Bronchiectasis Flashcards

1
Q

What is bronchiectasis?

A

An acquired irreversible dilation and distortion of the airways that often results when pulmonary infection leads to destruction of bronchial wall cartilage, blood vessels elastic tissue and smooth muscle

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1
Q

An acquired irreversible dilation and distortion of the airways describes what?

A

Bronchiectassis

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2
Q

What causes bronchiectasis?

A

A pulmonary infection that leads to destruction of bronchial wall cartilage, blood vessels, elastic tissue and smooth muscle

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3
Q

What portion of the lung is bronchiectasis most likely to affect?

A

Smaller airways with less supporting cartilage

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4
Q

T/F: Bronchiectasis is generally limited to one area of the lung

A

False, it can be limited to one specific area by it also can involve multiple areas or be diffuse

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5
Q

T/F: bronchiectasis is a primary disease process

A

False. Bronchiectasis develops secondary to another disease process, generally pulmonary infections

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6
Q

When diagnosing bronchiectasis, what questions should you be asking?

A

What other disease processes are active with this
What other disease processes we active that allowed for this in the past

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7
Q

What are the 3 patterns of dilation associated with bronchiectasis?

A

Cylindrical aka tubular
Varicose aka fusiform
Saccular aka cystic

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8
Q

Describe varicose bronchiectasis

A

The bronchi are dilated and constricted in an irregular fashion similar to varicose veins resulting in a distorted bulbous shape
Kind of have a corrugated look to the bronchi

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9
Q

Describe cylindrical bronchiectasis

A

The bronchi are dilated and rigid and have regular outlines like a tube. They will fail to taper for 6-10 generations before appearing to abruptly end because of mucus obstruction

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10
Q

Describe cystic/saccular bronchiectasis

A

The bronchi progressively increase in diameter until they end in large cyst like sacs in the lung parenchyma
Ring opacities can be visible at bases of the lung

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11
Q

Describe the effects of bronchiectasis on the lungs

A

Chronic dilation and distortion of bronchial airways
Excessive production of foul smelling sputum
Bronchospasm
Hyperinflation of alveoli
Atelectasis
Consolidation and parenchymal fibrosis
Hemorrhage secondary to bronchial arterial erosion

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12
Q

What is the prevalence of bronchiectasis in the united states

A

350-500k adults have the disease

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13
Q

Who is more likely to be diagnosed with bronchiectasis?

A

Women
Older than 60

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14
Q

Describe how bronchiectasis emerges as a disease process in an individual with a pulmonary infection

A

An individual has a pulmonary infection or injury to their airway, as a result the body responds with inflammation which damages the airway walls and impairs the mucociliary escalator which compromises secretion clearance and allows for continued infection resulting in a repeat of the cycle

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15
Q

What kind of conditions can result in bronchiectasis?

A

Pulmonary infection
Obstruction
Impairment of normal airway clearance
Impairment of immune response

15
Q

Infections are a key cause of bronchiectasis, what kind of infection history could support a diagnosis of bronchiectasis?

A

A history of severe pulmonary infections
A history of pulmonary infections as a child
Repeated viral, bacterial or fungal infections of the respiratory system

16
Q

How are COPD and bronchiectasis related?

A

COPD causes flow restrictions and airway remodeling leading to reduced airway clearance and chronic infections resulting in chronic inflammation responses which can cause bronchiectasis

16
Q

How can mycobacteria lead to bronchiectasis?

A

Mycobacteria are responsible for tuberculosis which can serve as a catalyst for starting the inflammation cycle that can result in bronchiectasis

16
Q

Describe hypersensitivity bronchiectasis

A

Infection with aspergillus fumigatus leads to a aspergillus hypersensitivity resulting in repeated inflammatory responses resulting in bronchiectasis

17
Q

How can aspiration lead to bronchiectasis?

A

Aspirations leading to obstruction via a foreign body can lead to retained secretions and infection
Aspiration of stomach contents can cause chronic inflammation and damage the airway

18
Q

How can tumors or enlarged lymph nodes lead to bronchiectasis?

A

The can obstruct airways and prevent airway clearance leading to chronic infection and inflammation

19
Q

What immunocompromised states can lead to bronchiectasis?

A

HIV
Chemotherapy

19
Q

What is necessary for a bronchiectasis diagnosis?

A

History of appropriate clinical manifestations
A high resolution CT scan

19
Q

What systemic inflammatory disease conditions can lead to bronchiectasis?

A

Rheumatoid arthritis
Sarcoid
Systemic lupus erythmatosis

20
Q

What clinical manifestations are required to diagnose bronchiectasis?

A

Cough on most days of the week
Sputum production on most days of the week
History of exacerbations

21
Q

T/F: bronchiectasis can present as an obstructive disorder, a restrictive disorder, or a combination of both

A

True

21
Q

Describe how airways might appear on a HR CT scan of a patient with bronchiectasis

A

The internal airway lumen can be wider than the adjacent pulmonary artery diameter
Lack of tapering in the bronchi = tram track appearance
Airway visibility with 1 cm of costal pleural surface or touching the mediastinal pleura

22
Q

What might a patient experience during a bronchiectasis exacerbation?

A

Changes in cough
Changes in sputum production, volume, or consistency
Changes in breathlessness or exercise tolerance
Fatigue or malaise
Hemoptysis

23
Q

How is bronchiectasis managed?

A

By treating the underlying comorbidity
Antibiotics, airway clearance aerosolized medications….