P2 TH7 LUNG ABSCESS/ BRONCHIECTASIS Flashcards
WHAT IS BRONCHIECTASIS
> 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
3 MAIN TYPES OF PATHOLOGICAL CLASSIFICATION OF BRONCHIECTASIS?
- CYLINDRICAL
- SACCULAR
- MIXED (VARICOSE)
PATHOLOGICAL CLASSIFICATION OF CYLINDRICAL BRONCHIECTASIS
> UNIFORMLY DIALTED BRONCHI UNTIL JUNCTION OF SMALLER AIRWAYS
usually obstructed by massive secretion
THIS TYPE > ASSOCIATED MC WITH = TB
PATHOLOGICAL CHARACTERISTICS OF SACCULAR BRONCHIECTASIS?
PERIPHERAL BRONCHI DILATED + END IN BLIND SACS WITHOUTH FUNCTIONAL BRONCHIAL STRUCTURES PERIPHERAL TO THE DILATED AREA
PATHOLOGICAL CHARACTERISTICS OF MIXED BRONCHIECTASIS
AFFECTED BRONCHI HAVE IRREGULAR/ BEADED DILATION PATTERN
> EVOCATIVE OF VARICOSE VEINS
STANDARD EXAMINATION FOR DIAGNOSIS OF BRONCHIECTASIS
> COMPUTED TOMOGRAPHY SCAN
high resolution CT > very sensitive method for detecting bronchiectasis + assessment of distribution of bronchiectatic alteration
CLINICAL MANIFESTATION OF BRONCHIECTASIS
USUALLY DOMINATED BY CHRONIC/ RECURRENT PULMONARY INFECTION
> ABUNDANT SPUTUM PRODUCTION
CLINICAL SYMPTOMS OF BRONCHIECTASIS
RECURRENT/ PERMANENT COUGH + AMPLE SPUTUM PRODUCTION
> frequently sputum = purulent
- advanced stage > with hemoptysis
TREATEMTN WITH POTENTIAL CURE FOR BRONCHIECTASIS
SURGERY - only option with potential cure
WHICH IS THE APPROPRIATE SURGICAL OPTION ON END STAGE OF BRONCHIECTASIS DISEASE?
> end stage > after utilisation of all conservative treatment + no option for localised resection
> LUNG TRANSPLANTATION = APPROPRITATE SURGICAL OPTION
MOST SEVERE ACUTE COMPLICATION OF BRONCHIECTASIS?
MASSIVE BLEEDING
> life threatening condition
> due to > erosion of hypertrophic bronchial arteries/ lesions of abnormal anastomoses between pulmonary + bronchial artery circulation
DEFINE LUNG ABSCESS
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
TYPES OF LUNG ABSCESS BASED ON ETIOLOGY?
- PRIMARY
- result of necrotising pulmonary infection
- including in immunosuppressed host
- or aspiration of GI content/ oropharyngeal secretions - SECONDARY
- complication of bacteremia/ bronchial obstruction (adjacent supportive infection)
- infection of previous destroyed/ damaged lung parenchyma
CLINICAL PRESENTATION OF LUNG ABSCESS
COUGH FEVER CHILLS MALAISE FATIGUE WEIGHT LOSS PLEURITC CHEST PAIN DYSPNEA LESS COMMON > HEMOPTYSIS
INDICATION OF WHAT IS SUDDEN PRODUCTION OF LARGE QUANTITY OF PUTRID SPUTUM IN PX WITH LUNG ABSCESS?
COMMUNICATION ABSCESS WITH BRONCHIAL TREE
- may lead to infection to non involved lungs > respiratory failure
2 STAGES OF PRIMARY LUNG ABSCESS?
- ACUTE
- duration of symps < 6 weeks - CHRONIC
- symps > more than 6 weeks
3 COMPLICATION OF ACUTE STAGE OF LUNG ABSCESS AND INDICATION FOR EMERGENCY SURGERY?
- BRONCHOPLEURAL FISTULA
- EMPYEMA
- BLEEDING
MANAGEMENT FOR CHRONIC LUNG ABSCESS?
SURGERY
MAIN TREATMENT FOR ACUTE LUNG ABSCESS?
SYSTEMIC ANTIBIOTICS
- most acute lung abscess resolve within 2 weeks of management
- resolve radiographically 2-5 months
WHAT DOES LACK OF CLINICAL RESPONSE FOR MEDICAL THERAPY OF LUNG ABSCESS SUGGEST?
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
WHICH DIAGNOSIS TECHNIQUES NEEDED TO DETERMINE PRESENCE OF LUNG ABSCESS?
- RADIOGRAPHIC IMAGING > will confirm lung abscess
- POSTEROANTERIOR + LATERAL CHEST RADIOGRAPHY CT of CHEST
WHICH ARE TYPICAL SIGNS OF INTACT PULMONARY HYDATID CYST ON X-RAY?
ROUND/ OVAL SHAPES
SOLITARY/ MULTIPLE
HOMOGENOUS DENSITY
PERFECTLY DEFINED MARGIN - can be drawn with marking pen
OBECTIVE SURGICAL TREATMENT FOR PULMONARY HYDATIDOSIS?
ERADICATE THE PARASITE
- to prevent intraoperative rupture of cyst + remove residual cavity
WHY DO HYDATID CYST GROW MORE RAPIDLY IN LUNGS THAN OTHER ORGANS?
DUE TO NEGATIVE PRESSURE + GREAT ELASTICITY OF PULMONARY TISSUE
