BRONCHIECTASIS

Defination:-
It is defined as a permanent dilation of the Bronchi and Bronchioles,as a
Result of long term obstruction and/or infection.It is usually associated with
Pneumonia, collapse or emphysema.

Etiology:-
(1)Congenital:-
(a) kartanger syndrome:- It is triad of sinusitis,bronchiectasis and situs
inversus.
(b) William cambell syndrome:- absence of bronchial cartilage and
ring.
(2)Obstructive:-
(a)Foreign body
(b)Thick mucus plugs in cystic fibrosis,chronic asthama and chronic
.bronchitis.

(3)Infective:-
measles, pertusis,sinusitis,tuberculosis,staphylococcal pneumonia.

(4) Aspiration:-
gastroesophagial refius.

(5)Immunodeficiency disorder:-
AIDS & congenital

PATHOGENESIS:-
*Recurrent pulmonary infection & aspirations leads to damage to
bronchial wall leading to permanent dilation of bronchi.
*They are of four types: 1)Saccular
2)cylindrical
3)Fusiform
4)Venous

CLINICAL FEATURES:-
*Onset is usually insidious with persistent or recurrent cough with
production pf mucopurulent, foul smelling sputum.
*patient breath is foul smelling, when sputum is collected in conical
flask it forms three layers:- thin &frothy superficial layer, thick & mucopurulent
intermediate layer, opaque & purulent layer with Dietrich’s plug at bottom.
*Advanced cases present with Dyspnea, clubbing,hemoptysis &cynosis.
*On auscultation localized crepitutions are found.Signs of collapse or
emphysema may also be found.

DIAGNOSIS:-
(1) Chest X-ray:-
(a) Increased bronchovascular markings.[BVM]
(b) Loss of lung volume suggested by crowding of BVM.
(c) Honey Comb pattern.
(d) Rail road tracks pattern (linear streaks)
(e) Cystic lesions with air fluid level.
(2) CT Scan :- more informative than chest x- ray.
(3) Bacteriological examination of sputum.
(4) Broncho graphy :- now a days replaced by CT scan

TREATMENT :-
(1) Appropriate systemic antibiotics covering suspected organism:-
H.influenza-B ,pneumococci, s.aureus,pseudomonas.
(2)postural drainage :-with help of mucolytics (N acety cystein)
& bronchodilator.
(3)Breathing exercire &chest physiotherapy.
(4)Surgical intervention :-segmental or lobar resection.

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