Bronchiectasis and Lung Abscess Flashcards
Define bronchiectasis
It is a chronic disease characterised by irreversible dilation of bronchi caused by bronchial wall damage resulting from infection and inflammation.
What are the morphological changes usually accompanied by
Chronic suppurative lung disease with a cough productive purulent sputum
describe the inflammatory response in bronchiectasis
ineffective in eradicating infection and a persistent cycle of chronic infection and inflammation ensues resulting in further tissue damage
What leads to an accumulation of secretions
Impaired mucociliary clearance
What predispose to bacterial infection
Accumulated secretions
What does infection provoke
An inflammatory response - increased mucus production and impaired ciliary function
What causes tissue damage
Excessive inflammation
What produces dilation of bronchi and disruption of mucociliary clearance
Damage to the bronchial wall
What are the most common causes of bronchial wall damage and bronchiectasis
Severe infections
What two causes are declining due to childhood vaccination
Pertussis (whooping cough) and measles
What is still a common cause of bronchiectasis in developing countries
TB
In children what might give rise to bronchial obstruction and distal bronchiectasis
Inhalation of a foreign body
What should all patients with bronchiectasis have measured
Immunoglobulins IgG, IgA and IgM with serum electrophoresis
What should all patients with bronchiectasis have measured
Immunoglobulins IgG, IgA and IgM with serum electrophoresis
What is an aspergilloma
A ball of fungal hyphae that appear on Xray as a mass in the centre of a cavity surrounded by a halo of radiolucency
What gives rise to fleeting Xray shadows
Eosinophilic infiltrates in the lung
Define primary ciliary dyskinesia
An autosomal recessive condition in which there is an abnormality of the ultrastructure of cilia throughout the body such that they do not beat in a coordinated fashion
What is Kartagener’s syndrome
Ciliary dyskinesia with situs inversus
How is the definitive test for primary ciliary dyskinesia performed
Brush biopsy of nasal mucosa
When does cystic fibrosis usually present
In early childhood with recurrent respiratory infections and failure to thrive due to pancreatic insufficiency
name some of the diseases which seem to have an increased incidence of bronchiectasis
Rheymatoid arthritis
Ulcerative colitis
Crohn’s disease
Coeliac disease
What is the cardinal feature of bronchiectasis
Chronic cough productive of copious purulent sputum
Infective exacerbation of bronchiectasis may be associated with what
Fever and pleuritic pain
chronic severe bronchiectasis may cause what 3 things
Malaise
weight loss and
halitosis (foul breath)
What is sometimes present
Clubbing
What can be heard over affected areas
Coarse crackles
What is the gold standard investigation for bronchiectasis
CT scan
What should be performed to define what infective organisms are present as a guide for antibiotic treatment
Sputum microbiology
What help to determine whether bronchodilator drugs may be helpful
Lung function tests
What an effective treatment in clearing secretions
Chest physiotherapy
What is sometimes useful in improving sputum clearance
Nebulised hypertonic saline
What are antibiotics used for
To suppress chronic infection and to treat exacerbations
When are bronchodilator drug and an inhaled steroid indicated
Where there is associated reversible airways obstruction
what is a potential treatment for the few patients who have localised disease and troublesome symptoms
Surgical excision
Where bronchiectasis has progressed to respiratory failure, what is an option
Lung transplantation
WHat is a lung abscess
A localised collection of pus within a cavitated necrotic lesion in the lung parenchyma
What does a patient with a lung abscess typically complain of
A cough with expectoration of large amount of foul material often accompanied by haemoptysis, fever, weight loss and malaise
What may be required to distinguish between a lung abscess and other causes of cavitating lung lesions
A fine -needle aspiration of the lesion
What is the most common cause of a lung abscess
Oropharyngeal aspiration
What is the most common cause of a lung abscess
Oropharyngeal aspiration
What is a key aspect of treatment with lung abscesses
Drainage of pus from the abscess cavity
How is drainage achieved
Bronchial drainage using postural drainage physiotherapy or
percutaneous drainage by positioning a catheter drainage tube under radiological guidance
What is necrobacillosis
An unusual cause of lung abscess that is associated with a very characteristic clinical picture first described by Limiere
What are lung abscesses with necrobacillosis frequently involved with
Multiple abscesses forming often with a pleural empyema and evidence of infection elsewhere
What is bronchopulmonary sequestration
A congenital anomaly in which an area of lung is not connected to the bronchial tree and has an anomalous blood supply usually from the aorta
What is required to treat bronchopulmonary sequestration
Surgical resection
What are the 4 treatment methods for bronchiectasis
Chest physio
Antibiotics
Inhaled bronchodilators
Specific treatment of any underlying cause
