, bronchopneumonia (lobular
pneumonia), and interstitial pneumonia are the three classic types of pneumonia. Lobar pneumonia is caused
by infection spreading throughout the acini, Kohn pores, and Lambert canals, affecting partial or complete lung
segments or an entire lobe. Infection concentrated on bigger airways is referred to as bronchopneumonia
(lobular). Finally, interstitial pneumonia is characterized by an inflammatory cellular process involving the
interlobular and peribronchovascular interstitium in a preferential manner.

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 What are the signs and symptoms?

Pneumonia is still the most common cause of infection-related death in the United States. Cough, fever,
pleuritic discomfort, dyspnea, and sputum production are all classic CAP symptoms. However, among elderly
people who have altered mental status or frailty, CAP might be clinically mild. Streptococcus pneumoniae,
Haemophilus influenzae, Staphylococcus aureus, Mycoplasma pneumoniae, Chlamydia pneumoniae, Klebsiella
pneumoniae, and Legionella pneumophila are among the bacteria linked to CAP. Gram-negative bacteria are
commonly seen in the elderly, drinkers, and those suffering from chronic debilitating conditions. CAP can be
complicated by any microbe, however empyema and lung abscesses are common consequences in individuals
with aspiration pneumonia.

Reference: Spencer, D.A. and M.F. Thomas, Necrotising pneumonia in children. Paediatric respiratory reviews,
2014. 15(3): p. 240-245.

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