Bronchiectasis Flashcards
What are the examination findings in acute severe asthma?
• Inspection:
Severe recession; sc/ic/ tracheal tug
Posture sitting forward; ‘Tripod’ position
• Additional noises:
Wheeze intermittent
• Palpation:
Hyperexpanded chest; Symmetrical expansion;
poor expansion if severe
otrachea central cardiac apex in usual position
liver pushed down; edge palpable.
• Percussion:
Resonant but equal
• Auscultation:
Air entry symmetrical; poor Air entry indicates increasing severity
What are the examination findings in severe pneumonia?
• Inspection:
Respiratory distress with recession and tracheal tug
• Additional noises:
Wet cough with or without grunting
• Palpation:
Expansion may be asymmetrical if severe unilateral pneumonia
• Percussion:
Dullness over consolidation may be present.
• Auscultation:
Reduced air entry
Bronchial breathing and crackles over area of infection.
What are the examination findings in pneumothorax?
Inspection:
Signs of increased respiratory effort with recession, asymmetrical chest expansion
Additional noises:
None
Palpation:
Asymmetrical chest expansion
Trachea may be deviated and cardiac apex displaced (if Tension)
Percussion:
Hyperresonant
Auscultation:
No air entry over the affected side.
What are the examination findings in cardiac failure?
Inspection:
Tachypnoea with little recession
Additional noises:
None
Palpation:
Symmetrical expansion
Liver enlarged
Percussion:
Resonant, symmetrical
Auscultation:
Crepitations over both lung bases.
Heart murmur may be present
What are the examination findings in upper airway obstruction ?
• Inspection: Respiratory distress with recession and tracheal tug • Additional noises: Stridor, hoarse voice with or without drooling • Palpation: Symmetrical expansion • Percussion: Resonant, symmetrical • Auscultation: Transmitted sounds
Why is children’s respiratory examination different from adult’s?
An increased emphasis is placed on looking for signs of increased respiratory effort and respiratory distress.
Normal ranges for respiratory rate vary according to age.
Aspects such as a ‘carbon dioxide flap’ would be very unusual
What is Harrison’s sulci?
Harrison’s sulci is a groove at the lower end of the rib cage seen in young children with abnormally weak bones (rickets) or chronic respiratory disease (severe asthma)
When are respiratory symptoms more likely to have a chronic cause?
The initial history given of a recurrent cough and recurrent ‘chest infections’ treated in primary and secondary care
The presence of slow growth
The physical signs of chronic chest disease;
- bony chest wall deformity (Harrison’s sulci) suggesting on-going increased activity of intercostal and diaphragmatic muscles, or chronic increased respiratory effort.
- early clubbing
What is bronchiectasis?
Bronchiectasis is a permanent dilatation and thickening of the airways, characterised by chronic cough, excessive sputum production, bacterial colonisation, and recurrent acute infections
It may be widespread throughout the lungs (diffuse) or more localised (focal).
It is caused by chronic inflammation of the airways, and is associated with, or caused by, a large number of diseases.
It may develop after lung infections, particularly in childhood and in association with underlying problems, such as immunodeficiency and cystic fibrosis.
What are the classification of bronchiectasis?
Cylindrical
Varicose
Saccular/cystic
What is cylindrical bronchiectasis?
Cylindrical bronchiectasis: bronchi are enlarged and cylindrical.
What is varicose bronchiectasis?
Varicose bronchiectasis: bronchi are irregular with areas of dilatation and constriction.
What is saccular/cystic bronchiectasis?
Saccular or cystic: dilated bronchi form clusters of cysts. This is the most severe form of bronchiectasis and is often found in patients with cystic fibrosis.
What is the aetiology of bronchiectasis?
Post-infection such as childhood respiratory viral infections such as measles, pertussis and RSV, TB, bacterial pneumonia. Infection is the most common cause.
Immunodeficiency including HIV infection.
Connective tissue diseases such as rheumatoid arthritis, Sjogren’s syndrome, SLE and Marfan’s syndrome.
Asthma
Congenital defects such as cystic fibrosis, Kartagener’s syndrome and yellow nail syndrome.
IBD
Bronchial obstruction by lymphadenopathy, tumour or inhaled foreign bodies.
Bronchial obstruction and bronchopneumonia are more likely to cause a focal bronchiectasis, whereas the other causes are more likely to result in diffuse disease.
What is the pathophysiology of bronchiectasis?
The affected airways are inflamed and easily collapse. There is an impairment of airflow and drainage of secretions, leading to the accumulation of a large amount of mucus in the lungs.
The mucus collects bacteria, predisposing to frequent and often severe lower respiratory tract infections.
The disease is caused by chronic inflammation of the airways. It may therefore be caused by a large number of disorders which cause inflammation and infection, particularly conditions that facilitate infections, which therefore tend to be recurrent and more severe and so cause damage to the lungs.
All causative conditions cause dilation of the airways (due to continued inflammation destroying their elastic and muscular structure) followed by poor mucus clearance, and bacterial colonisation of collected mucus. This then can progress, as chronic infection causes further inflammation in a cyclical fashion.
