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Z Year3 Resp Conditions > Bronchiectasis > Flashcards

Bronchiectasis Flashcards

1
Q

What is the pathophysiology for bronchiectasis?

A

Chronic inflammation of bronchi and bronchioles leader to permanent dilation and thinning of these airways

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2
Q

What are the main causative organsims in bronchiectasis?

A
  1. H influenzae - most common
  2. Psedomona aeuginosa
  3. Strep.pneumonia
  4. Staph, aureus
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3
Q

What are congenital causes of bronchiectasis?

A
  1. CF - most common cause in western world

2. Primary ciliary dyskinesia

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4
Q

What are some post infection causes of bronchiectasis?

A
  1. Measles
  2. Pertussis
  3. Bronchiolitis
  4. Pneumonia
  5. TB - most common cause worldwide
  6. HIV
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5
Q

What are other causes of bronchiectasis?

A
  1. Bronchiole obstruction
  2. Allergic bronchopulmonary aspergillosis
  3. Rheumatoid arthritis
  4. UC
  5. Idiopathic
  6. Chronic aspiration GORD, aspiration
  7. Asthma
  8. COPD
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6
Q

What are symptoms for bronchietasis?

A
  1. Chronic daily productive cough (>8 weeks)
  2. Cup full of sputum
  3. Mucopurulent thick sputum (pus)
  4. Foul-smelling
  5. Green/Yellow during infective episode (otherwise mucoid (white)
  6. Haemoptysis flecks of blood, rusty colour)
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7
Q

What other pulmonary symptoms of bronchiectasis?

A
  1. Dyspnoaea/ SOB
  2. Fever
  3. Weight loss
  4. Non-pleuritic chest pains between exacerbations
  5. Recurrent chest infections
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8
Q

What are possible DDx for bronchiectasis?

A
  1. COPD
  2. Asthma
  3. Pneumonia
  4. Chronic sinusitis
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9
Q

When should you collect a sputum MCS sample?

A

in stable state and during acute exacerbations

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10
Q

What imaging can be used in bronchiecastasis?

A

CXR and HRCT

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11
Q

What may CXR show in bronchiectasis?

A
  • may be normal
  • show obscured hemidiaphragm
  • thin-walled ring shadows with or without fluid levels, tram lines (thickened bronchial walls)
  • tubular or ovoid opacities
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12
Q

What would HRCT show in bronchiectasis?

A
  1. thickened, dilated airways with or without air fluid levels
  2. varicose constrictions along airways
  3. cysts and/or tree-in-bud pattern
  4. Signet ring
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13
Q

What would FBC show in bronchiectasis?

A
  1. WBC high eosinophil count in bronchopulmonary aspergillosis
  2. neutrophilia suggest superimposed infection or exacerbation
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14
Q

What other tests would you do for bronchiectasis?

A
  1. Sputum culture and sensitivity
  2. Serum alpha-1 antitrypsin phenotype and level
  3. Serum immunoglobumins
  4. Sweat chloride test
  5. RF
  6. Specific IgE or skin prick test to Aspergillus fumigatus
  7. Serum HIV antibody
  8. Nasal nitric oxide
  9. PFTs
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15
Q

What could sputum culture and sensitivity show?

A
  • gram-positive bacteria
  • gram-negative bacteria
  • non-tuberculous mycobacteria
  • fungi
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16
Q

Why do you do sweat chloride test?

A

check if CF

17
Q

What would nasal nitric oxide show?

A
  1. low (<100 parts per billion) NNO level in primary ciliary dyskinesia, if cystic fibrosis is excluded
  2. high NNO level excludes a diagnosis of PCD
18
Q

What do PFTs show in bronchiectasis?

A

reduced FEV₁, elevated residual volume (RV)/total lung capacity (TLC) – obstructive pattern

19
Q

What is acute treatment of first presentation bronchiectasis?

A
  1. 1st line: exercise and improved nutrition + airway clearance therapy
  2. inhaled bronchodilator
  3. mucoactive agent
20
Q

What is ongoing treatment for bronchiectasis with acute exacerbation?

A

1st line: short term antibiotics

  • increase airway clearance
  • maybe surgery
21
Q

What is ongoing treatment for bronchiectasis with 3 or more exacerbation despite maintaince?

A

1st line: reassess physio, muco active treatment + maintenance therapy

  • LT antibtioics
  • Surgery maybe
22
Q

What would steroids be used in bronchiecastsis?

A

ABPA

23
Q

What is general management for bronchiectasis?

A
  • Systemic antibiotics
  • Daily airway clearance
  • Maintenance aerosolides antibiotics for severe bronchiectasis or recurrent Pseudomonas aeruginosa infections
  • Surgical therapy, such as lung transplantation considered
24
Q

What are possible complications of bronchiectasis?

A
  1. Massive haemoptysis
  2. Respiratory failure
  3. Cor pulmonale
  4. Ischaemic stroke
  5. Pleural effusion
25
Q

What are RF for bronchiectasis?

A
  1. Cystic fibrosis
  2. Immunodeficiency
  3. Previous infections
  4. Congenital disorders of bronchial airways
  5. Primary ciliary dyskineasia
  6. Alpah-1-antitrypsin deficiency
  7. Connective tissue disease
  8. IBD
  9. Aspiration or inhalation injury
  10. Focal bronchial obstruction
26
Q

What is Kartagener’s syndrome?

A

associated with primary ciliary dyskinesia (PCD)

27
Q

What are 3 things in Kartagner’s syndrome?

A
  1. Bronchiectasis
  2. Sinusitis
  3. Situs inverses
28
Q

What are signs in bronchiectasis?

A
  1. Finger clubbing
  2. Wheeze
  3. Coarse crackles in lower zones
29
Q

What are the resp causes of clubbing?

A
  1. Bronchiectasis
  2. ILD (IPF)
  3. Lung cancer
  4. Lung abscess
  5. Emphysema
  6. TB
  7. Cystic fibrosis
30
Q

What other bloods would you do for bronchiectasis?

A
  1. U+Es
  2. CRP: high
  3. LFTs
  4. ABG (dyspnoea)
  5. Culutre (sepsis)
31
Q

What may suggest ABPA?

A

bronchiectasis, eosinophilia and increased IgE

32
Q

What is gold standard investigation for bronchiectasis?

A

HRCT

33
Q

What is the conservative management of bronchiectasis?

A
  1. Exercise, good diet
  2. Vaccinations: one-off pneumococcal, seasonal influenza
  3. Smoking cessation
  4. Airway clearance - IMPORTANT
34
Q

What are different types of airway clearance?

A
  • Chest physiotherapy – GOLD
  • Nebulized hypertonic saline
  • High frequency oscillation devices
35
Q

What is pharmacological treatment for bronchiectasis?

A
  1. Steroids/Bronchodilators
  2. IV Abx (if acute exacerbation)
  3. Oral Abx
36
Q

What antibiotics are given for pseudonomonas (deadly)?

A

ciprofloxacin – complications of Achilles tendonitis/rupture

37
Q

What antibiotics may be given prophylactically for bronchiectasis?

A

Prophylactic e.g. azithromycin need to check QT interval before starting on ECG

Z Year3 Resp Conditions (20 decks)

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