Resp - Bronchiectasis

Question 1

Pathophysiology + bugs

Answer 1

• Chronic infection of bronchi/bronchioles leads to permanent dilatation
• Get retained inflammatory secretions and microbes, which damage airway and cause recurrent infection
• Organisms: H influenza, Pneumococcus, S aureus, pseudomonas

Question 2

Causes: what types + 1 example for each?

Answer 2

• idiopathic 50%
• Congenital: CF
• post-infectious: measles, pertussis, pneumonia, TB, bronchiolitis
• immunodeficiency: hypogammaglobulinaemia
• other: bronchial obstruction (lymph nodes, foreign body)

Question 3

Symptoms

Answer 3

• Persistent cough with purulent sputum
• haemoptysis (may be massive)
• Fever and wt loss

Question 4

Signs

Answer 4

• clubbing
• coarse inspiratory creps
• Wheeze
• purulent sputum

Question 5

Symptoms

Answer 5

• Persistent cough with purulent sputum
• Haemoptysis
• fever and wt loss

Question 6

Complications

Answer 6

• pneumonia
• pleural effusion
• pneumothorax
• PHTN
• cerebral abscess

Question 7

Ix:

Answer 7

• Sputum: MCS
• Bloods: serum Ig, aspergillosis precipitins, alpha 1 AT levels + test response to pneumococcal vaccine.
• CXR: thicket bronchial walls
• CT: will show dilated/thickened airways + saccular dilatations in clusters with pools of mucus.
• Bronchoscopy + mucosal biopsy
• CF sweat test

Question 8

Rx

Answer 8

• Chest physio: expectoration, drainage and pulmonary rehab
• ABX for exacerbation
• Bronchodilators: nebuliser B agonists
• Surgery may be indicated in severe localised disease
• Treat underlying cause: eg immune deficiency give IV Ig