BRONCHIECTASIS
LUNG ABSCESS
CYSTIC FIBROSIS
BRONCHIECTASIS
DEFINITION
Irreversible(permanent),abnormal dilatation of the
cartilage containing airway bronchi or bronchioles.
Bronchiectasis develops due to the destruction of elastic
and muscular components of the bronchial wall.
classification
1. saccular bronchiectasis(cystic)
This occurs in the proximal large bronchi.
The bronchi show marked dilatation,ending in large sacs.
2.Cylinderical bronchiectasis(fusiform)
This involves the airway from 6th to 10th generation
The bronchi looks cylindrical or beaded,and end squarely and abruptly
3.Varicose bronchiectasis
This is intermediate btn saccular and cylindrical changes.
The bronchi resemble varicose veins.
AETIOLOGY
Congenital-
cystic fibrosis
ciliary dysfunction syndrome –
1.kartagener’s syndrome(sinusitis and transposition of the
viscera
2.Primary ciliary dyskinesia-young’s syndrome-immotile cilia
syndrome
Primary hypogamaglobulinemia
Alpha –antitrypsin deficiency
Acquired: children
Pneumonia
Primary tb
Inhailed foreign body
Acquired: adults
Primary tb
Allergic bronchopulmonary aspergillosis
Post-obstructive bronchiectasis-endobronchial
tumor,enlarged hilar lymph node
Rheumatoid arthritis
Bronchiolitis after lung transplantation
PATHOPHYSIOLOGY
Chronic persistent necrotising infection--
increases secretions—leads to mechanical
obstruction—impairs clearing mechanism of
the lung—results in accumulation of
secretions distal to obstruction—leads to
secondary infection—inflammation—
weakens and dilates airway
Clinical feature
Severe persistent (chronic)productive cough-most common
symptom
Sputum-foul smelling,thick copious and continuously purulent and
sometimes bloody
Hemoptysis
Pleuritic(chest)pain
Infective exacerbation
General debility
Bronchiectasis sicca/dry bronchiectasis-asymptomatic pthaving
non purulent cough which follows tb of upper lobe.
Situs inversus is found in 50% cases of ciliary
dyskinesia
Recurrent pneumonias developing in pts with
bronchiectasis are characterized by fever with
chillsand rigors,night sweats,xray evidence of
pneumonia.
Physical findings
May reveal anemia,clubbing of the
digits,fever,weight loss,night
sweat,weakness,halitosis and sinusitis
Respiratory sigh may b u/l bt are usually b/l and
basal.
Auscultation reveals crackles and wheezing,and
presence of large amount of secretions is
responsible for characteristic b/l coarse leathey
crepitation.
Investigation
Blood –anemia,increased ESR,leucocytosis indicating
suppuration.
Sputum examination
Chest radiograph
Chest CT- IOC for confirmation
Sinus x-rays
Bronchoscopy
Pulmonary function test
Urine examinaion
Electrocardiogram
Sweat electrolytes
Serum immunoglobulins
Assesment of ciliary function
Complication
Haemoptysis
Pneumonia
Lung abscess
Empyema
Septicemia
Osteomylitis
amyloidosis
Asapergilloma
Cor pulomonale
Respiratory failure
hypoproteinamia
Management
goals:
1.Improvement in secretion clearance and bronchial
hygiene
2.Ab therapy
3.Antiinflammatory therapy
4.Reversal of airflow obstruction
5.Sx therapy
6.others
Prevention
Adequate Rx and prophylaxis of childhood
whooping cough,measles,and primary tb
Early recognition and removal of bronchial
obstruction
Genetic counselling in cystic fibrosis.
Lung abscess
Definition
It
is defined as necrotic areas of lung
parenchyma containing purulent material
Aetiology
Aspiration of nasopharyngeal or oropharyngeal
contents (aspiration abscess)
Pulmonary tb is an important cause of lung
abscess
Necrotising pneumonia
Bronchial obstruction
Haematogenous spread
Rupture of amoebis liver abscess into lung.
Clinical feature
2 modes of presentation
1. Acute
2. Chronic
Acute (<1month of symptoms)
High grade fever,chills and rigors,pleuritic chest pain,and dry
cough.
Pts suddenly start expectorating large quantities of sputum when
abscess cavity ruptures after few days.sputum is large in
volume,purulent,foul smelling,and often blood
tinged.expectoration varies with position.
Chronic(>1month of symptoms)
Lung abscess due to aspiration is often chronic in
presentation with insidious onset of low grade
fever,malaise,weight loss,anorexia,and a deep seated
chest discomfort. Sputum has putrid smell in many cases.
Physical findings:
Generalexamination reveals anemia,fever,finger
clubbing,halitosis,and oronasal sepsis.
Respiratorysystem examination may be normal in early
stage.later,frank sign of consolidation like dullness on
percussion,increasesd vocal fremitus and vocal
resonance,bronchial breathing,and pleural rub appear
Investigation
Anemia,leucocytosis,and raised ESR.
Sputum studies
Chest
radiograph often shows radiolucency in an
opaque area of consolidation
Bronchoscopy-to exclude malignancy
CTscan of thorax can detect lung abscess with
certaininty.
Complication
Haemoptysis
Pleuraleffusion
Pneumothorax
Metastatic cerebral abscess
Amyloidosis
Aspergilloma
Bronchiectasis
Treatment
Postural drainage and chest physiotherapy.
Antibiotic therapy –ampicillin 500 mg four times daily
or cotrimoxazole 960mg twice daily.
In anaerobic bacterial-oral metronidazole 400 mg 8
hour;ly should be added.
Seriously ill pts will require parentral ab therapy in form
of penicillin
In large abscess,percutaneous aspiration is important.
Resectional surgery is indicated only in
selected situations:
Massive haemoptysis
Localised malignancy
Associated symptomatic bronchiectasis
Persistent abscess cavity
Cystic fibrosis
This
is the most common fatal genetic disease with
autosomal recessive inheritance
Result of mutations affecting a gene on the long arm of
chromosome 7,which codes for chloride channel known as
cystic fibrosis transmembrane conductance
regulator(CFTR)
Clinical feature:
Recurrent exacerbation of
bronchiectasis,initially in the upper lobes
but subsequently throughout both
lungs,causes progressive lung
damage,resulting in death from
respiratory failure.
Complication
Respiratory
Infective exacerbations of bronchiectasis
Spontaneous pneumothorax
Haemoptysis
Nasal polyp
Respiratory failure
Gastrointestinal
Malabsorption and steatorrhoea
Billiary cirrhosis
Gallstones
Others:
Diabetes delayed puberty
Male infertility
osteoporosis
Management
As same as severe bronchiectasis.
