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bronchiectasis - Chronic Obstructive Pulmonary Disease...

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Unformatted text preview: Chronic Obstructive Pulmonary Disease Bronchiectasis RPTH 445 Pulmonary Disease I Bronchiectasis • Chronic dilation and distortion of bronchi • Limited – Lobe – Segment – Lower portion of the lung Bronchiectasis Bronchiectasis ‐ Forms • Varicose • Cylindrical • Saccular Bronchiectasis Forms Bronchiectasis - Forms Varicose Varicose Dilated, Dilated, constricted, distorted Irregular Irregular Bronchiectasis Forms Bronchiectasis - Forms Cylindrical Cylindrical Tubular – loss of tapering tapering • 6-10 generations generations Square Square in appearance on appearance on bronchogram bronchogram • Mucus / cast plugging plugging Bronchiectasis Bronchiectasis ‐ Forms • Saccular – Progressive dilation • Large cystlike • Greatest damage of bronchial mucosa Bronchiectasis Bronchiectasis • Etiology – Acquired • Frequent pulmonary infection • Tuberculosis • Bronchial obstruction – Congenital • Katagener’s Syndrome – Bronchiectasis – Dextrocardia – Paranasal sinusitis • Hypogammaglobulinemia • Cystic Fibrosis Bronchiectasis Bronchiectasis Pathology and Pathophysiology Obstruction Obstruction – Infection Inflammation Inflammation Destruction Bronchial Bronchial wall • Cartilage, blood vessels, elastic tissue, smooth bl ti muscle muscle Mucociliary impairment Mucociliary impairment AccumulationAccumulation-stagnation of secretions Haemophilus influenza, streptococcus, Haemophilus influenza, streptococcus, Pseudomonas Pseudomonas aeruginosa Foul Foul smelling Bronchiectasis Bronchiectasis Pathology and Pathophysiology‐ cont. – Increase V/Q mismatch • Airway Obstruction – Mucus plugging » Atelectasis, consolidation – Inflammation – dilation and distortion – airways – Smooth muscle constriction » hyperinflation • Parenchymal fibrosis Bronchial Bronchial Cast Bronchiectasis Bronchiectasis ‐ Casts Clinical Clinical Findings • • • • • • • • Increased respiratory rate Increased heart rate Use of accessory muscles Pursed lip breathing Cynaosis Digital clubbing Signs of cor pulmonale Cough, sputum production, hemoptysis Chronic Bronchitis Chronic Bronchitis Clinical Clinical features Same as other COPD clinical findings COPD fi sputum sputum • Foul smelling Anerobic Anerobic Streptococcus pneumoniae Stre Haemophilus Haemophilus influenzae Pseudomonas Pseudomonas aeruginosa • Bloody - hemoptysis Bloody Bronchiectasis (micro) BRONCHIECTASIS, MICRO BRONCHIOLOALVEOLAR CARCINOMA, There is dilatation of bronchial walls with prominent submucosal inflammation. There is exfoliation of bronchial epithelial lining cells (squamous metaplastic cells and/or respiratory lining cells) Early (squamous metaplastic cells and/or respiratory lining cells). Early peribronchial fibrosis is present. Bronchiectasis • Obstructive • Restrictive ...
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