Week Three - Case Four Flashcards
what is bronchiectasis
an obstructive lung disease
It is almost always a result of bronchial obstruction leading to infection with inflammation (distal to the obstruction)
what causes bronchiectasis
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
what are the symptoms of bronchiectasis
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
what are the signs of bronchiectasis
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
what is the pathology behind bronchiectasis
there will be destruction of the alveolar walls (and the elastin contained in them), with fibrosing of the remaining parenchyma.
what will then happen to the airway
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
where in the lungs is most greatly affected
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
what may you find in a sputum sample
you may find pseudomonas aeruginosa, H influenzae, staph aureus, aspergillus fumigates, fungi (e.g. Aspergillus) and various mycobacteria
what may u see on a CXR in advanced disease
In advanced disease you may be able to see areas of thickened airway walls, cystic spaces, and consolidation or collapse.
what is the management of bronchiectasis the same as
the management of CF
what is essential in the management of bronchiectasis
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
what are the most common antibiotics given in bronchiectasis
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.
what else may be given in the management of bronchiectasis (3 things)
steroids
bronchodilators
surgery
what are the complications of bronchiectasis
pneumonia
abscess
empyema
pulmonary fibrosis
cor pulmonale
metastatic absences in the brain
what plaques may form as a result of bronchiectasis
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