Bronchiectasis Flashcards
Pathophysiology of bronchiectasis
Chronic infection of bronchi/bronchioles → permanent
dilatation.
Retained inflammatory secretions and microbes →
airway damage and recurrent infection
Organisms of bronchiectasis
H. influenzae - most common
Streptococcus Pneumoniae
Pseudomonas aeruginosa
Klebsiella
Causes of bronchiectasis
Congenital:
- cystic fibrosis
- young’s syndrome
Post-infectious:
- TB
- Measles
- Pertussis
- Pneumonia
- Bronchiolitis
Other:
- RA
- UC
Young’s syndrome
Bronchiectasis and infertility
Complications of bronchiectasis
Pneumonia Pleural effusion Pneumothorax Pulmonary HTN Massive haemoptysis Cerebral abscess Amyloidosis
Investigations of bronchiectasis
Respiratory examination Basic obs Sputum MCS Blood: Se Ig, , RF, α1-AT level CXR: Spirometry: obstructive pattern Bronchoscopy + mucosal biopsy CF sweat test
Bronchiectasis on CXR
Thickened bronchial walls Tramlines and signet rings
Mx of bronchiectasis
Smoking cessation Chest physio Abx for exacerbations Bronchodilators: nebulised β agonists Treat underlying cause
Cystic fibrosis pathogenesis
Auto recessive
Mutation in CFTR gene Chr 7
↓ luminal Cl secretion and ↑ Na reabsorption →
viscous secretions as water not secreted
Clinical features of CF
Neonate:
- failure to thrive
- Meconium ileus
- Rectal prolapse
Children / Young Adults
Nose: nasal polyps, sinusitis
Resp: cough, wheeze, infections, bronchiectasis,
haemoptysis, pneumothorax, cor pulmonale
GI: Pancreatic insufficiency: DM, steatorrhoea Distal Intestinal Obstruction Syndrome Gallstones Cirrhosis
Other: male infertility
Signs of CF
Increased viscous secretion Clubbing Cyanosis Bilateral coarse creps Salty sweat
Common Respiratory CF Organisms
Early:
S. aureus
H. influenza
Late:
P. aeruginosa
Diagnosing CF
Sweat test: Na and Cl
Genetic screening for common mutations
Faecal elastase
Immunoreactive trypsinogen - neonate screening
Investigations for CF
Respiratory exam
Basic obs
Bloods: FBC, LFTs, clotting, ADEK levels, glucose
Sputum MCS
CXR: bronchiectasis
Abdo US: fatty liver, cirrhosis, pancreatitis
Spirometry: obstructive defect
Mx of CF
MDT
Chest: Physio Abx and prophylaxis Mucloytics: DNAse Bronchodilators Vaccinate - (NHS)
GI:
Pancreatic enzyme replacement
ADEK supplements
Insulin
