Bronchiectasis and Fibrotic lung disease Flashcards Preview

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Flashcards in Bronchiectasis and Fibrotic lung disease Deck (27)
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1

What is bronchiectasis

- This is chronic inflammation of the bronchi and bronchioles that leads to a permanent dilatation and thinning of these airways

2

What are the main organisms that cause bronchiectasis

- H.influenzae
- Strep.pneumoniae
- Staph.aureus
- Pseudomonas aeruginosa

3

What are the common causes of bronchiectasis

Congenital
- Cystic fibrosis
- young's syndrome
- primary colliery dyskinesia
- Kartagener's syndrome

Post infection
- measles
- pertussis
- bronchiolitis
- pneumonia
- TB
- HIV

Other
- bronchial obstruction
- allergic bronchopulmonary aspergillosis
- rheumatoid arthritis
- ulcerative colitis

4

What are the symptoms of bronchiectasis

- persistent cough
- large amounts of purulent sputum
- intermittent haemoptysis
- breathlessness occurs as disease progression
- infection characterised by increase sputum volume and purulence
- pleuritic chest pain
- coarse crackles can occur

5

What are the signs of bronchiectasis

- finger clubbing
- coarse inspiratory crepitations
- wheeze

6

What are the complications of bronchiectasis

- pneumonia
- pleural effusion
- pneumothorax
- haemoptysis
- cerebral abscess
- amyloidosis

7

What investigations do you use to diagnose bronchiectasis

- HRCT scanning
- Sputum culture
- CXR
- spirometry
- bronchoscopy
- serum immunoglobulins
- CF - Sweat test
- skin prick test
- aspergillus precipitins

8

What differences do you observe on an CXR to diagnose bronchiectasis with

- cystic shadows
- thickened bronchial walls

9

What does spirometry show in bronchiectasis

- obstruction pattern
- reversibility should be assessed

10

What is the global leading cause of bronchiectasis

TB

11

describe the pathophysiology of bronchiectasis

- abnormal and permanently dilated airways
- characterised by a vicious circle of neutrophilic inflammation, recurrent infection and damage to the airways
- this impairs mucociliary clearance and persistent inflammation which leads to the impairment of immunity

12

What is the management for bronchiectasis

- airway clearance
- anti-inflammatories
- antibiotics
- bronchodilators
- corticosteroids
-

13

Describe how you would use airway clearance in bronchiectasis

- airway clearance techniques and mucolytics
- chest physiotherapy and devices such as a flutter valve can help sputum expectoration and mucus drainage

14

Why are anti-inflammatories sued in bronchiectasis

- long term azithromycin has an immunomodulatory effect and has been demonstrated to reduce exacerbation

15

When should antibiotics be prescribed in bronchiectasis and what antibiotics should be prescribed

- Should be prescribed according to bacterial sensitivities
- patients known to culture pseudomonas aeruginosa require either oral ciprofloxacin
- if you have more than or equal to 3 exacerbations a year long term antibiotic should be considered

16

Why is P.aeruginosa important to isolate in bronchiectasis

patients with P. aeruginosa experience an accelerated decline in lung function and more frequent exacerbations
- increases morbidity

17

What are the differential diagnosis of a cough with sputum

- infection
- COPD
- cystic fibrosis
- pneumonia
- lung abscess
- pulmonary edema

18

Name the similarities and differences between COPD and Bronchiectasis

COPD
- caused by smoking or environmental causes
- corticosteroid and LABA/LAMA treatment

Bronchiectasis
- consistent infection
- excess mucus
- treatment involves airway clearance and antibiotics to treat infection

Both have similar symptoms

19

What is the pathophysiology of fibrotic lung disease

- there is fibrosis and remodelling of the interstitium
- chronic inflammation
- hyperplasia of type II epithelial cells
- type II pneumocytes

20

What are the common causes of fibrotic lung disease

known cause
- occupation
- drugs
- hypersensitivity reactions
- infections

Systemic disorders
- sarcoidosis
- rheumatoid arthritis
- SLE
- ulcerative colitis, renal tubular acidosis, autoimmune thyroid diseases

Idiopathic
- idiopathic pulmonary fibrosis
- cryptogenic organising pneumonia
- non-specific interstitial pneumonitis

21

What are the symptoms of fibrotic lung disease

- dyspnoea on exertion
- non productive paroxysmal cough
- abnormal breath sounds

22

What are the signs of fibrotic lung disease

- abnormal CXR
- restrictive pulmonary spirometry
- decrease DLCO

23

What investigations are used to confirm the diagnosis of fibrotic lung disease

- CXR
- Spirometry
- DLCO

24

What causes fibrotic shadowing in the upper zone of a CXR

- TB hypersensitivity pneumonitis
- ankylosing spondylitis
- radiotherapy
- progressive massive fibrosis

25

What causes fibrotic shadowing in the mid zone of a CXR

- sarcoidosis
- histoplasmosis

26

What causes fibrotic shadowing in the lower zone of a CXR

- idiopathic pulmonary fibrosis
- asbestosis

27

How do you manage fibrotic disease

- corticosteroids
- oxygen support
- pulmonary rehabilitation
- lung transplant