Bronchiectasis Flashcards
(23 cards)
Definition of Bronchiectasis
Abnormal, irreversible dilatation of bronchi caused by destructive and inflammatory changes in airway walls, associated with infection
Etiology of Bronchiectasis
One or both lungs involved
Found generally in lower lobes (smaller bronchi tend to be most affected)
Commonly limited to a lobe or segment
May be acquired or congenital
Acquired Bronchiectasis-Pulmonary Infection
Repeated and prolonged respiratory infection
Frequent bronchopneumonia in children ® Bronchiectasis as adults
Significant lung infection in childhood can cause anatomical alterations in the developing lungs which lead to more infections and ultimately bronchiectasis
Acquired Bronchiectasis-Bronchial Obstruction
Caused by tumour, enlarged lymph node ® impaired mucociliary clearance ® bacterial infection ® bronchiectasis distal to obstruction
Acquired Bronchiectasis-Pulmonary Tuberclosis
Inflammatory changes and bronchial wall destruction ® bronchiectasis as secondary complication
Types of Acquired Bronchiectasis
Pulmonary infection
Bronchial obstruction
Pulmonary Tuberclosis
Types of Congenital Bronchiectasis-Cystic Fibrosis
Abundance of thick, stagnant mucus
Impaired mucocillary clearance
Bronchial obstruction
Necrotizing inflammation and infection
All the above lead to secondary bronchiectasis
Types of Congenital Bronchiectasis-Hypogammaglobulinemia
Inherited/acquired immune deficiency disorders
High risk for respiratory infections
Cystic fibrosis
Abundance of thick, stagnant mucus
Impaired mucocillary clearance
Bronchial obstruction
Necrotizing inflammation and infection
All the above lead to secondary bronchiectasis
Types of Congenital Bronchiectasis-Kartageners Syndrome
Accounts for 20% of congenital bronchiectasis
Triad consisting of bronchiectasis, dextrocardia (hart on right side of the body) and paranasal sinusitis
Types of Congenital Bronchiectasis
Kartageners Syndrome
Hypogammaglobulinemia
Cystic fibrosis
Pathophysiology of Bronchiectasis
- Bronchial Wall Destruction
- Impaired Mucocillary Mechanism
- Copious Amount of Foul Smelling Sputums
- Distal Bronchioles Obstruction with Secretions
- Hyperinflation of Distal Aveoli/Atelectasis Consolidation and Parachymal Fibrosis
- V/Q Mismatch, Hypoxemia, Increased WOB, Cor Pulmonale
Cylindrical Classification
Regular pattern with the airway wall of the bronchioles uniformly dilated in a cylinderical shape
Occurs for 6-10 generations and appears to end squarely on bronchogram due to mucus obstruction
Increased bronchial markings
Emphysema
Varicose Classification
Irregular pattern with areas of constriction and dilation
End in a distorted bulbous shape
Cystic/Saccular Classification
A progressive increase in diameter with distal enlargement of airways resulting in sac like structures in lung parenchyma
Causes most damage to tracheobronchial tree
Loss of cartilage, elastic tissue and smooth muscle with fibrous tissue forming bronchial walls
Fibrotic markings
Atelectasis
Emphysema
Hgh Resolution CT Scan
Has known mostly replaced bronchoscopy for classifying bronchiectasis
Severe bronchiectasis is associated with:
i. Vesicular breath sounds
ii. Cor pulmonale
iii. JVD
iv. Polycythemia
ii. Cor pulmonale
iii. JVD
iv. Polycythemia
The clinical manifestations are a result from the pathophysiologic mechanisms caused (or activated) by
Atelectasis
Consolidation
Excessive Bronchial Secretions
Clinical Manifestations
Cough, sputum production, and hemoptysis
A chronic cough will produce large quantities of foul smelling sputum which is a hallmark of bronchiectasis
Sputum Examination
Streptococcus pneumonia
Haemophilus influenza
Pseudomonas aeruginosa
Anaerobic organisms
General Treatment Includes
Controlling Pulmonary Infections
Controlling Airway Secretions
Preventing Complications
Other Treatment Options Include
Bronchopulmonary Hygiene
Supplemental Oxygen Therapy
Mechanical Ventilation
Surgical Resection of Localized Area
Lung Transplant
Respiratory Care Treatment Protocols
Oxygen therapy protocol
Bronchopulmonary hygiene therapy protocol
Hyperinflation therapy protocol
Aerosolized medication protocol
Mechanical ventilation protocol
Medications
Antibiotics
Mucolytic agents
Bronchodilators/anticholinergics/ xanthines
Expectorants