Chapter 22: Bronchiectasis

Question 1

Etiology of Bronchiectasis

Answer 1

• dilation of the bronchial wall
• acquired (rare) or congenital
• is both an obstructive and suppurative (pus forming) disorder
• Associated with cystic fibrosis
• increased risk in children

Question 2

Pathogenesis of Bronchiectasis

Answer 2

• recurrent infection of bronchial walls leads to persistant dilation
• bronchial wall thickening
• Inflammation results in destruction of walls
• destructive process leads to loss of cilliated epithelium (transforms to squamous cell and pus formation; leads to bronchial obstruction; predisposes patient to infection)

Question 3

clinical manifestations of Bronchiectasis

Answer 3

• persistent, daily, chronic, productive cough (w/foul sputum)
• Hemoptysis
• Fever, night sweats
• Moist crackles including bases, rhonchi
• Halitosis (bad breath)
• Skin pallor
• Digital Clubbing (infrequent)

Question 4

Clubbing

Answer 4

• caused by prolonged, decreased oxygenation
• associated with lymphocytic extravasation (something goes into tissue that shouldn’t), increased vascularity, and edema
• severity parallels the severity of the disease.

Question 5

Diagnosis of Bronchiectasis

Answer 5

• History of chronic, productive cough
• Chest xray (small cysts, bronchial wall thickening)
• PFTs (decreased airflow and vital capacity)
• ABG (decreased PaO2, increased PaCO2)
• CT scan (BEST CHOICE FOR DIAGNOSIS)

Question 6

Treatment of Bronchiectasis

Answer 6

• antibiotic therapy, inhaled bronchodilators, vigorous chest percussion (hitting chest) and postural drainage