Bronchiectasis

Permanent abnormal dilatation of one or more bronchi due to the destruction of elastic n muscular components of d bronchial wall.

CLASSIFICATION
1 SACCULAR BRONCHIECTASIS
 - Occurs in d proximal large bronchi
 - bronchi shows large dilatation, ending in large sacs.

2 CYLINDRICAL
 - Invoves d airway frm 6th to 10th generation.
 - bronchi look cylindrical or beaded.

3 VARICOSE
 - Bronchi resemble varicose vein

AETIOLOGY
CONEINITAL
 bronchial cysts, bronhomalacia, cystic fibrosis,

ACUQIRED( chldren )
necrotizing pneumonias, primary. TB,etc

ACUQIRED( adults )
 pulmonary TB, suppurative pneumoias. Postoperative bronchiectesis, tumour or froeign body etc

PATHOLOGY
 - Characteristic faature is multiple bronchiectatic cavities.
 - left lung is involve mor than right
 - lower lobe is involve mor than upper
 - common site- lower lobe, lingula, n middile lobe.

C/F
 - chronic cough wit sputum production , haemoptysis n recurrent pneumonias.
 - sputun is copious, purulent n foul smelling. Maximun in 1st 2 hrs after waking up.
 - tree layer sputum - mucoid layer on d top, mucnpurulent in d middle n purulen at d bottom.
 - haemoptysis is due to rupture of d thin walled vessels.
 - dyspnoea n wheezing
 - systemic symp. Like fiver, wt loss, anaemia, night sweats n weakness.

PHYSICAL FINDING
 - gen. Exam^- anaemia, clubbing. Five, halitosis n sinusitis.
 - bilateral, basal, coarse, leathery creapitation.

INVESTIGATIONS.
 - BLOOD- anaemia, raise ESR n leucocytosis.
 - URINE- proteinuria wit anyloidosis
 - SPUTUM - gm stain. zn stain, culture sensitivity.
 - CHEST X ray- usually norm. Cystic or saccular type diagnosed by multiple 1 to cm cystic lesion wit or witout fluid levels.
 - ECG usually norm.
 - BRONCHOSCOPY
 - BRONCHOGRAPHY
 - CT SCAN
 - PULMONARY FUNCT^ TEST - may shows obstruction.
 - ARTEIAI BLOOD GAS STUDIES-shows respiratory alkolosis or hypoxaemia
 - IMMUNOLGIC SURVEY

COMPLICTION
 - Haemoptysis
 - Pneumonia
 - Lung abscess
 - Septicaemia
 - Brain absces
 - Respirtotry failure
 - Emphyema

MANAGEMENT
1 Treat underlying cause
2 Drainage
3 Antibiotics
 - choic depends on culture n sensitivity
 - mild- oral agent like amoxicillin, amphicillin, tetracyclin, cotrimoxazole. Shud b use
 - sever- parentral antibiotic used
4 Bronchodilators
 - it improve obstruction n aid clearance of secreation.
5 Surgical treatment
- Indications.
 - child or young adult wit localised lesion
 - recurrent haemoptysis
 - recurrent localised pneumonias.
6 Other
 - cigarette smoking should b stop
 - episodes of sinusitis should b treat promptly.
 - complicated case may require nasal oxyen on a chronic basis.