Bronchiectasis PDF Presentation

Bronchiectasis Dr. Jameel Hakeem PhD, RTT 24/10/24 Respiratory Department Dr. Jameel Hakeem  References for this Lecture 2 Dr. Jameel Hakeem  Objectives State definitions of Bronc...

Bronchiectasis Dr. Jameel Hakeem PhD, RTT 24/10/24 Respiratory Department Dr. Jameel Hakeem  References for this Lecture 2 Dr. Jameel Hakeem  Objectives State definitions of Bronchiectasis Recognize the pathophysiology of Bronchiectasis Describe clinical findings of Bronchiectasis in chest X-ray Describe the treatment currently available for patients with bronchiectasis Dr. Jameel Hakeem  Objectives State definitions of Bronchiectasis Dr. Jameel Hakeem  DEFINITION ▪ Bronchiectasis is defined as permanent dilatation and distortion of a portion of a bronchus due to structural weakness in the wall of the airway after chronic and recurrent infection and inflammation of airways. ▪ Destruction: bronchial wall cartilage, blood vessels, elastic tissue, and smooth muscles. Dr. Jameel Hakeem Dr. Jameel Hakeem  Pneumonectomy showing grossly dilated bronchi with mucous plugging (blue arrows) and distal consolidation. Dr. Jameel Hakeem  Objectives Recognize the pathophysiology of Bronchiectasis Dr. Jameel Hakeem  ETIOLOGY The etiology of bronchiectasis is not always clear, but evidence indicates that the disease may be either acquired or congenital Dr. Jameel Hakeem  Acquired ▪ Recurrent Pulmonary Infection ▪ TB; pneumonia; pertussis ▪ Fungal ▪ Allergic bronchopulmonary aspergillosis ▪ Bronchial Obstruction (FBO, tumor) ▪ Inhalation & aspiration Dr. Jameel Hakeem  Congenital ▪ Kartagener’s Syndrome ▪ syndrome refers to a condition that involves difficulty with clearing mucus secretions ▪ Immunodeficiency ▪ Cystic Fibrosis – 50% Dr. Jameel Hakeem  Pathophysiology of Bronchiectasis ▪ Because of bronchial wall destruction, the mucociliary clearance mechanism is impaired. ▪ This results in the accumulation of copious amount of bronchial secretions. ▪ The small bronchi or bronchioles distal to the affected areas become partially or totally obstructed with secretions. This leads to one or both of the following: ▪ Hyperinflation of the distal alveoli ▪ Atelectasis, consolidation, fibrosis as a result of complete bronchial obstruction 12 Dr. Jameel Hakeem  Objectives Describe clinical findings of Bronchiectasis in chest X-ray Dr. Jameel Hakeem  Clinical findings of Bronchiectasis ▪ The following clinical manifestations result from the pathophysiologic mechanisms caused by: ▪ Atelectasis ▪ Consolidation ▪ Increased Alveolar-Capillary Membrane Thickness ▪ Bronchospasm ▪ Excessive Bronchial Secretions 14 Dr. Jameel Hakeem Gross cystic bronchiectasis. Posteroanterior chest radiograph showing overinflated lungs. There are multiple ring opacities, most obvious at the lung bases, ranging from 3 to 15 mm in diameter. Dr. Jameel Hakeem  Left lower lobe bronchiectasis. The marked volume loss of left lower lobe is indicated by a depressed hilum, vertical left mainstem bronchus, mediastinal shift, and left-sided transradiancy. Dr. Jameel Hakeem  Figure 13-4. Ciliary dyskinesia syndrome—Kartagener’s syndrome. This 62-year-old woman gave a 40 year history consistent with bronchiectasis. The aortic arch, descending aorta, heart, and gastric air bubble are all on the right side. There is diffuse complex pulmonary shadowing with many ring opacities. Broad-branching band shadows can just be seen through heart and represent dilated fluid- filled airways. Dr. Jameel Hakeem  Cylindrical bronchiectasis. Left posterior oblique projection of a left bronchogram showing cylindrical bronchiectasis affecting the whole of the lower lobe except for the superior segment. Few side branches fill. Basal airways are crowded together, indicating volume loss of the lower lobe, a common finding in bronchiectasis. Dr. Jameel Hakeem  Cystic (saccular) bronchiectasis. Right lateral bronchogram showing cystic bronchiectasis affecting mainly the lower lobe and posterior segment of the upper lobe. Dr. Jameel Hakeem  Clinical findings of Bronchiectasis VITAL SIGNS ▪ Increased respiratory rate ▪ Increased heart rate ▪ Increased blood pressure ▪ Increased cardiac output 20 Dr. Jameel Hakeem  Clinical findings of Bronchiectasis INSPECTION ▪ Pursed lip breathing ▪ Use of accessory muscles during inspiration & expiration ▪ Venous distention ▪ Barrel chest ▪ Cyanosis ▪ Digital clubbing ▪ Peripheral edema 21 Dr. Jameel Hakeem  Clinical findings of Bronchiectasis PALPATION ▪ Decreased tactile fremitus PERCUSSION ▪ Hyporesonant on consolidation / hyperresonant on other aera. AUSCULTATION ▪ Diminished breath sounds ▪ Rhonchi and Wheezing 22 Dr. Jameel Hakeem  Clinical findings of Bronchiectasis ▪ Cough, sputum production, and hemoptysis ▪ Chronic cough with production of large quantities of sputum is a hallmark of bronchiectasis. 23 Dr. Jameel Hakeem  ABG FINDINGS ▪ Mild to Moderate Bronchiectasis – pH: Increased – PaCO2: Decreased – HCO3: Decreased (slightly) – PaO2: Decreased ▪ Chronic Bronchiectasis – pH: Normal – PaCO2: Increased – HCO3: Increased (Significantly) – PaO2: Decreased 24 Dr. Jameel Hakeem  Objectives Describe the treatment currently available for patients with bronchiectasis Dr. Jameel Hakeem  TREATMENTS RESPIRATORY CARE TREATMENTS ▪ Oxygen Therapy ▪ Bronchopulmonary Hygiene Therapy ▪ Hyperinflation Therapy ▪ Aerosolized Medication Therapy – Bronchodilators; steroids ▪ Mechanical Ventilation 26 Dr. Jameel Hakeem  TREATMENTS OTHER TREATMENTS ▪ Bronchodilators ▪ Expectorants ▪ Antibiotics ▪ Hydration ▪ Surgical resection ▪ Lung transplant ▪ Rare; severe cases 27 Dr. Jameel Hakeem  Thank you 28 Dr. Jameel Hakeem