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What is bronchiectasis?
Permanent dilatation of bronchi
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What is the main pathogenesis of bronchiectasis?
Chronic infection of bronchi and bronchioles
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What are the main organisms causing bronchiectasis?
- H. influenzae
- Strep pneumo
- Staph aureus
- Pseudomonas aeruginosa
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What are the congenital causes of bronchiectasis?
- 1. ciliary dyskinesia
- a. primary ciliary dyskinesia: immotile cilia
- b. kartaganers syndrome: immotile cilia, situs invertus, chronic sinusitis
- c. young’s syndrome: bronchiectasis and absent vas deferens
- 2. cystic fibrosis
- 3. Ig deficiency (IgG2, 4) due to recurrent infections
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What are the acquired causes of bronchiectasis?
- 1. Post infective bronchial damage:
- a. Childhood infections: pertussis, measles, bronchiolitis
- b. TB
- c. HIV
- 2. Airway obstruction
- a. Inhaled foreign body
- b. Tumour
- c. Enlarged LN
- 3. Acquired immunodeficiency – AIDS (histoplasmosis fungal infection)
- 4. ABPA
- 5. RA
- 6. UC
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What are the symptoms of bronchiectasis?
- Persistent cough
- Copious purulent sputum
- Intermittent haemoptysis
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What are the signs of bronchiectasis?
- Finger clubbing
- Coarse inspiratory crepitations (lung bases usually)
- Wheeze
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What are the complications of bronchiectasis?
- Pneumonia
- Pleural effusion
- PT
- Haemoptysis
- Cerebral abscess
- Amyloidosis
- Eventually respiratory failure
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Which Ix need to be done to diagnose bronchiectasis?
- Sputum culture
- CXR
- HRCT
- Spirometry
- Bronchoscopy – to locate site of haemoptysis or exclude obstruction
- Sweat test
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What does CXR show in bronchiectasis?
- Dilated bronchi
- Thickened bronchial walls (tramline and ring shadows)
- Multiple cysts containing fluid → cystic shadows
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What is the one investigation of choice to diagnose bronchiectasis and what does it show?
- HRCT:
- airway dilatation,
- bronchial wall thickening,
- bronchial wall cysts
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which investigations need to be done in an infective exacerbation of bronchiectasis?
Sputum culture
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What would spirometry show in bronchiectasis?
Obstructive pattern
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Is bronchiectasis usually confined or widespread?
- Usually widespread
- Confined to a lobe if due to inhaled foreign body or lobar pneumonia
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What are the most frequently isolated organisms in bronchiectasis?
are pneumococcus and H. influenzae
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how do TB and histoplasmosis (fungus, AIDS) cause bronchiectasis?
- Necrotizing inflammatory process
- Weakens bronchus wall
- Dilation
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How do measles and pertussis cause bronchiectasis?
- Explosive coughing contribute to a dilatation of bronchial wall
- Weakened by inflamm process
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How does allergic aspergillosis contribute to bronchiectasis?
- Ag-Ab complexes in bronchial wall
- Lead to inflamm reaction
- Wall destruction
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what is the management of bronchiectasis?
- 1.postural drainage: bd
- 2.chest physio: aid sputum expectoriation and mucous drainage
- 3.antibiotics.
- a.Staph aureus: flucloxacillin
- b.If pseudomonas then need oral ciprofloxacin or iv ceftazidime
- 4.bronchodilators eg salbutamol nebs if have asthma, COPD, CF, ABPA
- 5.corticosteroids eg prednisolone for ABPA
- 6.surgery if LOCALISED disease or to control severe haemoptysis
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