Bronchiectasis Flashcards
What is bronchiectasis?
Abnormal dilation of the airways associated with destruction of the bronchial tissue
What are the two classes of bronchiectasis?
CF caused
Non-CF caused
Describe the pathophysiology of non-CF caused bronchiectasis
Inflammatory response to a severe infection leads to structural damage within the bronchial walls which cause dilation
Scarring which results as a consequence of the immune system reduces the number of cilia within the bronchi, predisposing them to further infections
List some causes of bronchiectasis
Post-infectious Immunodeficiency Primary ciliary dyskinesia Post-obstructive Congenital syndromes - Youngs and yellow-nail syndrome
List the typical organisms found in bronchiectasis
Streptococcus pneumonia Staphylococcus aureus Adenovirus Measles Influenza Bordetella pertussis Mycobacterium tuberculosis
Give some causes of immunodeficiency resulting in bronchiectasis
HIV
Antibody defects - agammaglobulinemia - IgA/IgG deficiency
Ataxia telangiectasia
Describe the inheritance pattern of primary ciliary dyskinesia
Autosomal recessive
What is primary ciliary dyskinesia
Reduced efficacy or complete inaction of bronchial cilia
Reduced mucocillary clearance leading to increased susceptibility to infection and irritation from bacteria and particulates
Describe youngs syndrome
Rare condition associated with bronchiectasis, reduced fertility and rhinosinusitis
Describe yellow-nail syndrome
Rare condition associated with pleural effusions, lymphoedema and dystrophic nails
List the symptoms of bronchiectasis
Chronic productive cough Purulent sputum Chest pain Wheeze Breathlessness on exertion Haemoptysis Recurrent or persistent infections of the LRT
List the examination findings of bronchiectasis
Finger clubbing
Inspiratory crackles
Wheeze
What investigations are required for bronchiectasis?
CXR - bronchial wall thickening or airway dilation
HRCT - bronchial wall thickening, signet ring sign, visible peripheral bronchi
Bronchoscopy - if airway abnormality plus ciliary brush biopsy
Chloride sweat test - CF
FBC and leucocyte differential
Immunoglobulin panel - deficiency
Specific antibody levels to vaccinations - Hib, pneumococcal
HIV test
Microbiological assessment
Lung function
Describe signet ring sign
Where the bronchial wall is bigger than the bronchial artery which lies next to it
Which condition is bilateral upper bronchiectasis more commonly seen in?
CF
