| ID | 94 |
|---|---|
| Name | BRONCHIECTASIS |
| Cause | |
| Signs Symptoms | |
| Diagnosis | |
| Investigations | Investigation: 1. Radiography: X-ray chest- honey comb appearance (dilated, thickened airways and scattered, irregular opacities); atelectasis, and focal consolidation may be present. 2. Bronchography or High-resolution CT: Most diagnostic investigation. 3. A F B & Gram staining of the sputum to exclude TB & other pathogenic bacteria. 4. Sputum for C/S 5. Assessment of ciliary dysfunction. |
| Management | Management: 1. Stop smoking 2. Postural drainage & chest physiotherapy: Aim is to keep the dilated bronchi emptied of secretion- twice daily. 3. Antibiotics: Empiric oral therapy: Amoxycillin 500mg or co-amoxiclav 625mg (in b-lactamase resistant cases) 8 hourly, or cotrimoxazole 960mg 12 hourly, or tetracycline 500mg 6 hourly for 10-14 days is reasonable therapy in an acute exacerbation if a specific bacterial pathogen can’t be isolated. Or other antibiotics according to culture & sensitivity test, for ID-14 days. Alternating cycles of 2 or 3 of these antibiotics, given orally for 2-4 weeks, are sometimes employed in stable bronchiectasis patients with copious, purulent sputum. 4. Bronchodilators: Sometimes helpful. 5. Surgery: Surgical resection is reserved for a few patients- when there is uncontrolled haemoptysis and the disease process is localized & fail to respond to conservative management. 6. If cystic fibrosis with secondary infection then treatment with oral ciprofloxacin 250-750mg twice daily, or i.v ceftazidime 100-150mg/kg daily in 3 divided doses for requisite period is found effective. |
| Introduction | Definition: Bronchiectasis is a chronic necrotizing infection of the bronchi & bronchioles leading to or associated with permanent, abnormal dilation and destruction of bronchial walls. Aetiologically, it may be congenital or acquired. Pathological changes are due to recurrent inflammation or infection of the airways and may be localized or diffuse. |
| History | |
| Etiology | Etiology: A. Acquired-Infective- Secondary to measles, whooping cough, tuberculosis, pneumo nia, lung abscess, fungal infections. Obstructive- 1. In the lumen- foreign body. 2. In the wall- growth (Br. carcinoma). 3. Outside the wall- enlarged lymph node due to TB, lymphoma. Abnormal lung defense mechanisms- 1. Humoral immunodeficiency. 2. cq-antiprotease (ctpantitrypsin) deficiency with cigarette smoking. B. Congenital- 1. Cystic fibrosis- it causes about half of all causes of bronchiectasis. 2. Ciliary dysfunction syndrome. |
| Clinical Features | Clinical features: Simptoms: 1. Chronic cough- usually worse in the morning. 2. Purulent sputum- copious & fetid in advanced cases. 3. Recurrent attack of fever, malaise, shivering & chest pain. 4. Haemoptysis. 5. General ill health. Signs: 1. Anemia and clubbing may be present. 2. Chest movement slightly reduced on affected side. Mediastinal displacement towards the lesion may be present. Percussion note may be impaired. Vocal resonance increased with localised course crepitation. 3. Signs due to underlying causes. |
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