L8: Suppurative Lung Diseases Flashcards
Def of SLD
- Pulmonary diseases characterized by cough and expectoration that is usually copious, and
related to posture and time.
Types of SLD
- Bronchiectasis.
- Lung abscess.
- Empyema with bronchopleural fistula.
- Infected cystic lung.
Def of Bronchiectasis
- Persistent (irreversible) dilatation of the medium sized bronchi due to destruction of epithelial, elastic and muscular elements of bronchi.
Morphological Types of Bronchiectasis
- Cylindrical or tubular
- Saccular (cystic).
- Fusiform
- Varicose (tortuous).
Etiology of Bronchiectasis
Etiology of Bronchiectasis
- Congenital
Etiology of Bronchiectasis
- Ciliary dyskinesia syndromes (Immotile cilia syndrome)
Etiology of Bronchiectasis
- Acquired
Acquired Causes of Bronchiectasis
- Airway Obstruction
Acquired Causes of Bronchiectasis
- Post-Infectious
- Tuberculosis
- Bacterial pneumonia
- Pertussis
- Measles and influenza
CP of Bronchiectasis
CP of Bronchiectasis
- Symptoms
Symptoms of Bronchiectasis
- Cough and expectoration
Symptoms of Bronchiectasis
- Hemoptysis
- Common in upper lobes (e. g. post -TB).
- It may be massive and recurrent.
Symptoms of Bronchiectasis
- Recurrent pleuritic chest pain
Recurrent pleuritic chest pain and pneumonia at the same site.
Symptoms of Bronchiectasis
- Wheezy Chest
Uncommon but may be present.
Symptoms of Bronchiectasis
- Dyspnea
- Present late in the course of the disease
- Indicates wide spread lung disease.
Symptoms of Bronchiectasis
- General Manifestations
Signs of Bronchiectasis
Signs of Bronchiectasis
- Mild & Early Stages
No signs especially in mild & early stage bronchiectasis.
Signs of Bronchiectasis
- Clubbing
Digital clubbing
Signs of Bronchiectasis
- At the time of infective exacerbation
- Fever
- Increased respiratory rate
- Anemia
- Toxemic manifestations
Signs of Bronchiectasis
- Crackels
Complications of Bronchiectasis
DDx of Bronchiectasis
INVx for Bronchiectasis
INVx for Bronchiectasis
- Rads
- Plain x-ray chest
- High resolution CT (HRCT): gold stander investigation
INVx for Bronchiectasis
- Labs
- Sputum Gram stain and Culture: for infecting organism(s).
- Pulmonary Function Tests (PFTs)
INVx for Bronchiectasis
- Bronchoscopy
- To assess cause of obstruction
INVx for Bronchiectasis
- Others
Treatment of Bronchiectasis
Treatment of Bronchiectasis
- Supportive
Treatment of Bronchiectasis
- O2
Oxygen therapy is reserved for patients who are:
- Hypoxemic with severe disease and end-stage complications, such as cor pulmonale.
Treatment of Bronchiectasis
- Medical
Antibiotics in Bronchiectasis
- Value
The main line of therapy in bronchiectasis
Antibiotics in Bronchiectasis
- Route
- Oral,
- Parenteral,
- Aerosolized
Antibiotics in Bronchiectasis
- Examples
Antibiotics in Bronchiectasis
- Acceptable choices for the outpatient who is mild to moderately ill include …..
- Amoxicillin,
- Tetracycline
- Trimethoprim-sulfamethoxazole.
Antibiotics in Bronchiectasis
- Ciprofloxacin, aminoglycosides and ceftazidime
- Cover gram negative organisms as Pseudomonus aerogenosa which colonize the bronchial tree of advanced forms of bronchiectasis
Antibiotics in Bronchiectasis
- Antibiotic against anaerobes (metronidazole and clindamycin)
- Added in suspected anaerobic infection (by fetid odor)
Antibiotics in Bronchiectasis
- Culture and sensitivity of protected samples taken via fiberoptic bronchoscope (FOB) in immunocompromized patients
….
TTT of Bronchiectasis
- Postural Drainage
TTT of Bronchiectasis
- Others (Acc to cause)
TTT of Bronchiectasis
- TTT of Complications
- Mechanical ventilation for respiratory failure.
- Intercostal tube drainage under water seal for pneumothorax and empyema.
TTT of Bronchiectasis
- TTT of Cause
TTT of Bronchiectasis
- Embolic Therapy
Indicated in cases of massive hemoptysis to control bleeding
TTT of Bronchiectasis
- Surgical TTT
- Lobectomy,
- Pneumonectomy
- Lung transplantation
