Bronchiestasis

Question 1

def

Answer 1

chronic bronchial dilation, impaired mucociliary clearance, frequent bacterial infections

Question 2

aetiology

Answer 2

severe inflammation causes fibrosis & dilation of bronchi
followed by pooling of mucus which predisposes to further cycles of infection, damage & fibrosis to bronchial walls

Question 3

what are the causes of bronchiestasis

Answer 3

• idiopathic (50%)
• post-infectious (pneumonia, TB)
• host defence defects (CF, Ig deficiency)
• obstruction of bronchi (foreign body, enlarged lymph nodes)
• GORD
• inflammatory disorders (RA)

Question 4

epi

Answer 4

1/1000PA
common in childhood
incidence has decreased with antibiotic use

Question 5

history

Answer 5

productive cough (purulent sputum or haemoptysis)
breathlessness, chest pain, fever, weight loss
symptoms usually begin after an acute respiratory illness

Question 6

what is purulent sputum

Answer 6

contains pus, composed of WBCs, cellular debris, viscous liquid (mucus)
typically yellow/green

Question 7

examination

Answer 7

clubbing
coarse crepitations at bases which shift when coughing
wheeze

Question 8

investigations

Answer 8

1 sputum
-culture & sensitivity
-pseudomonas aeruginosa, haemophilus influenzae, S. aureus, streptococcus pneumoniae
2 CXR
-dilated bronchi as parallel lines radiating from hilum to diaphragm
-may show fibrosis, atelectasis
3 high-resolution CT
-dilated bronchi with thickened walls
-best diagnostic tool
4 other
-sweat electrolytes (CF)
-serum Ig (10% of adults have Ig deficiency)

Question 9

what is atelectasis

Answer 9

complete/partial collapse of lung/lobe when alveoli in the lung become deflated

Question 10

management

Answer 10

1 acute exacerbations
-two IV antibiotics with efficacy for psuedomonas
-prophylactic for frequent exacerbations
2 inhaled corticosteroids (fluticasone)
-reduces inflammation & volume of sputum
-does not affect frequency of exacerbations
3 bronchodilators
-for patients with responsive disease
4 maintain hydration
5 flu vaccination
6 physiotherapy
-for sputum & mucus clearance
7 bronchial artery embolization
-for life threatening haemoptysis due to bronchiectasis
7 surgical
-localised resection
-lung/heart-lung transplant

Question 11

complications

Answer 11

life threatening haemoptysis
recurrent infections
empyema
respiratory failure

Question 12

prognosis

Answer 12

chronic symptoms

Question 13

what is empyema

Answer 13

collection of pus in a cavity in the body

especially pleural cavity