Week Three - Case Four Flashcards

1
Q

what is bronchiectasis

A

an obstructive lung disease

It is almost always a result of bronchial obstruction leading to infection with inflammation (distal to the obstruction)

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2
Q

what causes bronchiectasis

A

Cystic fibrosis – the most common cause in developed countries

Bordetella pertussis infections (Whooping Cough) can sometimes cause bronchiectasis later in life

Ciliary dysfunction syndromes

Primary hypogammaglobuminaemia

Congenital abnormalities (usually rare ones)

TB – this is the most common cause worldwide

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3
Q

what are the symptoms of bronchiectasis

A

chronic cough

production of large amounts of foul smelling sputum - may have flecks of blood

finger clubbing may be present

recurrent RTIs

fever and malaise

haemopytsis

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4
Q

what are the signs of bronchiectasis

A

May be unilateral or bilateral.

Coarse crackles (numerous) over areas containing large amounts of sputum
Possible collapse (no breath sounds)
Reduced or absent breath sounds at areas distal to places of obstruction

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5
Q

what is the pathology behind bronchiectasis

A

there will be destruction of the alveolar walls (and the elastin contained in them), with fibrosing of the remaining parenchyma.

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6
Q

what will then happen to the airway

A

the airway will then dilate as the surrounding scar tissue contracts. this can in itself cause secondary inflammatory changes which leads to further destruction of the airwaysw

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7
Q

where in the lungs is most greatly affected

A

usually the lower lobes are most greatly affected. this can lead to pooling of bronchial secretions, which increases the risk of further infections in this area. there will also be collections of pus

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8
Q

what may you find in a sputum sample

A

you may find pseudomonas aeruginosa, H influenzae, staph aureus, aspergillus fumigates, fungi (e.g. Aspergillus) and various mycobacteria

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9
Q

what may u see on a CXR in advanced disease

A

In advanced disease you may be able to see areas of thickened airway walls, cystic spaces, and consolidation or collapse.

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10
Q

what is the management of bronchiectasis the same as

A

the management of CF

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11
Q

what is essential in the management of bronchiectasis

A

Postural drainage – this is essential! Patients should be trained by physiotherapists in how to tip themselves into a position in which the affected lobe(s) is drained in an uppermost direction at least 3 times a day for 10-20 minutes – most patients find the most effective position is to lie down over the side of the bed with the head and thorax down

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12
Q

what are the most common antibiotics given in bronchiectasis

A

to halt progression of the disease you need to give adequate antibiotic therapy. This obviously depends on the infective organism:

Initially, try a broad spectrum, such as cefaclor or ciprofloxacin.

Try flucloxacillin 500mg every 6 hours if this fails. This is to treat staph aureus.

If the sputum remains yellow or green after regular phsyio and other AB’s, then it is likely the infective organism is P aeruginosa. This probably required inhaled AB’s, such as ceftazidime (which can also be given IV). You could also try inhaled cipro, but this creates resistance quickly.

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13
Q

what else may be given in the management of bronchiectasis (3 things)

A

steroids

bronchodilators

surgery

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14
Q

what are the complications of bronchiectasis

A

pneumonia
abscess
empyema
pulmonary fibrosis
cor pulmonale
metastatic absences in the brain

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15
Q

what plaques may form as a result of bronchiectasis

A

Amyloid plaques are insoluble fibrous protein aggregates. Their accumulation can lead to amyloidosis. A protein as described as being amyloid if it has a slightly altered structure, making it insoluble.
Amyloidosis can occur in many organs, and the symptoms vary greatly from organ to organ

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16
Q

what is the prognosis of bronchiectasis

A

This has greatly improved with antibiotic therapy. Ultimately, many patients die from respiratory failure due to deterioration of the lung tissue. Cor pulmonale is also common.

17
Q

what are the features consistent on a CXR with bronchiectasis

A
  • tram-track opacity
  • mucus plugging
  • ring shadow
  • consolidation
18
Q

what is bronchiectasis

A

is a chronic condition in which the bronchial tree becomes abnormally and irreversibly dilated. the bronchial walls become thickened and inflamed, leading to a build-up of excess mucus which can make the lungs vulnerable to infection

19
Q

what are the causes of non-CF bronchiectasis

A

Idiopathic (most common)

Post-infective – e.g., bacterial pneumonia, mycobacterial infection

Allergic – e.g., to mould or fungus, especially in allergic bronchopulmonary aspergillosis (ABPA)

Autoimmune – associations with connective tissue diseases and inflammatory bowel disease

Immunodeficiency – e.g., primary ciliary dyskinesia, primary immunodeficiency disorders, HIV/AIDs

Obstruction – secondary to severe asthma or COPD, or distal to a neoplasm or inhaled foreign body

20
Q

what is the epidemiology of bronchiectasis

A

An estimated 212,00 people in the UK are living with non-CF bronchiectasis

There is a female to male predominance

Incidence increases with age, with 60% of diagnoses made in the over-70 age group

Interestingly, bronchiectasis is more commonly diagnosed in the least deprived sections of the UK population, in contrast to other respiratory disorders

21
Q

what is the investigations for Cystic fibrosis

A

sweat test and CFTR genetic testing

22
Q

what does bronchoscopy test for

A

lung cancer

23
Q

what does total IgE test for

A

ABPA

24
Q

what does decal calprotectin test for

A

inflammatory bowel diseasew

25
Q

what does immunoglobulins (IgG, IgA and IgM test for)

A

immunodeficiency

26
Q

what is the treatment plan for bronchiectasis

A

Physiotherapy and airway clearance techniques

Cough assist devices

Smoking cessation: it is important for healthcare professionals to know what services are available to refer patients to, do you know how to find this information?

Pneumococcal and annual influenza vaccinations

Treatment with short courses of antibiotics for exacerbations or chest infections

In rare cases surgery, for example a lobectomy if bronchiectasis is localised and symptoms are debilitating

27
Q

what can treat Moraxella catarrhalis and what is it resistant to

A

it is sensitive to co-amoxiclav and resistant to amoxicillin

28
Q

what is the sail sign

A

a dense triangular opacity overlying the cardiac shadow

29
Q

what is classed as an exacerbation of bronchiectasis

A

defined as deterioration in three or more of the following key respiratory symptoms for at least 48 hours

  • cough
  • sputum volume/consistency
  • sputum purulence
  • breathlessness
  • fatigue and or malaise
  • haemopysis
30
Q
A