Bronchiectesis Flashcards
Definition
Lung airway disease characterised by chronic bronchial dilation, impaired mucocilliary clearance and frequent bacterial infections
Pathology
Severe inflammation in the lung causes fibrosis and dilation of bronchi.
Results in pooling of mucus, predisposing to infection, more damage and more fibrosis.
Causes
Idiopathic in 50 percent
Post infectious - severe pneumonia, whooping cough, TB
Kartagener’s syndrome, CF, yellow nail syndrome
Obstruction of bronchi - foreign body, enlarged lymph nodes.
GORD
Inflammatory disorders e.g. rheumatoid arthritis
What is kartagener’s syndrome
genetic condition resulting in immotile cilia
sinusitis, bronchietesis, dextrocardia, infertility.
what is yellow nail syndrome
pleural effusions, lymphoedema, yello dystrophic nails, bronchietisis in 40 percetn
symptoms
productive cough with purulent sputum or haemoptysis
breathless, chest pain, malaise, fever, weight loss, symptoms often begin after acute resp illness
examination
finger clubbing, coarse creps at bases which shift with coughing, wheeze
investigations
sputum culture - common organsims on exacerbation are psudomonnas, haemophilis influenzae, staph aureus, step pneumonia moraxella, mycobacteria
CXR - dilated bronchi seen as paralel lines ‘tramline shadow’
CT is diagnostic
Management
treat acute exacerbations with IV antibiotics.
inhaled steroids (fluticasone) - reduce inflammation and sputum but no effect on frequency of exacerbations
consider bronchodilatros
maintain adequate oral fluid intace
consider flu vaccine
physiotherapy is mainstay-
postural drainage
bronchial artery embolisation in life threatening haemoptysis
Surgical treatment
what infective organsism is most common
pseudomonas
when should prophylactic antibiotics be given
if 3 or more exacerbations/year
what investigation is done sometimes before surgery (think its rarely done)
bronchography
complications
Life-threatening haemoptysis, persistent infections, empyema, respi- ratory failure, cor pulmonale, multi-organ abscesses.
