Transcript BRONCHIECTASIS-for-4th-year-AM-college-Oct

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This young man has
long
history
of
productive cough and
wheezing.
He
is
afebrile
and
chest
auscultation
reveals
coarse
crackles
at
right lower chest
BRONCHIECTASIS
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Bronciectasis (Greek word)
•Bronkos ---- Wind pipe
•Ektesis ---- Stretching
HOW DO YOU DEFINE BRONCHIECTASIS ?
BRONCHIECTASIS
Abnormal and permanent
dilatation of bronchi and
bronchioles greater than 2 mm
CLASSIFICATION
REID’S CLASSIFICATION (1950)
• Based on Pathology & Bronchography
Cylindrical
 Varicose
 Saccular (Cystic)
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Sacular type
Cylindrical
Varicose Type
MUCOUS PLUGS
DILATED
BRONCHIOLE
PATHOGENESIS
NORMAL HOST RESPONSE TO
BRONCHIAL INSULT
BRONCHIAL INSULT
RETURN TO HEALTH
MUCOCILLIARY CLEARENCE
INFLAMMATION
ABNORMAL HOST RESPONSE TO
BRONCHIAL INSULT
BRONCHIAL INSULT
BRONCHIECTASIS
INFLAMMATION
BRONCHIAL DAMAGE
IMPAIRED MUCOCILLIARY
CLEARENCE
FURTHER INFLAMMATION
BRONCHIAL OBSTRUCTION
PATHOGENESIS
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OBSTRUCTION
INFLAMMATION
ETIOLOGY OF
BRONCHIECTASIS
Congenital
Acquired
Case Study
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While doing clinical elective in UK,
you happen to see a young man,
who has been regularly visiting chest
clinic since birth with multiple
admissions. He c/o productive cough
and shortness of breath. His brother
also suffers from the same disease.
His chest x-ray is
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What is the
diagnosis ?
What is mode of
inheritance ?
What do you see
on this chest x-ray.
What is pathology
CYSTIC FIBROSIS
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What is the
diagnosis ?
What is mode of
inheritance ?
What do you see
on this chest x-ray.
What is pathology
Case Study
30 Years old gentleman comes to you
with chronic sinusitis and productive
cough. His x-ray of sinuses and chest
are
What is the diagnosis ?
Kartageyner Syndrome
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Primary ciliary dyskinesia (PCD)
or Kartagener Syndrome (KS), is a
rare, ciliopathic, autosomal recessive gene
tic disorder that causes a defect in the
action of the cilia lining the respiratory
tract (lower and pper, sinuses, Eustachian
tube,middle ear) and fallopian tube.
Kartageyner Syndrome
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It is combination of Ciliary
Dyskinesia and situs inversus
(complete or incomplete)
Infertility
What are the congenital causes
of Bronchiectasis ?
ETIOLOGY: CONGENITAL
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Cystic Fibrosis
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Primary Ciliary Dyskinesia
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Kartagener’s Syndrome
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Immunodeficiency States
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Intralobular Lung Sequestration
AQUIRED CAUSES
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POST INFECTIOUS
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BRONCHIAL OBSTRUCTION
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MISCELLANEOUS CONDITIONS
AQUIRED CAUSES
POST INFECTIOUS
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Bacterial
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Mycobacterium tuberculosis
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Pseudomonas aureginosa
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Hemophillus influenzae
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Staphylococcus aureus
AQUIRED CAUSES:
POSTINFECTIOUS
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Viral
Adenovirus
 Influenza
 HIV
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Fungal
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Aspergillus fumigatus (ABPA)
Allergic Bronchopulmonary
Aspergillosis (ABPA)
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Mainly in
Asthmatics
Sensitization to
aspergillous
Raised IgE level
Tubular
Bronchiectasis
ETIOLOGY : BRONCHIAL
OBSTRUCTION
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Tumour
Foreign Bodies
Mucous Plugs
ETIOLOGY: OTHER CAUSES
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Rheumatoid Arthritis
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Inflammatory Bowel Disease
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Systemic Lupus Erythematosus
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Post transplant
CLINICAL PRESENTATION
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SYMPTOMS
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Persistent cough
Purulent sputum
(green and foul smelling)
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Hemoptysis
Dyspnea
Wheeze
Fever
Severe Pneumonia
Asymptomatic
Non Productive Cough
WET TYPE
DRY TYPE
CLINICAL PRESENTATI0N
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SIGNS
• On GPE
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Digital Clubbing
Cyanosis
Plethora
Muscle wasting
• On Auscultation
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Crackles
Wheeze
Ronchi
COMPLICATIONS
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Recurrent pneumonia
Empyema
Haemoptysis
Pneumothorax
Lung abscess
Brain abscess
Amyloidosis
Cor pulmonale
DIAGNOSIS
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CLINICAL PRESENTATION
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SPUTUM ANALYSIS
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RADIOLOGY
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DIRECT VISUALISATION
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ESTABLISHMENT OF CAUSE
CLINICAL PRESENTATION
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HISTORY
CLINICAL EXAMINATION
RULE OUT
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Pneumonia
Emphysema
Lung abscess
SPUTUM ANALYSIS
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Amount of sputum
24 hr Sputum Production
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Mild
Moderate
Severe
< 10 ml/day
<150 ml/day
>150 ml/day
Visual Impression
Microbiology
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Streptococcus pneumoneae
Hemophillus influenzae
Aspergillus
Psedomonas
E. coli
LAB TESTS
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Blood complete picture
Quantitative immunoglobulin
Alpha-1 anti-trypsin level
RADIOLOGY
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Chest X-ray PA view
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Cylindrical
Varicose
Saccular
Bronchography
CT Scan
DIRECT VISUALISATION
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Bronchoscoy
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Flexible
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Rigid
ESTABLISHMENT OF CAUSE
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Serum Protein electrophoresis
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Serum Immunoglobulins
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Pilocarpine Iontophoresis (Sweat Test)
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Aspergillus Precipitin Test
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Electron Microscopy
MANAGEMENT
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4 GOALS
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Elimination of Problem
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Clear Tracheo-bronchial Secretions
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Control Infections
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Reverse Airflow Obstruction
MANAGEMENT
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POSTURAL DRAINAGE
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BRONCHODIALATORS
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CORTICOSTEROIDS
TREAT INFECTIONS
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Antibiotics (according to C&S)
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Amoxicillin 250mg
-------Co-amoxiclav 325mg -------Levofloxacin 500mg -------Ceftazidime
Preventive and suppressive
antibiotics
TDS
TDS
BD
Other treatment
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Inhaled Broncho dilators
Inhaled aerosolized aminoglycosides
Surgery
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Reserved for patients with localised
bronchiectasis and adequate lung
functions
Sometime in massive haemoptysis
PREVENTION
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VACCINATION
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Influenza vaccine
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Pneumococcal vaccine
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AVOID EXACERBATING FACTORS
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Regular chest physiotherapy
Stay together