Bronchiectasis Flashcards
What are the 3 risk factors for developing chronic pulmonary infection?
- Abnormal host response- immunodeficiency, immunosuppression (drugs, cancer)
- Abnormal innate host defence- damaged bronchial mucosa, cilia
- Repeated insult- aspiration, indwelling material.
What are some common causes of immunodeficiency? (4)
- Immunoglobin deficiency
- Hypo-splenism- loss of B lymphocytes through non functioning spleen
- HIV
- Immune paresis- (myeloma, lymphoma)
What are the common types of Immunoglobin deficiency? (3)
- IgA deficiency
- Hypoglobulinanaemia
- CVID
What are some causes of damaged bronchial mucosa? (3)
- Smoking
- Malignancy
- Infection (pneumonia or flu)
What are some reasons of abnormal cilia production?
- Kartengers
2. Youngs
Some causes of abnormal mucus? (2)
- CF
2. Channelopathies- disturbance in ion channel and its functioning
Some forms of CHRONIC pulmonary infection. (dont need to remember this)
- Intrapulmonary abscess
- Empyema
- Chronic bronchial sepsis
- Bronchiectasis
- CF & other oddities
What are the common symptoms of intrapulmonary abscess? (3)
- Weight loss
- Cough +/- sputum
- Tiredness
Intrapulmonary Abscess- Severe localised lung infection associated with necrotic cavity formation.
What kind of things can an intrapulmonary abscess be proceeded by?
- Pneumonia
- Foreign body
- Post viral
Some common bacterial and fungal pathogens that can cause intrapulmonary abscess?
Bac
- Strep
- Staph
- E. coli
- Gram -
Fungal - Aspergillus
Apart from right sided endocarditis, a septic emboli can also cause _ and _ .
- Infected DVT
2. Septicaemia
Empyema is the formation of _ in the _
pus, pleural space
What is the commonest cause of Empyema?
Pneumonia, rest are idiopathic, iatrogenic (due to treatment)
Changes in what factors marks progression from simple to complicated effusion to empyema?
- pH- More than 7.2 in simple but keeps decreasing till empyema
- LDH- initially less than a 1000 but increases to a 1000 in empyema.
- Glucose- Initially more than 2.2, decreases less to it.
Complicated parapneumonic effusion requires a chest tube drainage. T/F?
True
Aerobic Gram + and - such as what usually cause empyema?
Gram +
- Strep mileri
- Staph aureus
Gram -
- E. coli
- H. influenzae
- Klebsiella
- Pseudomonas
What factors can determine empyema diagnosis?
- Slow resolving Pneumonia
- Persisting Locular (cavity) effusion
- CT.
USS- Ultrasound most definite way to confirm diagnosis
Pleural effusions often show up on CXR’s as a _ shaped sign.
D- lungs reduced to that shape.
Treatment for Empyema? (2)
- Chest drainage- 5 intercostal space? removes fluid
- Antibiotics
IV- broad spectrum: amoxicillin
Oral- targeted to pathogen
Bronchiectasis is the localised, irreversible _ of the bronchial tree.
Dilation
Involved bronchi are dilated, _ and easily collapsible.
Inflammed
Bronchiectasis does not affect clearance of secretions. T/F?
False- impaired secretion clearance
What are the symptoms and signs of Bronchiectasis? (3 each)
Symptoms
- Recurrent infections
- Copious purulent sputum.
- +/- haemoptysis
Signs
- Finger clubbing
- Coarse inspiratory crackles (NB- Fine crackles seen in pulmonary fibrosis)
- Wheeze
Common pathogens causing Bronchiectasis? (4)
- H influenzae
- Strep pneumonia
- Staph aureus
- Pseudomonas
Bronchiectasis usually causes lower respiratory tract infections. T/F?
True
Some common causes of Bronchiectasis?
- Congenital- CF, Youngs, Kartanagers
2. Others- bronchial obstruction, Rheumatoid, hypogammaglobulinaemia,
More than 50% of Bronchiectasis cases are idiopathic. T/F?
True
Chronic bronchial sepsis has the same hallmarks as bronchiectasis but different CT appereances. T/F?
True
Chronic bronchial sepsis usually affects _ people
Young.
Older - associated with COPD or other airway disease
What is the treatment for Bronchiectasis when colonised by bacteria?
- Prophylactic- Nebulised gentamicin, colomycin
- Macrolides- Clarithromycin, Azithromycin 250mg
Anti-inflammatory antibiotics reduce exacerbation rates in bronchiectasis.
