Bronchiectasis/cystic fibrosis/lung abscess Flashcards
what is the definition of bronchiectasis
irreversible dilation of one or more bronchi in a focal or diffuse manner due to inflammation
what is the classification of bronchiactasis
cylindrical or tubular
varicose
cystic
what is the etiology of the two types of bronchiactasis?
focal -> obstruction
diffuse -> infections, bacterial
what are other causes of bronchictasis?
immuno def
Kartageners syndrome
explain shortly the pathogenesis of bronchictasis
decreased mucociliary clearance casues secretion retention -> increased risk of infection -> infllamtion causing weakening wall -> bronchictasis -> deficitary secretion clearance ->
what are the clinical manifestations ?
persistent orductive cough
with production of thick, tenacious sputum
acute exacerbations
- changes in the nature of sputum production
- increased volume and purulence
explain the physical examination findings
crackles
wheezing
clubbing of the digits
explain the diagnosis of bronchiactasis
specific findings of bronchiectasis
persistent chronic cough and sputum production
radiography - tram tracks
CT - tree bud
wall thickening
cysts from the wall
signet ring sign
what is the bronchoscopy in bronchicatsis used for?
to asses forcal bronchiectasis
what is pulmonary fucntional testing for in bronchiectasis?
obstruction dysfunction - early
obstructive/restrctive - later
what are the treatment for bronchictasis ?
antibiotics
bronchial hygiene
anti inflammatory
surgery
transplnatation
what are the complications of bronchictasis ?
hemoptysis due to bronchial artery embolism
respiratory failure
what is the definition of cystic fibrosis
autosomal recessive transmitted disease affecting the secretion of exocrine glands
resulting in production of an inspissated secretion
explain the clinical manifestations of CF
bronchiectasis with collateral tissue injury
pancreatic insufficiency
intestinal obstruction
What is CFTR and what does it do?
Cystic Fibrosis Transmembrane Conductance Regulator
It’s a protein that acts as an anion channel in the cell membranes of epithelial cells (cells lining passageways in the body).
It regulates the movement of salt and water, which is essential for the consistency of secretions like mucus.
The gene for CFTR is located on chromosome 7.
How does a faulty CFTR protein lead to the thick mucus seen in cystic fibrosis?
Impaired Ion Transport: In CF, the CFTR protein doesn’t work properly, so chloride ions can’t move correctly across cell membranes. This disrupts the balance of salt and water in secretions.
Dehydrated Mucus: The mucus layer becomes dehydrated and thick because water is drawn towards the higher salt concentration outside the cells.
Reduced Mucociliary Clearance: The thick mucus can’t be easily cleared by the cilia (tiny hairs that sweep mucus out of the airways), leading to blockages and infections.
What are the effects of thick mucus accumulation in the airways of someone with CF?
Airway Obstruction: Thick mucus plugs the airways, making it difficult to breathe.
Chronic Infection: Bacteria thrive in the stagnant mucus, leading to repeated lung infections.
Inflammation and Damage: Ongoing infection and inflammation damage the airways, eventually causing bronchiectasis (permanent widening).
Submucosal Gland Hypertrophy: The glands that produce mucus become enlarged and filled with thick secretions.
Epithelial Damage: The airway lining is damaged and buried under layers of mucus and debris.
what are the clinical manifestions of CF?
sputum secretion, like bronchiectasis, clubbing
dyspnea
what are the rare respiratory manifestations of CF?
spontaneous pneumothorax
asthma
ABPA
what are the GI manifesations?
pancreatic insufficiency
if not treated it causes steatorrhea
biliary duct obstruction -> biliary cirrhosis ->
- hepatic failure
- splenomegaly
- hemmorhage from esophageal carices
what are the distal intestional obstruction syndrome in CF?
ingestion of large quantity of fats
in the absence of enzyme substitution therapy
what is the diagnosis of CF?
lab tests -> confirmation
- DNA analysis - most valuable
- sweat analysis - shows elevated salt level
- electric potential diff - hgiher in CF
- screening - DNA test, increased trypsin
what is the treatment of CF?
deit
postural drainage
what is the definition of lung abscess ?
necrosis and cavitation of the lung following a microbial infection
can be single or multiple
classify lung abscess
primary
- occur without an underlying condition
- most of them arise from aspiration
secondary
- occur in the setting of an underlying condition
- system or post obstructive process
what are the risk factors of lung abcess ?
respiratory tract infections
diminishing of normal defense mechanisms
mechnical obstructions
How does a primary lung abscess form?
Aspiration: Foreign material enters the lung.
Obstruction: The material blocks an airway, causing atelectasis (collapse of part of the lung).
Infection: Bacteria in the aspirated material multiply, leading to pneumonitis (lung inflammation).
Necrosis and Cavitation: Over 7-14 days, the infection causes tissue death (necrosis) and a cavity forms (abscess).
Important things to remember about lung abscesses?
Right Lung Predominance: The right main bronchus is less angled, so aspirated material is more likely to end up in the right lung.
Delayed Radiological Signs: It takes 7-14 days after aspiration for the abscess to show up on an X-ray.
Aspiration Positions and Location:
- Supine (lying flat): Abscesses often form in the superior lower lobes or posterior upper lobes.
- Elevated/Semi-Elevated: Abscesses often form in the basal lower lobes.
What’s the difference between a primary and secondary lung abscess?
Primary: Starts with aspiration (inhaling something into the lungs), usually from the mouth. The aspirated material directly causes the infection and abscess.
Secondary: Develops due to an underlying condition or complication, such as:
Bronchial obstruction (tumor, foreign body)
Immunosuppression
Cystic fibrosis
Septic emboli (infectious clots)
What are the early symptoms of a lung abscess (1-3 days after aspiration)?
Sudden onset
High fever
Shivering (chills)
Altered general condition (feeling unwell)
Productive cough (coughing up phlegm)
Pleuritic chest pain (sharp pain when breathing)
What are the symptoms of a chronic lung abscess, and how do they differ depending on the cause of infection?
Chronic Symptoms:
Anemia (low red blood cell count)
Weight loss
Specific Findings:
Gram-negative bacteria, Staph, amoebas: Fulminant onset (sudden and severe), purulent sputum (pus-filled phlegm), no foul smell.
Anaerobic bacteria: Develops after ~10 days, large amount of pus-filled sputum with a foul smell, sometimes bloody.
What is pleuritic chest pain and what happens if a lung abscess ruptures?
Pleuritic Chest Pain:
Sudden, intense, sharp, stabbing or burning pain when breathing.
Worsens with deep breathing, coughing, sneezing, laughing.
May be referred to the neck or shoulder if inflammation is near the diaphragm.
Rupture into Pleural Cavity:
Intense chest pain, worse with deep breaths
Signs of empyema (pus in the pleural space) or pyopneumothorax (pus and air in the pleural space)
Symptoms of empyema include: dry cough, fever, chills, night sweats, malaise, weight loss, chest pain.
what is the physical examination in lung absces?
- In the initial phase - signs of pneumonia
○ In the initial phase - signs of pneumonia
§ Dullness
§ Crackles- After the evacuation of the abscess
○ Cavernous breath sound on lung auscultation
○ Pleural fluid
○ If bronchial drainage is not efficient –> clubbing (after several weeks) - Predisposing factors
○ Poor dentition
○ Gingival disease
Absence of gag reflex
- After the evacuation of the abscess
how is lung abscess diagnosed?
imaging
what is the treatment ?
antibiotics
