Presentation on theme: "Chapter 14 – Des Jardins P – Merck Manual"— Presentation transcript:
1Chapter 14 – Des Jardins P. 584-589 – Merck Manual BronchiectasisChapter 14 – Des JardinsP – Merck Manual
2Objectives State the clinical definition for Bronchieactasis Describe the anatomic alterations of the lungs in BronchieactasisDescribe the etiology of BronchieactasisList the clinical manifestations seen in Bronchieactasis. Include findings of the physical examination, laboratory tests, pulmonary function tests, chest x-rays, arterial blood-gas values, and hemodynamic indices.Describe the management of Bronchieactasis.
3DefinitionA chronic dilation and distortion of one or more bronchi due to extensive inflammation and destruction of the bronchial wall cartilage, blood vessels, elastic tissue and smooth muscle.
4Etiology Usually occurs secondary to: Congenital Defect Repeated, severe pneumoniaMeasles, Pertussis, Adenovirus in childrenKlebsiellaStaphylococciInfluenza virusFungal infectionsMyocbacteriaMycoplasmaBronchial ObstructionCongenital DefectManifestation of Cystic FibrosisKartagener’s SyndromePrimary ciliary dyskinesia (PCD)
5Etiology (cont.) Idiopathic Immune-related diseases Accounts for roughly 50 to 80% of casesPossible immunologic defect or autoimmune abnormality.Immune-related diseasesAllergic bronchopulmonary aspergillosis (ABPA)Collagen Vascular diseasesRheumatoid arthritisSjögren syndromeUlcerative colitisCrohn’s diseaseImmune deficiencies (?)
6Pathophysiology Either one or both lungs may be involved. It is commonly limited to a lobe or segment and is frequently found in the lower lobes.Right Middle Lobe and Left Lingula also possible.Extent and character of pathologic changes determines the functional abnormalities.Increased mucus production with impaired mucociliary clearanceChanges in lung volumes distal to obstructionIncreased due to Ball-Valve effectDecreased due to atelectasisReduced flow rates/ defects with hypoxemia
9Types of Bronchiectasis VaricoseSaccularTechnically there are 2 other kinds: Follicular and Traction. But….who cares?Cylindrical
10Varicose Bronchiectasis Bronchi are dilated and constricted in an irregular fashion similar to varicose veins.Varicose bronchiectasis is also called fusiform.
11Cylindrical Bronchiectasis Bronchi are dilated and have regular outlines similar to a tube. The dilated bronchi fail to taper for 6-10 generations and then in the bronchogram appear to end squarely because of mucous obstruction
12Saccular Bronchiectasis Bronchi progressively increase in diameter until they end in large, cyst-like sacs in the lung parenchyma.This form causes the greatest damage to the tracheobronchial tree.The bronchial walls become composed of fibrous tissue.Cartilage, elastic tissue and smooth muscle are all absent.
13Anatomic Alterations Copious amounts of bronchial secretions. Mucociliary clearance mechanism is impaired.Foul smelling mucous from anaerobic organisms.Mucous plugs cause partial or complete obstruction.Hyperinflation of the distal alveoli as a result of an expiratory check valve obstruction.Atelectasis, consolidation, and fibrosis results from complete bronchial obstruction.
14PathophysiologyObstructive Lung Diseases but can have a restrictive component if alveolar lung volumes are reduced.Obstructive and Restrictive Disease
16Physical Examination Palpation: Percussion: Auscultation: Use of accessory muscles during I & E.Percussion:Hyperresonant if obstructive, Dull if restrictive.Auscultation:Inspiratory crackles and/or rhonchi.May be diminished if obstructive, bronchial with restrictive.
17Physical Assessment Chief complaint: Cough with large volume of sputumHemoptysisSputum settles into distinct layers with streaks of blood often seenThick, tenacious sputumChronic sinusitis is a common complaint.Also nasal polypsKartagener’s Syndrome (Bronchiectasis, dextrocardia & paranasal sinusitis).20% of Bronchieactasis is as a result of Kartagener’s.
18ABG Mild to Moderate Bronchiectasis Severe Bronchiectasis Acute alveolar hyperventilation with hypoxemia.Severe BronchiectasisChronic ventilatory failure with hypoxemia.Oxygenation IndicesIncreased shunting.Decreased oxygen delivery.
19Pulmonary Function Studies Obstructive DiseaseDecreased FVC and FEV1.0Decreased FlowratesIncreased RV, FRC, TLC, RV/TLCRestrictive DefectReduced RV, FRC, TLCRV/TLC ratio normalFlows are normal.
22Laboratory Findings Culture and Sensitivity CBC Haemophilus influenzae Streptococcus pneumoniaeStaphylococcus aureusPseudomonas aeruginosaAnaerobic organismsSputum separates into layersCBCPolycythemia and increased WBC (infection).
23Diagnosis Bronchography (Bronchogram) High-Resolution CT Scan Injection of opaque contrast material into the TB treeRarely done.High-Resolution CT ScanBronchial walls appear thick, dilated.Replaced standard CT scan and Bronchography as gold standard.
24ProphylaxisAwareness and early identification may allow for earlier intervention.Childhood immunizations.Reduce exacerbations.
26Treatment Antibiotics to treat pneumonia Inhaled steroids to reduce inflammationOxygen therapy (low FiO2)Bronchial Hygiene ProtocolCPT/PDHydrationDeep breathing/coughingHumidification
27Therapy Aerosol Therapy Flu shots/Pneumonia Vaccinations Bronchoscopy MucolyticsBronchodilatorsFlu shots/Pneumonia VaccinationsBronchoscopyAvoidance of respiratory irritantsSurgical resectionSaccular is most suitable for surgery
28Prognosis Mild Bronchiectasis – may have a normal life span Extensive Bronchiectasis – shorter life spanResult of respiratory infection and complicationsDisease of slow deterioration interspersed by episodes of exacerbation