Wednesday 28 May 2008

Bronchiectasis

causes:

1- congenital syndromes

      • cystic fibrosis

      • ciliary dysfunction syndromes

      • hypogammaglobulinaemia

      • Yellow nail syndrome

2- airway obstruction

  • foreign body/neoplasm/stricture

3- Infection

  • suppurative pneumonae

  • Pul TB

  • ABBA

  • severe bacterial infection in childhood

Features:

  • Chronic productive cough

sputum copious,persistantly purulent

  • Fever

  • Malaise

  • Haemoptysis→ can be torrential

  • Wt loss

  • Clubbing

o/e:Low pitch leathery inspiratory and expiratory crackles or coarse creps

Investigations:

  1. Sputum C/S

  2. CXR

  3. CT chest

  4. Spirometry

  5. Bronchoscopy

  • Assessment of ciliary function

  • Serum immunoglobulins

  • Sweat test for CF

  • Skin prick test for ABBA

CXR:

  • Cystic shadows

  • Fluid level

  • Thickened bronchial wall

  • collapse

CT

  • Definitive diagnosis

Management

  1. Postural drainage twice daily

  2. Antibiotics guided by the C/S

      1. e.g cipro,ceftazidine

  3. Bronchodilators

  4. Surgical treatment

Complications:

  • Haemoptysis

  • Respiratory failure

  • Cor pulmonale

  • Pneumothorax

  • Brain abscess

  • Amyloidosis



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2 comments:

  1. remember:
    check check the sputum pot
    clubbing
    ask to examine the spleen if it is long standing(amyloidosis)

    ReplyDelete
  2. is it inspiratory and expiratory crackles or late inspiratory crackles??

    ReplyDelete