Syndrome of pathological bronchial dilation.pptx

Syndrome of pathological bronchial dilation
(widening).
Physical diagnosis of pulmonary syndromes
KYRGYZ - RUSSIAN SLAVIC UNIVERSITY
Department of Therapy No. 1
GULBARCHYN SURANOVA

Syndrome of pathological
bronchial dilation
•Bronchial dilatation, also known as
Bronchiectasis, is a chronic
respiratory condition characterized by
the abnormal widening and thickening
of the bronchial tubes, leading to
impaired mucus clearance and
recurrent lung infections.

• What are the types of bronchiectasis?

Classification of bronchiectasis by REID
a) Tubular (or cylindrical)
bronchiectasis.
• the mildest form of bronchiectasis
shows the loss of
normal airway tapering.
• The bronchi are regularly outlined
(tubular), dilated in diameter, with
straight walls, often coming to a
straight abrupt end, instead of a
tapering end, due to obstruction of the
peripheral bronchial tree by secretions,
casts, and inflammatory wall edema.
• This is the dominant form currently
seen.

b) Saccular or
Varicose bronchiectasis.
shows further distortion of
the airway wall along with
more mucous and sputum
production by the individual;
some of the bronchi may
appear to be in a beaded
form.
Presence of irregular
dilatations, outpouchings, and
tortuosity of the airways.
characterized by focal
constrictive areas along the
dilated airways that result
from defects in the bronchial
wall

c) Cystic bronchiectasis.
3. The most severe form of
bronchiectasis and the least common
form is this one.
Dilatation and cystic distortion of the
distal airways that may be focal or
more generalized, resulting in saccules
that appear as a cluster of grapes.
This form has large air spaces and a
honeycombed appearance in CT
scan studies and usually has thicker
walls than the blebs seen
with emphysema. Some people have
more than one type in their lungs

So,
• Bronchiectasis is a chronic inflammatory lung
disease, which is clinically characterized by
recurrent or persistent (> 8 weeks) cough with the
production of purulent or mucopurulent sputum and
recurrent respiratory tract infections, and
radiologically - persistent dilation or ectasia of the
bronchi and violation of their architectonics

Etiology
• TYPE
• PRIMARY:
• Congenital are rare: Hereditary structural
abnormalities of lung development
associated with weakness of the
bronchial wall can lead to bronchiectasis
• SECONDARY:
• Acquired
as a complication of other disease
Aethiology • Sievert — Cartagener syndrome —
structural and functional disorders of the
ciliated epithelium of the bronchi;
• Munier-Kuhn syndrome — congenital
elongation and expansion of the
cartilaginous rings of the trachea and
large bronchi
• Williams— Campbell syndrome —
congenital failure of bronchial cartilage;
• Marfan syndrome is a congenital
disorder of the connective tissue
structure;
• Landsteiner's disease Fanconi (cystic
fibrosis )
- congenital (alpha-1 antitrypsin
deficiency, immotile cilia syndrome).
• Chronic respiratory tract infections:
Chronic pulmonary abscess,
Tuberculosis caverna, COPD,
immunodeficiency
• Repeated inhalation of foreign bodies,
causing irritation and acute
inflammation of the respiratory tract.
• Chemical or physical damage to the
lungs.
• Gastro-esophageal reflux
- environmental exposure
- drug and/or alcohol abuse

Pathogenesis
• 2 conditions are necessary for the development of bronchiectasis:
1. Inflammatory reaction in the bronchial wall
2. Violation of bronchial drainage function
1. Bronchiectasis is caused by damage to the walls of the bronchi; this
damage consists of destroying the smooth muscles and the elastic tissue
that allows the bronchial tubes to contract.
2. Consequently, if the bronchi are damaged, secretions that are normally
produced in the lung are not well removed (drainage) and cause an
increased likelihood that infections (pneumonia, bronchitis) can develop.
• Unfortunately, these infections can cause further damage to the
bronchial walls producing a cycle of increased damage and then
increased infection. As the cycle continues, lung functionality
decreases.

Why does bronchiectasis occur in Landsteiner's disease
Fanconi (cystic fibrosis, MV)?
MV develops as an outcome of a mutation of a
gene located on the long arm of the 7th
chromosome in which there is a lack of protein
function, which leads to a malfunction of the
chloride channel located in the apical (apical)
part of the cells of the exocrine glands.
As a result of this defect, chlorine anions are
retained in the cell, increasing the absorption of
sodium and water cations. The loss of water
from the lumen of the exocrine glands leads to
an increase in the viscosity of their secretions,
obturation of organs and disruption of their
functions.
In the lungs, the secretion of the bronchi is
dehydrated; it becomes more viscous, the
clearance of mucus on the surface of the ciliated
epithelium is disrupted. This provokes the
development of bacterial infection, which causes
morphological changes in the bronchial tree and
lung interstitium; typical changes in MV are
bronchiectasis and bronchiolectasis, foci of
interstitial fibrosis, cystic changes, bullous
emphysema and segment atelectasis.

• History of recurrent chest infections,
• Cough: invariably present
• Expectoration: Purulent, tenacious sputum production, frequently worse in the
morning
• “Dry bronchiectasis” presenting as cough, minimal sputum expectoration,
and/or hemoptysis is occasionally described.
• Hemoptysis: 40 to 70%
• Increasing cough, dyspnea, and volume and colour of sputum, fever are
hallmarks of acute exacerbations.
• Intoxication: perspiration, weakness, fever during exacerbations.
Intoxication, at first, is present in exacerbation only, then it becomes
constant.
• Dyspnea: expiratory, due to bronchial obstruction and emphysema in late
stages
Clinical features

Cough with purulent sputum
• Cough: excessive (The daily amount of excreted moisture varies from
100 to 500 ml, more in saccular, less in cylindrical bronchiectases)
purulent sputum which is divided in 2 layers while kept in ordinary
conditions. Upper layer is slime, in the form of viscous conforming
liquid, lower layer is fused sediment.
• The most amount of the sputum goes off in the morning.
• The sputum is better removed in certain parts of the patient’s body,
called drainage.
When bronchoectasias are located in the basal segments of the left lung
sputum is best to be placed in a right-sided position with the head and body
lowered ("hanging from the bed"). Easier and more moisture can be
removed if there are cylindrical bronchoectases.
• After the discharge of a large amount of sputum, the patient feels short-
term relief

Physical Methods of
Investigation

Examine the patient
• When examining patients with
bronchiectasis, you can
notice:
• - Cyanosis
• - Drumsticks and watch
glasses (cone-shaped
thickening of the terminal
phalanges of the fingers of the
hands). Mechanism:
prolonged violation of gas
metabolism against the
background of chronic lung
disease leads to hypertrophic
osteoarthropathy.

Examine the patient
Chest deformity –
The barrel
shape of the chest is
a late symptom
and indicates
pulmonary
insufficiency and
emphysema;

Palpation
•Increased vocal
tremor in the
affected area
•- Soreness in case
of complication of
infection

•- Dull sound over the
affected area in the
presence of exudate
•- Enhanced
tympanic sound in
the air cavity
Percussion

Main sounds
• In early stage - Weakened vesicular or vesicular with prolonged expiration
• respiration in the affected areas
• In late stage - bronchial respiration with an amphoric tinge above the lesion area
depends on the magnitude and number of bronchiectasis, the extent of infiltrative-
fibrous changes in the adjacent pulmonary parenchyma and are not always
determined;
Adventitious sounds
• - most often large- and medium-bubbly crackles, heard above the area of projection
of bronchiectasis on the chest (usually in the lower parts of the lungs), may decrease
or even disappear after coughing with the release of a significant amount of sputum
• - Pleural friction noise in case of pleurisy complication
• - Dry wheezing may also be heard, indicating a concomitant bronchial obstruction
syndrome
Auscultation
(Main+ Adventitious)

Complications (present, absent):
- pneumonia
- chronical purulent obstructive bronchitis
- bleeding
- pulmonary emphysema
- pneumosclerosis
- respiratory failure
- cor pulmonale
- secondary amyloidosis
- seronegative arthropathy, particularly during exacerbations of the disease.
Recent studies have suggested that the arthropathy may be the result of immune
complexes formed between high levels of circulating immunoglobulin and
bacterial antigens.
- Vasculitis: cutaneous vasculitis has been described in severe bronchiectasis with
and without cystic fibrosis. Again, the cause is thought to be circulating immune
complexes which may be deposited in peripheral vessels.

Laboratory and
instrumental diagnosis

Laboratory and instrumental analysis
1.Signs of inflammation:
CBC : WBC increase with shift of the neutrophils formula to the left;
ESR increase, increase of α2- and γ-globulins, fibrinogen level, CRP.
2. Secondary erythrocytosis may be present
3. Spirogram: both obstructive and restrictive changes (decrease of
both FVC and FEV1)
4. Chest X-ray: reticular deformation of lungs picture, pneumofibrosis
• signs, which also may lead to reduced lungs volume
5.CT and bronchograms are the main method of the diagnosis
6.Bronchoscopy may give possibility to suspect the diagnosis (pus coming
from one of the bronchi)

3. Chest X-ray:
• Bronchiectasis. On the
frontal projection of the
chest. Deformity and
cellular structure of the
pulmonary pattern,
areas of atelectasis,
and a decrease in the
volume of the affected
segment

Bronchiectasis.
Coloured frontal
X-ray of the chest
of a 48-year-old
woman who
presented with a
strong purulent
and persistent
cough.
She was
diagnosed with
bilateral bronchial
dilation in a form
of a condition
3. Chest X-ray:

MODERATE BRONCHIECTASIS
‐ Coarse white lines
extending out from hila

Circle filled
with air
SEVERE BRONCHIECTASIS

RINGS (CYSTS) CONTAINING AIR FLUID
‐ LEVELS

4. Bronchography
• is a method of X–ray examination of the
lungs, which allows you to study in detail the
structure of the respiratory tract.
• The essence of the method is that a special
contrast agent (usually based on iodine) is
injected into the bronchial tree of the patient's
lung, which is clearly visible on the lung X-ray.
• This substance fills the airways, as a result of
which they become visible on an X-ray (which
is not normally observed).
• The fact is that the respiratory tract (trachea,
bronchi) does not contain bone tissue. During
a conventional X-ray examination, X-rays
pass through them relatively easily, as a result
of which it is not possible to determine their
structure on an X-ray (X-ray).
• If contrast is injected into the lungs before
radiography, it will make them "visible" on the
X-ray.
• With the help of bronchography, it is possible
to assess the condition of the trachea, large
and small bronchi, as well as to identify
pathological changes in the structure of the
respiratory tract and lung tissue.

5. Bronchoscopy
(Endoscopic examination of the bronchi)
• – allows you to identify
an abundant, viscous
purulent secret, take
material for cytology
and bacanalysis,
identify the source of
bleeding, and sanitize
the bronchial tree to
prepare for the next
diagnostic stage –
bronchography

BRONCHIECTASI
S THE CT
SCAN
• Signet ring sign
• Tram tracks
‐
• String of beads
• Circles filled with air or air and fluid
• Tubular and branching opacities
• Bronchi visible within 1 cm of the pleura
• Scarring

SIGNET RING
‐ SIGN
Dilated bron
(ring)
Normal pulmonary
artery (pearl)

Dilated bronchi
filled with mucus
instead of air due to
proximal obstruction

Dilated bronchus
BRONCHIECTASIS

String
of beads
BRONCHIECTASIS
Bronchi visible
within 1 cm
of the pleura

Destroye
d lung
(Scarring)
BRONCHIECTASIS

Treatment
I. Approach to surgical treatment
•Is indicated in moderate course (in about 40% of patients) in one- sided localized bronchiectases
(pulmonary resection).
II. Medications
• 1. Antibiotics:
- depends on the results of bacteriological investigation (more often – wide spectrum penicillin,
augmentin, III generation cephalosporins, aminoglycosides).
- intravenous and intramuscular use of antibiotics.
- Endobronchial bronchoscopic clearance with removing of pus and infusion of antibacterial drugs
(0.1% furacilline or 1% dioxidine.
•2. Drainage
- postural drainage – 6-8 times a day – being in position with the bronchus enabling drainage is in
vertical downwards position
- mucolytics
- broncholytics (β2-mimetics, cholynolytics)
- endobronchial bronchoscopic clearance
•3. Infusions: metabolic and desintoxication treatment
•4. Immune system correction

Syndrome of pathological bronchial dilation.pptx

Syndrome of pathological bronchial dilation.pptx

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