bronchiectasis Flashcards
definition
It is a permanent dilatation of the bronchus due to destruction of muscle and elastic tissue
etiology
Etiology
- Primary infections – Staphylococcus aureus, Klebsiella, Mycobacterium tuberculosis, Mycoplasma pneumoniae, viral, Mycobacterium avium complex
- Bronchial obstruction – endobronchial tumours, stenosis, broncholithiasis, foreign body aspiration
- Cystic fibrosis
- Congenital - Young disease, primary ciliary dyskinesia,
- Congenital dysgenesis – bronchopulmonary sequestration, yellow-nail syndrome, Williams-Campbell syndrome (congenital cartilage deficiency)
- Allergic bronchopulmonary aspergillosis
- Immunodeficiency states – hypogammaglobulinemia, agammmaglobulinemia
- Autoimmune diseases – rheumatic disease
- α1-antitrypsin deficiency
- Diseases of upper airways
pathogenesis
- Main pathogenic mechanism is obstruction and chronic dilatation of bronchial tree and chronic persistent infection. inflammation & destruction of bronchial wall is irreversible
- infections release toxins damage the respiratory epithelium & impairs mucociliary clearance. Frequent bacterial infection add in
- bronchodilation occur, while host immune response & mediators from neutrophiles causing epithelial injury. This condition permit reinfection in dilated airways
- Therefore vicious cycle is formed, impaire clearance of secretions causes recurrent infection back to bronchial damage.
- obstruction of large bronchi is by compression of collapsed or congenitally inadequate bronchi &/ prolonged obstruction of the bronchi with a dense mucoid plug in acute resp infections
- bronchodilatating forces (high intrabronchial pressure during cough, bronchial distension due to accumulated secretion) promotes persistent dilatation of the bronchi
- bronchial dilatation and retention of bronchial secretion, promotes development of inflammation
Morphological types
Morphological types
- Saccular – ulceration with bronchial neovascularization and a resultant ballooned appearance that may have air-fluid levels.
- Cylindrical – diffuse mucosal edema, with resultant bronchi dilated minimally but have straight, regular outlines
- Fusiform – bulbous appearance with a dilated bronchus and interspersed sites of relative constriction and, potentially, obstructive scarring.
- Mixed – a combination of 2 or more
Clinical symptoms
2 phases: Relapsing, Remission 3 stages:
1. Mild - relapse 1-2x and btw them condition is satisfactory
2. Moderate - sputum < 100ml, & moderate disturbance
3. Severe - volume of sputum > 200ml, short remission & fever
Clinical symptoms
2 phases: Relapsing, Remission 3 stages:
1. Mild - relapse 1-2x and btw them condition is satisfactory
2. Moderate - sputum < 100ml, & moderate disturbance
3. Severe - volume of sputum > 200ml, short remission & fever
Early stage:
- Persistent or recurrent cough
- Purulent sputum production. In severe cases, continous production of thick, foul-smelling sputum
- Hemoptysis
- May be severe pneumonia
- Dyspnea – wheezing
- Fever, malaise
- On auscultation – crackles, rhonchi, wheezing
- Chronic hypoxia
- Possible weight loss
- finger clubbing
- breathlessness
In late stages, signs similar to cor pulmonale appear (page 62)
clinical picture
- cough with purulent sputum
- if relapsing full mouth sputum
- in remission have 2 level of sputum
- haemoptysis
- dyspnoe
- pain in the chest if near pleura pleuritis
- fever if relapsing > 38 C, in remission normal < 37.3
- has syndrome of obstruction
- malaise
- clubbing
investigation
- Objective examination
- dull sound/ band box sound
- respiration - rash , moist rales, medium bubbling rales which increase and decrease after cough - Blood – leucocystosis, toxic changes in neutrophil, increase ESR, anemia
- Biochemical picture – increased inflammatory proteins, decreased globulins
- serum immunoglobulins
- sputum has 2 level
- Mucous / serous
- Died neutrophil
- colour according to infectious agent, yellow in relapse, white in remission, mucous, presence of leukocytes
- stap aureus, pseudomonas aeruginosa, H. influenza and anaerobes - X-ray
- no specific changes
- maybe foci of inflammation
- sign of coarse deformation of lung pattern, in lower segment or the middle lobe of the right lung - Bronchography
- if the diagnosis is in doubt
- morphological signs of bronchiectasis seen
- localized changes, widespread bulging - Pulmonary function test – to determine degree of obstruction if present
- CT scanning – differentiation between morphological types
- bronchokinetography – reveal bronchiectasis with movable and rigid walls and to differentiate deforming bronchitis frm bronchiestasis
- bronchial arteriography – reveal blood shunting thru pathologically dilatated bronchopulmonary anastomoses
- lung scanning – reveal marked disturbances in capillary circulation
Treatment
- Conservative treatment
- Antibiotics – penicillin, ampicillin, amoxicillin. eg Ceftazidine
a. mild cases – intermitten chemotherapy with cefaclor / aprofloxacin
b. flucloxacillin if stap. Aureus is isolated
c. if p. aeruginosa, chemotherapy ceftazidime, ciprofloxacin
- Immunocorrection – respective globulin infusion
- Disintoxication
- Mucolytics – acetylcysteine (aerosol), bromhexine
- Bronchodilators – isoprenaline, salbutamol, theophylline
- Anti-inflammatory drugs – corticosteroids. Inhaled/oral steroids
- Immunization – influenza, pneumococcal pneumonia
- Pneumatic compression vest & nebulization with saline solution
- NSAIDS
- Broncholytics
- To increase immunity - Timolin, Timogen, T-activin
- postural drainage - uppermost lobe, 3 times daily for 10-20 min
- Surgical
- Surgical resection to correct localized form of bronchiectasis without complications
- Lung transplantation
- Bronchial arterial embolization
indication
- complication present
- positive result if operate - result of narcosis
