Module 5 Bronchiectasis

Question 1

Define Bronchiectasis

Answer 1

Dilation or Distension of the bronchi; airways become ultra floppy (distortion of bronchi)

• caused by bronchial wall/blood vessel/smooth muscle/elastic destruction
• Results in bronchial secretions and airway distortion/remodeling

Question 2

When does Bronchiectasis usually occur?

Answer 2

Lower lobes, could be both lungs but usually limited to lobes/segments

• It is a permanent chronic airway infection causing inflammation.
• characterized by mild to mod airflow obstruction (worsening over time)

Question 3

What elements are crucial to keep lungs free of infection?

Answer 3

mucous clearance and local defence mechs. against microorganisms

Question 4

complications of repeated infections when bronchi are impaired?

Answer 4

Damages bronchi wall; furthering impeding the clearance of mucous

Question 5

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Question 6

What causes Bronchiectasis?

Answer 6

Extensive inflammation and destruction of bronchial wall cartilage, blood vessels, elastic tissue, and smooth muscle components via chronic infection and extensive inflammation

• Potential causes could include foreign body aspiration, CF, tumors, COPD, measles or any condition that would affect mucocillary disorders

Question 7

What does bronchial wall destruction lead to?

Answer 7

muscular clearance defiances

(lots of bronchial secretions and blood leading to static sputum)

Question 8

How would tests reflect Bronchiectasis

Answer 8

Early stage: CT and Spirometry = normal

Advanced stage can be seen on PFT
-it’d show obstruction

Question 9

What would lead to secondary bronchial smooth muscle constriction and fibrosis?

Answer 9

Multiple infections and constant irritation.

Question 10

Bronchiectasis leads to which anatomic alterations?

Answer 10

• Hyperinflation of alveoli
• Atelectasis
• Chronic dilation/distortion of bronchial airways
• Fibrosis and parenchymal consolidation

Question 11

What do patients w/bronchiectasis typically have as a result?

Answer 11

chronic airway infection, puncated by acute exacerbations.

accompanied by progressive airflow obstruction

Question 12

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Missing slides 8 -> 16

Question 13

Bronchiectasis sees a increase in what aspects?

Answer 13

Compliance and Airway Resistance

Question 14

3 main congenital conditions where you see Bronchiectasis

Answer 14

Karageners syndrome

Hypogammaglobulinemia

cystic fibrosis

Question 15

Distribution of bronchiectasis can be characterized as?

Answer 15

Diffuse or generalized; affecting many areas of the lungs

Focal or localized: appearing in only 1 or 2 lung areas

Question 16

Diffuse Bronchiectasis develops in pts w/what?

Answer 16

genetic,immunologic, or anatomic defects that affect airways

Question 17

What happens when diffuse bronchiectasis progresses

Answer 17

Inflammation would spread beyond the airways to the lung parenchyma, causing fibrosis

Question 18

Describe Difuse Bronchiectasis

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Answer 18

when a case is disorder triggers inflammation of small and medium sized airways, releasing inflammatory mediators from intraluminal neutrophils

Resulting in irreversible bronchodilation

Question 19

Inflamed medium and small airways, macrophages and lymphocyte form infiltrates that thicken mucosal walls.

What does thickening of mucosal walls implicate?

Answer 19

Thickening will cause airway obstruction

Question 20

What are 3 types of Bronchiectasis?

Answer 20

Diffuse

Focal

Congenital

Question 21

When does Focal Bronchiectasis occur?

Answer 21

A large airway becomes obstructed

Question 22

Describe focal bronchiectasis

Answer 22

The inability to clear secretions leads to the “vicious cycle hypothesis”, inflammation, and bronchial wall damage.

Question 23

What section of the respiratory system is most affect by focal bronchiectasis?

Answer 23

The right middle lobe, because its bronchus is small and angulated, and has lymph nodes in close proximity

Question 24

What can cause bronchial obstruction and focal bronchiectasis?

Answer 24

Lymphadenopathy due to myocardial infection

Question 25

Describe the vicious cycle hypothesis

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Question 26

What are general causes and outcomes of Bronchiectasis?

Answer 26

Caused by bronchial wall cartilage/blood vessel/smooth muscle elastic tissue destruction

• Results in a permenant condition where major bronchi and bronchioles are chronically dilated/distorted. –> classified when more than 1 bronchi occurs

Question 27

Sign and symptoms of Bronchiectasis?

Answer 27

Increased WOB, RR, BP, AP chest diameter

• Cyanosis
• peripheral edema/venous distension
• digital clubbing
• foul smelling sputum

Question 28

Diagnostic tools for diagnosing Bronchiectasis?

Answer 28

High resolution CT is the gold standard for determining condition. Spirometry is often used to determine airflow limitation/severity

• bronchoscopy (rare)
• CxR

Question 29

Treatments for Bronchiectasis

Answer 29

LRVMs, O2 therapy, bronchodilators, airway clearance therapy

• Treatment of causative
  agent (if applicable)
• antibiotics
• surgery

Question 30

3 pattern types of Bronchiectasis (Reid classification)

Answer 30

1. Varicose (fusiform): dilated + constricted @irregular fashion
2. Cylindrical (tubular): dilated + rigid, tubular shape
3. Cystic (saccular): Progressive increase diameter till end in large cyst like sacs

Question 31

What is Acute Bronchitis?

Answer 31

Inflammation of the bronchi aka chest cold

• lining of the bronchi are inflamed and swollen = increased mucus production

Question 32

What is the difference between chronic and acute bronchitis?

Answer 32

Chronic bronchitis is associated with COPD while acute is usually associated with flu seasons

Question 33

What affect does Bronchitis have on the body?

Answer 33

Airway inflammation = edema and increased mucus production resulting in increased airway resistance

• Partial or complete airway obstructions
• Bronchoconstriction

Question 34

What causes Acute bronchitis?

Answer 34

Infections: viral usually, bacterial occasionally, and less commonly allergens/bacteria/irritants

• RSV
• Influenza etc etc.

Question 35

Sign and symptoms of acute bronchitis?

Answer 35

Non or mildly productive persistent coughing for 10 days to 4 weeks

• URI symptoms
• Dyspnea + chest tightness
• Scattered rhonchi + wheezing

Question 35

Treatments for Acute Bronchitis?

Answer 35

Self limiting disorder, treatment = supportive

Question 36

What is Bronchiolitis?

Answer 36

Inflammation of bronchioles caused most often by viral illness

• Lower resp tract infection that peaks in winter months
• Most common cause is RSV

Question 37

What population group is affected most by Bronchiolitis?

Answer 37

Children

Question 38

What affect does Bronchiolitis have on the body?

Answer 38

Airway inflammation = edema and increased mucus production which results in increased airway resistance.

• Small airway obstruction (partial/complete)
• Atelectasis
• Alveolar hyperinflation (check valve effect)
• Consolidation

Question 39

Sign and symptoms of Bronchiolitis

Answer 39

Can present with flu and fever symptoms. The most common identifier is crackles and wheezes on auscultation with a loss in appetite

• Potential hyperexpansion (air trapping)