支气管扩张症课件_9

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1、BronchiectasisSSVisser,PulmonologyInternalMedicineUPCONTENTSDefinitionAetiologyPathogenesisClinicalmanifestationsDiagnosisTreatmentBRONCHIECTASISDefinition:Abnormalandpermanentdilationofbronchi.FocalordiffusedistributionClinicalconsequences–chronicandrecurrentinfectionandPoolingofsecretionsi

2、ndilatedairways.Classification:Cylindrical(fusiform)SaccularVaricoseAetiology:A.Infections-Micro-organismsMeaslesandPertussisAdeno&InfluenzavirusBacterialinfectionwithvirulentorganisms:S.aureus,KlebsiellaAnaerobesAtypicalmycobacteriaMycoplasmaHIVTuberculosisFungiAETIOLOGY:IMPAIREDHOSTDEFENCE

3、Localcauses:EndobronchialobstructionGeneralisedimpairment:1.Immunoglobulindeficiency2.Primaryciliarydisorders3.CysticfibrosisAETIOLOGY:NON-INFECTIOUSToxinsortoxicsubstancesNH3;gastriccontentsImmuneresponses,ABPAInflammatorydiseases:ulcerativecolitis,rheumatoidarthritis,Sjögrensyndrome.-1-An

4、titrypsindeficiencyYellownailsyndromeCLINICALMANIFESTATIONSPersistentorrecurrentcoughwithpurulentsputum.HaemoptysisInitiatingepisode:Severepneumonia,orinsidiousonsetofsymptomsorasymptomaticornon-productivecough–drybronchiectasisinupperlobe,Dyspnoea,wheezing–widespreadbronchiectasisorunderlyi

5、ngCOPD.Exacerbationofinfection:Sputumvolumeincrease,purulenceorblood.PHYSICALEXAMINATIONAnycombinationofrhonchi,crepsorwheezes.Clubbingofdigits.ChronichypoxaemiacorpulmonaleRheartfailureAmiloidosis(rare)DIAGNOSIS-1ClinicalRadiology:ChestXR:Maybenon-specificmilddisease–normalXRCadvanceddise

6、ase–cysts+fluidlevelsperibronchialthickening,“tramtracks”,“ringshadows”CTScan:Peribronchialthickening,dilatedbronchioles.Sputumculture:Pseudomonasaeuruginosa,H.influenzae.DIAGNOSIS-2Lungfunction:Airflowobstruction–FEV1decreased.Airtrapping-RVincreasedSweattest–increasedsodiumandchlorideincys

7、ticfibrosisBronchoscopy:Obstruction–foreignbody,tumor.ImmunoglobulinCiliafunctionandstructure–Kartagenersyndrome.TREATMENT-14Goals:1.Eliminatecause2.Improvetracheobronchialclearance3.Controlinfection4.ReverseairflowobstructionTREATMENT-21.Immunoglo