Krup sutiyuq p'anqap pukyu qillqanta qhaway

{{Unquy
 | Name           = Krup (Laryngotracheobronchitis)
 | Image          = Croup steeple sign.jpg
 | Caption        = [[Kampanaryu unancha]], krupniyuq wawap kunkan, radiografía nisqapi rikusqa, antero-posterior
 | DiseasesDB     = 13233
 | ICD10          = {{ICD10|J|05|0|j|00}}
 | ICD9           = {{ICD9|464.4}}
 | ICDO           =
 | OMIM           =
 | MedlinePlus    = 000959
 | eMedicineSubj  = ped
 | eMedicineTopic = 510
 | eMedicine_mult = {{eMedicine2|emerg|370}} {{eMedicine2|radio|199}}
 | MeshID         = D003440
}}

'''Krup''', lat. '''Laryngotracheobronchitis''' (kast. ''crup'' icha ''laringotraqueobronquitis'') huk [[samana yawri|samanamanta]] unquy huk [[virus]] rayku mayqinchus patakaq sinqa ukhupi infeccionta ruwan.  Kay [[infeccion]]qa tonqori ukhuta punkichin, chayrayku mana allinta samachiwanchikchu, chaymanta kay sintomakunawan kachkanchik [[allqu uhuy]] (tos perruna), [[estridor]], chaymanta [[disfonía]] ima. Pisi, mana ancha sinchichu utaq sinchi sintomakunata rikhurichin, kaytaq ch’isinpi aswan sinchiman tukun. Kayqa hampikuy munan huk dosikunallawan kay [[esteroides]] kaqmanta; wakin kuti, ancha sinchi kaptin, kay [[epinefrina]] kaqwan hampikuy munan. Mayniqpi hina hampina wasiman qhipakuq yachachikun.

Kay imamantachus rinkhurinman karqa chaymanta chay aswan sinchi causasninta yachaspaña, kay crup kaqniyuq kanki ñisunku kay clínicapi qhawachikuspa (kay hina: [[epiglotitis]] utaq huk [[hawa ima kay vias respiratorias kaqpi]])kaqta. Mana qhipan qhawachikunata munakunchu – yawar qhawachina, [[rayos-X]], utaq cultivos ñisqata —. Kayqa huk rikhuriq unquypuni, wawakunapi huk 15% kaqman hap’in, aswantataq kay 6 killayuqman 5 utaq 6 watayuqmankama.  Mana nijayk’aq hina wayna runakunaman utaq machu runakunaman hap’inchu. Ñawpaqtaqa kay [[difteria]] juchayuqrayku rikhurinman karqa niqtinkupas, kay occidental pachapaqqa, kaypata hamuyninqa kusi yuyakunayapaq, kay [[vacunación]] kaqtin, kaywantaq aswan llimphu kananchikpaq chaymanta sumaq kawsaypaq ayllukunapi. 

==Signos y síntomas / Unanchakuna watupanakunawan==
{{listen 
 | filename     = Stridor 2OGG.ogg
 | title        = Hark’ana
 | description  = Huk hark’ana ukhumantaq hawamantaq samaspa tiyan, huk 13 killayuq wawapi, kay crup kaqniyuq.
 | format       = [[Ogg]]
}}
Kay crup kaqqa riqsichikuq kayrayku: [[tos]] “perruna”, [[estridor]], [[disfonía]] (voz kaqpi pantay), chaymanta [[Respiración entrecortada | sasacha respirarpaq]] mayqinchus ch’isipi aswan sinchiman tukun.<ref name=Au10>{{cite journal | author = Rajapaksa S, Starr M | title = Croup – assessment and management | journal = Aust Fam Physician | volume = 39 | issue = 5 | pages = 280–2 | year = 2010 | month = May | pmid = 20485713 | doi =  }}</ref>  Kay "perruna" ch’ujuqa aswanta rich’akuq kay [[Pinnípedo |foca]] waqllana waqayninman utaq kay[[lobo marino]] kaqman.<ref name="Cherry08_NEJM"/> Hark’ayqa aswan sinchi kanqa kay ansaqillayrayku utaq kay [[llanto]]kaqrayku, chaymanta, sichus wawa samakusaptin uyarikuy atikun chay, ñiy munan kay vías respiratorias sinchita k’uykuchaykukun. Hark’ayqa pisillanman kay crup kaq aswan sinchiyaptin. <ref name=Au10/> 

Wak sintomakunaqa kanman [[fiebre]], [[rinitis aguda]] (aswan riqsisqa síntomas kay [[resfriado común]])kaqmanta, chaymanta k’uykuchaykuy kay [[pared del tórax]] kaqpi.<ref name=Au10/><ref name=Alberta07>{{cite web |url=http://www.childhealthbc.ca/resources/category/5-croup?download=13%3Acroup-guideline |format=PDF|title=Diagnosis and Management of Croup | work=BC Children’s Hospital Division of Pediatric Emergency Medicine Clinical Practice Guidelines |accessdate=}}</ref>  [[El babeo]] utaq kay unqusqa hina rikukuq, huk willay wak hina unquykunamanta. <ref name=Alberta07/>

==Causas / Qallakuna==
Kay crup kaqqa huk infeccion huk virus huchayuqrayku nikun.<ref name=Au10/><ref name=PedN09/> Wakinkunataq kayllatataq ninku aswan mask’asqa simikunapi, kay hina [[laringotraqueítis aguda]], crup espasmódico, difteria laríngea, [[traqueítis bacteriana]], laringotraqueobronquitis, chaymanta laringotraqueobronconeumonía. Kay iskay ñawpa unquykuna huk virus yuchayuqrayku chaymanta mana ancha sinchichu kanku kay sintomaspi; kay tawa qhipan unquykunari bacterias yuchayuqrayku kanku chaymanta aswan sinchi kanku.<ref name="Cherry08_NEJM"/>

===Viral===
Kay crup viral kaq utaq laringotraqueítis aguda kaqqa kay [[virus de la parainfluenza]] huchayuqrayku, aswantataq kay 1 chaymanta 2 wallpamakuna, kay 75% casospi.<ref name=Croup09/> Wak unquykuna virus huchayuqrayku kaqkuna kanku: [[gripe]] A,B ima, [[sarampión]], [[adenovirus]] chaymanta [[virus respiratorio sincicial]] (VRS).<ref name="Cherry08_NEJM"/> Kay crup espasmódico kaq kay kikin virus qutu huchayuqrayku kay laringotraqueítis aguda kaqmanta ichapas kayqa mana infección signosniyuqchu (kay hina k’aja, kunka nanay chaymanta mirayaynin kay [[conteo de glóbulos blancos]]) kaqmanta.<ref name="Cherry08_NEJM"/>  Tratamienton chaymanta kay tratamientopaq kutichiynin kikinllataq kanku.<ref name=Croup09/>

===Bacteriano===
Kay bacteriano qutuqa rak’ikun kaypi: difteria laríngea, traqueítis bacteriana, laringotraqueobronquitis chaymanta laringotraqueo-bronconeumonía.<ref name="Cherry08_NEJM"/>  Kay difteria laríngea rikhurin kay ''[[Corynebacterium diphtheriae]]'' kaqrayku kay traqueítis bacteriana, kay laringotraqueobronquitis chaymanta kay laringotraqueo- bronconeumonía kaqkunataq huk infección viral primaria kaqraykupuni rikhurin huk bacteriano secundario thaskiyninwan.  Kay aswan riqsisqa rikhuriq bacterias kanku:  ''[[Staphylococcus aureus]]'', ''[[Streptococcus pneumoniae]]'', ''[[Hemophilus influenzae]]'', chaymanta ''[[Moraxella catarrhalis]]'' kaq ima.<ref name="Cherry08_NEJM"/>

==Patofisiología==
Kay infección viral kay crup ruwasqanqa punkichin kay [[laringe]], [[tráquea de los vertebrados|tráquea]], chaymanta hatun [[bronquios]]<ref name=PedN09/> kay [[glóbulos blancos]] yaykuyninrayku (aswantataq [[histiocitos]], [[linfocitos]], [[células plasmáticas]], chaymanta [[neutrófilos]])kaqrayku.<ref name="Cherry08_NEJM"/> kay punkiyqa kay vías respiratoriasta tapaykun, chaymanta ancha sinchi chayqa mana samayta ahinallatapacha atikunchu, chaymanta kan kay t’uki ruqyasqa ima wayra lluqsiypuni estridor sutichasqa..<ref name=PedN09/>

==Diagnóstico / Reqsichisa==
{| class="wikitable" style = "float: right; margin-left:15px; text-align:center"
|+ '''Westley kaqta ñiqin: Kay crup kaqmanta sinchinninman hina ñiqi '''<ref name=Croup09/><ref name=Peds99/> 
|-
! rowspan="2" |Imayna kaynin
! colspan="6" |Qusqa chanin kay imayna kayninpaq
|-
!0
!1
!2
!3
!4
!5
|-
| K’iskichaynin kay <br /> tórax ukhu pirqan
| style="width:80px;"|Mana kaq
| style="width:80px;"|Pisi kaq
| style="width:80px;"|Pachan kaq
| style="width:80px;"|Sinchi kaq
| style="width:80px;"|
| style="width:80px;"|
|-
| [[Estridor]]
| Mana kaq
| Kay <br /> l kaqwan ansaqillayqa
| Samariypi
| 
| 
| 
|-
| [[Cianosis]]
| Mana kaq
|  
|  
|  
| Kay <br /> kaqwan ansaqillayqa
| Samariypi
|-
| [[Nivel de conciencia|Nivel de <br />conciencia]]
| Pachan kaq
| 
| 
| 
| 
| Mana pachapi
|-
| Wayracha yaykuna 
| Pachan kaq
| Pisillasqa
| Ancha pisillasqa
| 
| 
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|}
Kay crup kaqqa clínicapi qhawachikun.<ref name=PedN09/>  Ñawpaqtaqa wak ima unquychus kay patakaq vías respiratoriasta tapachkan chayta raqpana tiyan kay hinakuna [[epiglotitis]], huk mana riqsisqa virus kay [[vías respiratorias]]kaqpi, [[estenosis subglótica]], [[angioedema]], [[absceso retrofaríngeo]],chaymanta [[traqueítis bacteriana]]kaqpas.<ref name="Cherry08_NEJM"/><ref name=PedN09/>

Mana [[rayos X] qhawachiykunata sapa kuti ruwakunchu,<ref name=PedN09/> Ichaqa ruwakun chay, tunquri k’uykuchakusqanta rikhuchinqa, kay [[signo del campanario]] sutichasqa, kay estenosis subglótica huchayuqrayku, kaytaq rich’akun kay [[(Arquitectura de)campanario |campanario]] rikukuyninpi.  Kay campanario signon huk willay kay qhawaypaq, ichaqa mana tarikuqchu kay aswan achkha casospi.<ref name=Alberta07/> 

Mana wak qhawachiykunata anchata munakunchu (kay hina [[análisis de sangre]] chaymanta [[cultivo viral]]), imaraykuchus mana munakuq ansaqillayta ruwachinman, kay hinatataq kay ch’ampayuq via área tensionta yapaykuchinman.<ref name=PedN09/> Ahina kaptinpis kay cultivos virales, [[nasofaríngea]] samaypi urkhukuptin, chaywan llamk’akunman yachanapaq imaraykuchus chay unquy kanman, aswantataq chaywan llamk’akun kay mask’ana pampapi.<ref name=Au10/>Sichus runaqa mana kutiripunchu kay pachan tratamientowan chayqa, huk infección bacterianapi umachana; chay hina chayqa aswan mask’aykunata kamachikunqa.<ref name="Cherry08_NEJM"/>

===Gravedad===
Kay crup may hina sinchichus kachkanta yachanapaq aswan llamk’achikusqa sistemaqa kasqa kay Escala de Westley ñisqa. Kayqa astawan llamk’achikuq kasqa kay mask’anapi manataq anchatachu kay clínica llamk’aypiqa.<ref name="Cherry08_NEJM">{{cite journal | author = Cherry JD | title = Clinical practice. Croup | journal = N. Engl. J. Med. | volume = 358 | issue = 4 | pages = 384–91 | year = 2008 | pmid = 18216359 | doi = 10.1056/NEJMcp072022 }}</ref> Kayqa huk yupakuy kay phisqa ruwaykunamanta qusqa: allin yuyay ñiqi, cianosis (qara anqasllasqa llimp’iyuq qhuñakuna ima), estridor, wayrachap yaykunan chaymanta contracciones ima. 
.<ref name="Cherry08_NEJM"/> Yupaykuna qusqa sapa llamk’anarayku kay pañakaq tawlapi rikuchikun, hunt’asqa lluqsimuynintaq kachkan kay 0 chaymanta 17 kaqman hina.<ref name=Peds99/>

* Huk hunt’asqa lluqsimuy kay ≤&nbsp;2 kaqmanta ñin crup ''pisi''. Kay perruna ch’uju rikhurinman, chaymanta kay disfonía ima, ichaqa mana estridor samariypi kanchu. <ref name=Croup09/>
* Huk hunt’asqa lluqsimuy kay 3 kaqmanta chaymanta 5 kaqman ñin crup ''sumaqlla''. Estridor kaqwan rikhurin sasata uyarikuq, ichaqa manaña aswan signos kanchu.  <ref name=Croup09/>
* Huk hunt’asqa lluqsimuy kay 6 kaqmanta chaymanta 11 kaqman ñin crup ''achkha''. Huk estridor kaqwanllataq rikhurin mana tapurikunapaq hina, ichaqa chantapas rikukun kay [[pared torácica]] kaqpi huk sut’i tiraje intercostal ñisqa(aychakuna waktapuramanta ukhuman aysanku).<ref name=Croup09/>
* Huk hunt’asqa lluqsimuy kay ≥&nbsp;12 kaqmanta ñin [[insuficiencia respiratoria]] ruwakunanta. Kay perruna ch’ujuqa chaymanta kay estridor ima ichapas mana ancha chaninniyuq kanmanchu kay pachapi.<ref name=Croup09/>

85% wawakunamanta apasqakuna kay departamento de emergencia ñisqaman kay unquyniyuq kanku mana ancha sinchi chaninniyuq; mayniqpi hina kay crup sinchi chaninniyuq rikhurin: (<1%).<ref name=Croup09/>

==Prevención==
Achkha unqusqakuna kay crup kaqwan saniyachikurqanku [[immunización]] kay  [[influenza]] chaymanta kay [[diferia]]kaqmanta. Ñawpaqtaqa, kay crup kay difteria kaqwan k'askachakuq karqa, ichaqa kay allin vacunación rayku, mana difteria rikhuriy atinmanchu kunanpachapiqa kay hina ñawpachasqa pachapiqa..<ref name="Cherry08_NEJM"/>

==Tratamiento==
Wawakuna kay crup kaqniyuq aswan atikusqa ñañiq kananku tiyan.<ref name=PedN09/> Aswantaqa kay esteroides kaqta qunku ,chaymanta kay sinchi unqusqakunapiqa [[epinefrina]]kaqta. <ref name=PedN09/> Kay [[saturación de oxígeno]] kaqniyuq wawakunapaqqa urapi kay 92% kaqmanta oxigenota qukunan tiyan,<ref name="Cherry08_NEJM"/> chaymanta hospitalpi qhipakunkuman qhawaypi kay unqusqakuna kay sinchi crup kaqniyuq.<ref name=Alberta07/> Sichus oxigenota munakun chayqa aswan allin kanqa kamachiy conductosninta (huk oxigeno quqta hap’ispa wawap uyan qayllapi) imaraykuchus aswan pisi ansaqiyta quchikun kay [[máscara de oxígeno |máscara]]kaqmantaqa.<ref name="Cherry08_NEJM"/> Tratamientowanqa, aswan pisi kay 0.2% runakunamanta munan kay [[intubación endotraqueal]] kaqta.<ref name=Peds99>{{cite journal | author = Klassen TP | title = Croup. A current perspective | journal = Pediatr. Clin. North Am. | volume = 46 | issue = 6 | pages = 1167–78 | year = 1999 | month = December | pmid = 10629679 | doi = 10.1016/S0031-3955(05)70180-2 }}</ref>

===Esteroides===
Rikuchikurqa, kay[[corticoesteroides]]kaqkunaqa, kay [[dexametasona]] kayjinaqa chaymanta kay [[budesónida]]kaqqa, sumaqllachinku lluqsiykunata kay crup kaqwan wawakunata, mayqinllapas kachun unquypa ñiqinqa.<ref name=Cochrane11>{{cite journal | author = Russell KF, Liang Y, O'Gorman K, Johnson DW, Klassen TP | title = Glucocorticoids for croup | journal = Cochrane Database Syst Rev | volume = 1 | issue = 1 | pages = CD001955 | year = 2011 | pmid = 21249651 | doi = 10.1002/14651858.CD001955.pub3 }}</ref>  Kay suqta phani kamachiyninmantapacha huk allin saniyay rikurikunña.<ref name=Cochrane11/>  Ichapas munasqa llamk’ayninta ruwanku sichus siminta, [[parenteral]], upyakunku chay, utaq muskhispa, aswanta munakun kay upyaspa.<ref name=PedN09/>  Huk dosisllata munakun chaywanqa sanillakunqapuni. <ref name=PedN09/> Kay Dexametasona kaq dosisqa kay 0.15, 0.3 chaymanta kay 0.6&nbsp;mg/kg kaqkunamanta kikin sanillachiyniyuq rich’akun.<ref>{{cite journal | author = Port C | title = Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 4. Dose of dexamethasone in croup | journal = Emerg Med J | volume = 26 | issue = 4 | pages = 291–2 | year = 2009 | month = April | pmid = 19307398 | doi = 10.1136/emj.2009.072090 }}</ref>

===Epinefrina===
Kay pachan crup utaq kay sinchi kaq, allichakapunman huch’uy pachapi kay [[epinefrina]] [[nebulizada | nebulizador]] kaqwan.<ref name=PedN09>{{cite journal | author = Everard ML | title = Acute bronchiolitis and croup | journal = Pediatr. Clin. North Am. | volume = 56 | issue = 1 | pages = 119–33, x–xi | year = 2009 | month = February | pmid = 19135584 | doi = 10.1016/j.pcl.2008.10.007 }}</ref> Kay epinefrina ruwachin kay crup unquypa ñiqin pisiyanata huk 10 30 chinini kaqpi, allichayninkunaqa 2 phanillata kawsan.<ref name=Au10/><ref name=PedN09/> Sichus allichayqa kay tratamientop qhipanta sayan chay kay 2 4&nbsp; phanipi chantataq mana ch’ampakuna kanchu chay, wawata hampina wasimanta lluqsichiy yachanku.<ref name=Au10/><ref name=PedN09/>

===Wak===
Ichapas mask’akurqanku wak tratamientos kay crup kappa, nimayqin allin lluqsiykunata qunchu kaykunawan llamk’anapaq hina. Yakup wapsinta utaq quñi wayrachata muskhiyqa huk ñawpa tratamiento kay [[auto-cuidado]] kaqmanta, mana chay allin hampichiyninta rikuchiy atirqankuchu <ref name="Cherry08_NEJM"/><ref name=PedN09/> chayrayku kunanpachaqa pisita ruwakun.<ref name=Hist2001>{{cite journal | author = Marchessault V | title = Historical review of croup | journal = Can J Infect Dis | volume = 12 | issue = 6 | pages = 337–9 | year = 2001 | month = November | pmid = 18159359 | pmc = 2094841 | doi =  }}</ref> Kay [[haminakuna tospaq]] kaqwan hampikunaqa, chantataq kay [[dextrometorfano]] chaymanta/utaq kay[[guaifenesina]] kaqniyuq, manallataq hampikunapaq kusachu.<ref name=Au10/> Ñawpapachapiqa muskhikuq karqa kay [[heliox]] kaq (huk piqtu kay [[helio]] kaqmanta kay [[oxígeno]] kaqwan) kay samana sayk’uyta pisillachinapaq, ichaqa mana ancha lluqsimuykuna tiyanchu kaywan hampikunapaq hina.<ref>{{cite journal | author = Vorwerk C, Coats T | title = Heliox for croup in children | journal = Cochrane Database Syst Rev | volume = 2 | issue = 2 | pages = CD006822 | year = 2010 | pmid = 20166089 | doi = 10.1002/14651858.CD006822.pub2 }}</ref>  Kay crup huk viral unquy kaptin, mana kay [[antibióticos]]kaqkunawan llamk’akunchu, ichapas huk infecion bacteriana secundaria rikhuriptin.<ref name=Au10/> Sichus huk infección bacteriana kaptin, kay antibióticos [[vancomicina]] chaymanta kay [[cefotaxima]]kaqwan llamk’akunman.<ref name="Cherry08_NEJM"/>gripe Aswan sinchi kaqtinqa kay &nbsp;A o B ch’ujuyuq ima chay, kay [[droga antiviral |antiviral]] [[inhibidores de la neuraminidasa]]kaqta qukunman<ref name="Cherry08_NEJM"/>

==Pronóstico==
kay crup viral kaqa huk [[Auto-limitante  (biología)| auto-limitada]] unquy ichaqa mayninpi hina kay,[[insuficiencia respiratoria]] chaymanta/utaq [[paro cardíacoaco]] wañuyman apanman.<ref name=Au10/>  Kay sintomasqa allinllanku  iskay&nbsp;p’unchaykunapi ichaqa qamchis&nbsp;p’unchaw unayta kanman.<ref name=Croup09/> Wak ch’ampakuna mana ancha rikukuq kanku: traqueítis bacteriana, [[neumonía]], chaymanta [[edema pulmonar]]kaq ima.<ref name=Croup09>{{cite journal | author = Johnson D | title = Croup | journal = Clin Evid (Online) | volume = 2009 | issue =  | pages =  | year = 2009 | pmid = 19445760 | pmc = 2907784 | doi =  }}</ref>

==Epidemiología==
Kay crup 15% wawakunaman hina hap’in, kay 6 killayuqmanta chaymanta kay 5 utaq 6 watayuqkama.<ref name="Cherry08_NEJM"/><ref name=PedN09/> 5% hampina wasiman yaykuq wawakunaman rikch’an.<ref name=Croup09/> Mana ancha rikukuq casospi, aswan huch’uy wawakunapipuni rikukunman kay kimsa killayuq hinapi, chaymanta aswan machu wawaspi kay 15 watayuq hinapi.<ref name=Croup09/> Qhari runakunaqa huk 50% hinapi hina unqunku aswan warmi wawakunamanta, chantataq aswanta [[prevalencia]] miray tiyan otoñopi.<ref name="Cherry08_NEJM"/>

==Historia / Ñawpaq willarina==
Kay “crup” simiqa kay “crup” verbomanta hamun, kay [[Inglés Moderno Temprano]] kaqmanta mayqinchus "Ch’akata qhapariy" ñin munay; Kay sutiqa ñawpa kutitaqa kay Escocia kaqpi unquyman sutichakurqa, chantataq aswanta riqsikurqa kay 18 pachaq watapi.<ref>Online Etymological Dictionary, [http://www.etymonline.com/index.php?term=croup croup]. Accessed 2010-09-13.</ref> Kay crup diftérico riqsikun kay [[Ñawpaq Grecia]] kay [[Homero]] kaq pachanmantapacha chantataq kay 1826 kaqpipuni kay [[Pierre Bretonneau|Bretonneau]]  waknarqa kay crup viral kaqta kay crup [[difteria]] kaqman yuchachasqa kaqwanta.<ref name=history>{{cite book |author=Feigin, Ralph D. |title=Textbook of pediatric infectious diseases |publisher=Saunders |location=Philadelphia |year=2004 |page=252 |isbn=0-7216-9329-6 |oclc= |doi= |accessdate=}}</ref> Franceces kaqkunaqa kay crup viral kaqtaqa suticharqanku "falso crup" hinata imaraykuchus kay “crup” chaypachataqa huchachakuq karqa kay bacteria de la difteria unquyman.<ref name=Hist2001/>  Kay crup difteriaman huchachakuq mana anchata riqsikunchu chay [[immunización]] vacunación rayku.<ref name=history/>

==Referencias / Willakuy==
<references/>

[[Katiguriya:Unquy]]