Respiratory: Bronchiectasis Flashcards
Describe the pathophysiology of bronchiectasis
Permanent irregular dilatation of the airways from chronic inflam/infection
Increased thick tenacious phlegm, damaged cilia, - predisposed to infection
Fibrosis in the surrounding parenchyma
Types = cylindrical, varicose, cystic
What are the causes of bronchiectasis?
CF - most common cause
Idiopathic
Post infective
Ciliary dysfunction
Immune deficiency
Allergic broncho pulmonary aspergillosis
Aspiration
What are the symptoms and signs of bronchiectasis?
Cough, sputum production
Breathlessness
Rhinosinusitis
Fatigue
Haemoptysis
Thoracic pain
Examination = coarse crackles, wheeze, clubbing, weight loss (chronic infection), muscle wasting, raised JVP (pulmonary HTN), peripheral oedema (cor-pulmonale)
What investigations should be performed for suspected bronchiectasis?
HRCT (gold standard) = increased broncho-arterial ratio (>1.5 bronchiectasis), lack of tapering, bronchial wall thickening, mucous impaction, air-trapping, mosaic perfusion, tram-track sign (dilated bronchus when captured longitudinally), signet ring sign (dilatation of airway with white vessel sitting on top), string of pearls sign, cluster of grapes sign
Differential blood count - eosinophilia (ABPA), raised WBC (active infection)
Serum Ig (IgG/A/M)
Sputum = MCS (AFP), rule out TB
Bronchoscopy = to gather sputum samples, rule out obstruction
Lung function testing = obstructive (usually, mucus), restrictive, mixed
What organisms are commonly associated with infective bronchiectasis?
H.influenza
Pseudomonas
How should bronchiectasis be managed?
No previous bacteriology = amoxicillin 500mg TDS for 2 weeks
High dose oral regimens = amoxicillin 1g TDS in severe bronchiectasis chronically colonised with H.influenza
Ciprofloxacin = pseudomonas aeruginosa colonisation
Treat coexisting obstructive airway disease = inhaled steroid, human Dnase, bronchodilators, mucolytics, physio, surgery
Long term Abx = >3 exacerbations/yr, macrolide or drug sensitivity/tolerability
What complications can arise from bronchiectasis?
Local = recurrent infections (pneumonia), lung abscess, empyema, haemoptysis
Systemic = sepsis, metastasis, amyloidosis, pulmonary HTN, HF, resp failure
What are the histological features of bronchiectasis?
Dilatation of airways
Thickened bronchi
Loss of cilia
Increased mucus
Destruction of muscle and elastic tissue - sec to inflam/infect
When should a pt with bronchiectasis be admitted?
Cant cope at home
Cyanosed or confused
RR >25
Cardiorespiratory failure
Fever >38
Unable to take oral therapy, or failed to respond
Have pleuritic pain severe enough to inhibit coughing and the clearing of secretions
