Bronchiectasis

Question 1

What is bronchiectasis?

Answer 1

Bronchiectasis is an abnormal destruction and dilation (widening) of the large airways. The
bronchi become inflamed, widened and enlarged so that lung secretions and mucus do not
pass out of the airways normally and instead can pool in the lung leading to infection.

Question 2

Classification of Bronchiectasis?

Answer 2

According to traditional classification:

• Normal
• Cylinderical
• Varicose
• Cystic

Question 3

Another Classification?

Answer 3

1. Congenital Bronchiectasis:
   - Is a rare condition in which the lung periphery fails to develop, resulting in cystic dilation
   of developed bronchi.
2. Acquired Bronchiectasis:
   - Direct bronchial wall destruction:
   due to infection, inhalation of noxious chemicals,
   immunologic reactions, or vascular abnormalities that interfere with bronchial nutrition.
   - Mechanical alterations: due to atelectasis or loss of parenchymal volume with increased
   traction on the walls of airways, leading to bronchial dilation and secondary infection.

Question 4

What are the Causes of Bronchiectasis?

Answer 4

1) Impairment of mucocilliary function as seen in primary ciliary dyskinesia and cystic
fibrosis.
2) Impairment of immunity as hypogammaglobulinaemia, which predisposes to recurrent
infection.
3) Acute necrotizing pneumonia resulting from viral or bacterial infections, including
tuberculosis. Bacterial endotoxins and proteases, proteases derived from circulating or
pulmonary inflammatory cells, superoxide radicals, and antigen-antibody complexes
may mediate bronchial wall damage.
4) Persistent infection with Aspergilus, as in asthmatic.
5) Bronchial obstruction by lymph nodes or by a foreign body.
6) Inhalation of corrosive materials

Question 5

What are the clinical features?

Complaints of the Patient?

Answer 5

1. chronic cough and sputum production (Most patients have chronic cough and sputum
   production-the most characteristic and common symptoms. Typically, it occurs regularly in
   the morning on arising. Sputum usually is mucous or mucous-purulent.
2. (Recurrent fever, with or without visible pneumonia, is also common;
   investigation of such symptoms may lead to the diagnosis of bronchiectasis
3. shortness of breath may occur in advanced cases with associated chronic
   bronchitis and emphysema
4. Weakness and Fatigue
5. Sputum with Blood - common complaint.

Question 6

What can you see in general inspection?

Answer 6

Central cyanosis. 
The skin is withered.
The hair is fragile.
Patients have weight loss.
Digital clubbing or hypertrophic pulmonary osteoarthropathy
develop. 
The chest is barrel.

Question 7

What can you feel in palpation?

Answer 7

Tactile fremitus is decreased, but may be increased over the

bronchiectasis. The elasticity of the chest becomes less.

Question 8

What can you hear in percussion?

Answer 8

gives hyper-resonance over the lungs, but over the bronchiectasis we may
find tympanic sound.

Question 9

What can you hear in Auscultation?

Answer 9

rough breath sounds, medium or large bubbling rales and rhonchi,
sometimes diffuse high-pitched wheezes.

Question 10

What can you observe in CVS?

Answer 10

right ventricular hypertrophy

Question 11

What happens if the condition progresses?

Answer 11

gradual loss of respiratory function.
Cor pulmonale is found in the late stages of the disease.
Periodic exacerbations are caused by superinfection and associated with fever, signs of pneumonia, lung abscess, empyema and septicemia.
Chronic disease may rarely be associated with secondary amyloid.

Question 12

What can you see in a blood test?

Answer 12

Leukocytosis
increased ESR.
Later anemia may appear.

Question 13

What revels in Sputum Analysis?

Answer 13

Sputum usually is mucous-purulent or purulent. Less commonly, in
long-standing cases, sputum is abundant and may separate into three layers: frothy at
the top, greenish and turbid in the middle, and thick with pus at the bottom. There are a
large number of neutrophils, erythrocytes in sputum. Sometimes elastic fibers may be
present.

Question 14

What can you see in chest xrays?

Answer 14

tandard chest x-rays may show increased secretions,
crowding from an atelectatic lung, tram lines. areas of honeycombing, or cystic areas with
or without fluid levels, but occasionally x-rays are normal.

Question 15

What can you see in Bronchoscopy?

Answer 15

when disease is unilateral or of recent onset, fiber optic ronchoscopy is
indicated to rule out tumor, foreign body, or other localized endobronchial abnormality

Question 16

How can you treat bronchiectasis?

Answer 16

controlling infections and bronchial secretions,
- relieving airway obstructions,
- removal of affected portions of lung by surgical removal or artery embolization
- preventing complications.
-Antiobiotic therapy
-bronchoiodilators
-Anti-inflammatory drugs
-Surgery
used to treat localized bronchiectasis, removing obstructions that could cause progression
of the disease.