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SURGICAL DISEASES > P2 TH7 LUNG ABSCESS/ BRONCHIECTASIS > Flashcards

P2 TH7 LUNG ABSCESS/ BRONCHIECTASIS Flashcards

1
Q

WHAT IS BRONCHIECTASIS

A

> chronic condition
walls of bronchi > thickened from inflammation + infection

PERMANENET DILATION OF BRONCHUS DUE TO DESTRUCTION OF ELASTIC + MUSCULAR COMPONENTS OF FROM BRONCHIAL WALL

> DISTRUCTION PATTERN:

  • diffused
  • localised
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2
Q

3 MAIN TYPES OF PATHOLOGICAL CLASSIFICATION OF BRONCHIECTASIS?

A
  1. CYLINDRICAL
  2. SACCULAR
  3. MIXED (VARICOSE)
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3
Q

PATHOLOGICAL CLASSIFICATION OF CYLINDRICAL BRONCHIECTASIS

A

> UNIFORMLY DIALTED BRONCHI UNTIL JUNCTION OF SMALLER AIRWAYS
usually obstructed by massive secretion
THIS TYPE > ASSOCIATED MC WITH = TB

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4
Q

PATHOLOGICAL CHARACTERISTICS OF SACCULAR BRONCHIECTASIS?

A

PERIPHERAL BRONCHI DILATED + END IN BLIND SACS WITHOUTH FUNCTIONAL BRONCHIAL STRUCTURES PERIPHERAL TO THE DILATED AREA

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5
Q

PATHOLOGICAL CHARACTERISTICS OF MIXED BRONCHIECTASIS

A

AFFECTED BRONCHI HAVE IRREGULAR/ BEADED DILATION PATTERN

> EVOCATIVE OF VARICOSE VEINS

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6
Q

STANDARD EXAMINATION FOR DIAGNOSIS OF BRONCHIECTASIS

A

> COMPUTED TOMOGRAPHY SCAN
high resolution CT > very sensitive method for detecting bronchiectasis + assessment of distribution of bronchiectatic alteration

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7
Q

CLINICAL MANIFESTATION OF BRONCHIECTASIS

A

USUALLY DOMINATED BY CHRONIC/ RECURRENT PULMONARY INFECTION

> ABUNDANT SPUTUM PRODUCTION

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8
Q

CLINICAL SYMPTOMS OF BRONCHIECTASIS

A

RECURRENT/ PERMANENT COUGH + AMPLE SPUTUM PRODUCTION

> frequently sputum = purulent
- advanced stage > with hemoptysis

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9
Q

TREATEMTN WITH POTENTIAL CURE FOR BRONCHIECTASIS

A

SURGERY - only option with potential cure

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10
Q

WHICH IS THE APPROPRIATE SURGICAL OPTION ON END STAGE OF BRONCHIECTASIS DISEASE?

A

> end stage > after utilisation of all conservative treatment + no option for localised resection

> LUNG TRANSPLANTATION = APPROPRITATE SURGICAL OPTION

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11
Q

MOST SEVERE ACUTE COMPLICATION OF BRONCHIECTASIS?

A

MASSIVE BLEEDING
> life threatening condition
> due to > erosion of hypertrophic bronchial arteries/ lesions of abnormal anastomoses between pulmonary + bronchial artery circulation

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12
Q

DEFINE LUNG ABSCESS

A

LOCALISED COLLECTION OF PUS CONTAINED IN CAVITY FORMED BY DESTRUCTION OF PULMONARY PARENCHYME

> EXCLUDES > infected bull + cyst in which infection develops within a pre existing space

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13
Q

TYPES OF LUNG ABSCESS BASED ON ETIOLOGY?

A
  1. PRIMARY
    - result of necrotising pulmonary infection
    - including in immunosuppressed host
    - or aspiration of GI content/ oropharyngeal secretions
  2. SECONDARY
    - complication of bacteremia/ bronchial obstruction (adjacent supportive infection)
    - infection of previous destroyed/ damaged lung parenchyma
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14
Q

CLINICAL PRESENTATION OF LUNG ABSCESS

A 
COUGH 
FEVER
CHILLS 
MALAISE 
FATIGUE 
WEIGHT LOSS
PLEURITC CHEST PAIN 
DYSPNEA 
LESS COMMON > HEMOPTYSIS
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15
Q

INDICATION OF WHAT IS SUDDEN PRODUCTION OF LARGE QUANTITY OF PUTRID SPUTUM IN PX WITH LUNG ABSCESS?

A

COMMUNICATION ABSCESS WITH BRONCHIAL TREE

- may lead to infection to non involved lungs > respiratory failure

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16
Q

2 STAGES OF PRIMARY LUNG ABSCESS?

A
  1. ACUTE
    - duration of symps < 6 weeks
  2. CHRONIC
    - symps > more than 6 weeks
17
Q

3 COMPLICATION OF ACUTE STAGE OF LUNG ABSCESS AND INDICATION FOR EMERGENCY SURGERY?

A
  1. BRONCHOPLEURAL FISTULA
  2. EMPYEMA
  3. BLEEDING
18
Q

MANAGEMENT FOR CHRONIC LUNG ABSCESS?

A

SURGERY

19
Q

MAIN TREATMENT FOR ACUTE LUNG ABSCESS?

A

SYSTEMIC ANTIBIOTICS

  • most acute lung abscess resolve within 2 weeks of management
  • resolve radiographically 2-5 months
20
Q

WHAT DOES LACK OF CLINICAL RESPONSE FOR MEDICAL THERAPY OF LUNG ABSCESS SUGGEST?

A

LACK OF CLINICAL RESPONSE WITHIN 2 WEEKS MEANS:

  • need to do invasive culturing
  • fine needle aspiration to ensure ABX is appropriate
  • bronchoscopy > to rule out endobronchial obstruction + re-evaluation of diagnosis
21
Q

WHICH DIAGNOSIS TECHNIQUES NEEDED TO DETERMINE PRESENCE OF LUNG ABSCESS?

A
  • RADIOGRAPHIC IMAGING > will confirm lung abscess

- POSTEROANTERIOR + LATERAL CHEST RADIOGRAPHY CT of CHEST

22
Q

WHICH ARE TYPICAL SIGNS OF INTACT PULMONARY HYDATID CYST ON X-RAY?

A

ROUND/ OVAL SHAPES
SOLITARY/ MULTIPLE
HOMOGENOUS DENSITY
PERFECTLY DEFINED MARGIN - can be drawn with marking pen

23
Q

OBECTIVE SURGICAL TREATMENT FOR PULMONARY HYDATIDOSIS?

A

ERADICATE THE PARASITE

- to prevent intraoperative rupture of cyst + remove residual cavity

24
Q

WHY DO HYDATID CYST GROW MORE RAPIDLY IN LUNGS THAN OTHER ORGANS?

A

DUE TO NEGATIVE PRESSURE + GREAT ELASTICITY OF PULMONARY TISSUE

25
Q

WHAT IS HYDATID CYST?

A

INFECTION AT LARVA STAGE OF ECHINOCOCCUS GRANULOSUS (tapeworm found in dogs + sheep)

26
Q

CLINICAL MANIFESTATION OF RUPUTRED HYDATID CYST INTO ADJACENT BRONCHUS?

A

> VIGOROUS COUGH
SALTY SPUTUM WITH MUCOUR HYDATID FLUID
sometimes fragments of laminated membrane “grape skin”
frothy blood
PX may develop severe hypersensitivity reaction
- rash
- high fever
- pulmonary congestion
- severe bronchospasm

27
Q

TREATMENT FOR PULMONARY HYDATID CYST?

A

SURGICAL TREATMENT

28
Q

WHICH LUNG HYDATID CYST IS DEFINED AS COMPLICATED?

A

any lung hydatid cyst that has ruptured into bronchus/ pleural cavity with or without infection = COMPLICATED

29
Q

WHICH IS THE GOLD STANDARD DIAGNOSTIC METHOD FOR EVALUATION OF HEPATIC HYDATID CYST?

A

ULTRASONOGRAPHY

30
Q

CLINICAL MANIFESTATION OF RUPTURED HYDATID CYST INTO PLEURAL CAVITY?

A 
> SEVERE/ INFREQUENT COMPLICATION 
> DRY COUGH 
> CHEST PAIN 
> MODERATE DYSPNEA 
> GENERALISED FEVER

> URTICARIA
INTENSE PRURITIS
SEVERE ANAPHYLACTIC SHOCK > possibly leading to death

PHYSICAL FINDINGS:
> inner intra pleural rupture > localised or generalised HYDROPNEUMOTHORAX

31
Q

WHICH PART OF LUNG IS MOST COMMONLY AFFECTED BY BRONCHIECTASIS?

A

LOWER LUNG LOBE

32
Q

PATIENT WITH HISTORY FOR LARGE QUANTITY OF “WATER LIKE” BITTER SPUTUM + IMAGING OF PULMONARY CAVITATION LESIONS WITH AIR FLUID LEVELS IS?

A

HYDATID CYST

33
Q

EXPECTORATION OF BIG AMOUNT OF PURULENT SPUTUM IS TYPICAL FOR?

A

LUNG ABSCESS

SURGICAL DISEASES (13 decks)

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