Download - Bronchiectasis Nisha
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RONCHIECTASIS
Presented by ,
Mr. Maheboob
1styear M.sc Nursing
Govt college of nursing
Holenarsipur
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DEFINITION:
ronchiectasis
is defined as
er!anent,
abnor!a"
di"atation of one
or !ore "ar#e
bronchi$
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DEFINITION:
ronchiectasis is defined as
abnor!a" and irre%ersib"e
di"atation of the bronchi and
bronchio"es reater than '!! in
dia!eter( de%e"oin# secondary to
inf"a!!atory )ea*enin# of
bronchia" )a""s$
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ETIO+O-:
Bronchiectasis has both
con#enita" and ac./ired
ca/ses$
http://en.wikipedia.org/wiki/Congenitalhttp://en.wikipedia.org/wiki/Acquiredhttp://en.wikipedia.org/wiki/Acquiredhttp://en.wikipedia.org/wiki/Congenital -
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THE YELLOWISH DISCOLORATION OF LUNG PARENCHYMA REFLECTS OBSTRUCTIVE PNEUMONIA.
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AC01IRED CA1SES
Tuberculosis,
pneumonia,
inhaled foreign bodies,
allergic bronchopulmonaryaspergillosis
and bronchioltumoursare the major
acquired causes of Bronchiectasis.
http://en.wikipedia.org/wiki/Tuberculosishttp://en.wikipedia.org/wiki/Allergic_bronchopulmonary_aspergillosishttp://en.wikipedia.org/wiki/Allergic_bronchopulmonary_aspergillosishttp://en.wikipedia.org/wiki/Lung_cancerhttp://en.wikipedia.org/wiki/Lung_cancerhttp://en.wikipedia.org/wiki/Lung_cancerhttp://en.wikipedia.org/wiki/Lung_cancerhttp://en.wikipedia.org/wiki/Allergic_bronchopulmonary_aspergillosishttp://en.wikipedia.org/wiki/Allergic_bronchopulmonary_aspergillosishttp://en.wikipedia.org/wiki/Allergic_bronchopulmonary_aspergillosishttp://en.wikipedia.org/wiki/Allergic_bronchopulmonary_aspergillosishttp://en.wikipedia.org/wiki/Tuberculosis -
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INFECTIE C!"#E# !##$CI!TE% &IT'B($NC'IECT!#I# INC)"%E
infections caused by
the #taphylococcus,
*lebsiella, or
Bordetellapertussis,
the causati+e agent
of hooping cough.
http://en.wikipedia.org/wiki/Staphylococcushttp://en.wikipedia.org/wiki/Klebsiellahttp://en.wikipedia.org/wiki/Bordetella_pertussishttp://en.wikipedia.org/wiki/Bordetella_pertussishttp://en.wikipedia.org/wiki/Whooping_coughhttp://en.wikipedia.org/wiki/Whooping_coughhttp://en.wikipedia.org/wiki/Bordetella_pertussishttp://en.wikipedia.org/wiki/Bordetella_pertussishttp://en.wikipedia.org/wiki/Bordetella_pertussishttp://en.wikipedia.org/wiki/Klebsiellahttp://en.wikipedia.org/wiki/Staphylococcus -
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!#-I(!TI$N $F !$NI!!N% $T'E( T$/IC 0!#E#,
pulmonary aspiration,
alcoholism, heroin1drug use2,
+arious allergies all appear to be
lin3ed to the de+elopment of
Bronchiectasis
http://en.wikipedia.org/wiki/Ammoniahttp://en.wikipedia.org/wiki/Pulmonary_aspirationhttp://en.wikipedia.org/wiki/Alcoholismhttp://en.wikipedia.org/wiki/Heroinhttp://en.wikipedia.org/wiki/Allergyhttp://en.wikipedia.org/wiki/Allergyhttp://en.wikipedia.org/wiki/Heroinhttp://en.wikipedia.org/wiki/Alcoholismhttp://en.wikipedia.org/wiki/Pulmonary_aspirationhttp://en.wikipedia.org/wiki/Ammonia -
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Childhood
!cquired Immune %e4ciency #yndrome 1!I%
#2
, hich predisposes patients to a +ariety of
pulmonary ailments, such as pneumoniaand
other opportunistic infections.
In5ammatory boel disease, especially
ulcerati+e colitis.
! 'iatalherniacan cause Bronchiectasis
hen the stomach acid that is aspirated
http://en.wikipedia.org/wiki/AIDShttp://en.wikipedia.org/wiki/AIDShttp://en.wikipedia.org/wiki/Pneumoniahttp://en.wikipedia.org/wiki/Opportunistic_infectionshttp://en.wikipedia.org/wiki/Inflammatory_bowel_diseasehttp://en.wikipedia.org/wiki/Ulcerative_colitishttp://en.wikipedia.org/wiki/Hiatal_herniahttp://en.wikipedia.org/wiki/Hiatal_herniahttp://en.wikipedia.org/wiki/Hiatal_herniahttp://en.wikipedia.org/wiki/Hiatal_herniahttp://en.wikipedia.org/wiki/Ulcerative_colitishttp://en.wikipedia.org/wiki/Inflammatory_bowel_diseasehttp://en.wikipedia.org/wiki/Opportunistic_infectionshttp://en.wikipedia.org/wiki/Pneumoniahttp://en.wikipedia.org/wiki/AIDShttp://en.wikipedia.org/wiki/AIDS -
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CONENITA+CA1SES
*artagener syndrome primary immunode4ciencies
&illiams6Campbell syndrome and
arfan7s syndrome.
-atients ith alpha 86antitrypsin
de4ciency ha+e been found to be
particularly susceptible to
bronchiectasis,
http://en.wikipedia.org/wiki/Primary_ciliary_dyskinesiahttp://en.wikipedia.org/wiki/Primary_immunodeficiencieshttp://en.wikipedia.org/wiki/Williams-Campbell_syndromehttp://en.wikipedia.org/wiki/Marfan_syndromehttp://en.wikipedia.org/wiki/Marfan_syndromehttp://en.wikipedia.org/wiki/Alpha_1-antitrypsinhttp://en.wikipedia.org/wiki/Alpha_1-antitrypsinhttp://en.wikipedia.org/wiki/Marfan_syndromehttp://en.wikipedia.org/wiki/Marfan_syndromehttp://en.wikipedia.org/wiki/Williams-Campbell_syndromehttp://en.wikipedia.org/wiki/Primary_immunodeficiencieshttp://en.wikipedia.org/wiki/Primary_immunodeficiencieshttp://en.wikipedia.org/wiki/Primary_ciliary_dyskinesiahttp://en.wikipedia.org/wiki/Primary_ciliary_dyskinesia -
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MORPHOLOGI!L "#P$%
Cylindrical or tubularbronchiectasis
aricose
saccular or cystic bronchiectasis
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Three diferent patterns o
bronchiectasis have been described
cylindrical bronchiectasis: theinvolved bronchi appear uniformly
dilatedvaricose bronchiectasis:the
aected bronchi have an irregular or
PATTERNS OF
BRONC!ECTAS!S
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#LIN&RI!L OR "'('L!R (RONHI$"!%I%
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)aricose bronchiectasis
*. &iagnosis 9 ChestCT
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Sacc/"ar &cystic( bronchiectasis:
The bronchi have a ballooned
appearance at the periphery"endin# in blind sacs $itho%t
reco#ni&able bronchial str%ct%resdistal to the sacs
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C:#TIC B($NC'IECT!#I#
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Cystis ; saccular
bronchiectasis
*. &iagnosis 9 ChestCT
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D/e to etio"o#ica" factor
Inf"a!!ation of bronchia" )a""
ca/sin#
+oss of s/ortin# str/ct/re
Res/"t in
Thic* s/t/! that obstr/ct the bronchi
The bronchia" )a"" beco!e
er!anent"y dia"ated and distorted
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PATHOPH-SIO+O-
&ilation an+ +istortion ofthe bronchi
&a,age of air-ayepitheliu,
&ilation an+ hyperplasiaof bloo+ capillary
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Bronchiectasis Pathophysiology
Airway Injury +
Secretion Stimuli
Secretion Stasis Infection
Airway Destruction +
Airway Dilation
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C)INIC!) !NIFE#T!TI$N
1. The produ!"o# o$ %&r'e (u!"!"e) o$ puru%e#! do$!e# $ou%*)+e%%"#' )pu!u+.
The +olume of sputum can be used for
estimating the se+erity of the disease
ild < 8= m)
oderate 8=>8?= m)
#e+ere @8?= m)
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A. Chro#" ou'h
,. He+op!-)"): Fre(ue#! More o++o#%- "# dr- &r"e!-
U)u&%%- +"%d /0%ood )!re&"#' o$ puru%e#!)pu!u+2
M&))"e he+op!-)") ") u)u&%%- $ro+
d"%&!ed 0ro#h"&% &r!er"e) or 0ro#h"&%*pu%+o#&r- &)!o+o)e) u#der )-)!e+"pre))ure
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4. Reurre#! p#eu+o#"&3
same segment
5. S-)!e+" +"$e)!&!"o#):
fever, weight loss
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SINS AND S-2PTO2S
Chronic cough ith foul smelling sputumproduction,
#ome people ith bronchiectasis mayproduce frequent green;yello sputum 1up
to A=ml 1 o2 daily2. Bronchiectasis may also present ith
hemoptysis -neumonia Bad breathindicati+e of acti+e infection. Frequent bronchial infections and
breathlessness are to possible indicators
of bronchiectasis.
http://en.wikipedia.org/wiki/Hemoptysishttp://en.wikipedia.org/wiki/Bad_breathhttp://en.wikipedia.org/wiki/Bad_breathhttp://en.wikipedia.org/wiki/Hemoptysis -
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DIANOSTIC E3A+1ATION:
History an+ physical ea,ination hest /ray " 0co,puterise+ to,ography scan (loo+ tests "esting of the ,ucus to i+entify any
bacteria present hec2ing oygen levels in the bloo+ Lung function tests 0spiro,etry.
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&ilate+ bronchus
(RONHI$"!%I%
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CO2P+ICATIONS
Progressive suppuration. Hae,optysis3 ,a4or pul,onary
hae,orrhage. OP&3 e,physe,a3 chronic respiratory insu5ciency
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C$-)IC!TI$N
)ocal complication
Recurrent pneu,onia
Lung abcess
$,pye,a
He,optysis
Pul,onary hypertension
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#ystemic complication
Hypoproteine,ia 6a,yloi+osis
Generali7e+ e+e,a 0188g,
sputu,9*:; g proteinprotein loosing
pneu,opathy
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TREAT2ENT
Treat!ent of bronchiectasis inc"/des
contro""in# infectionsand bronchia"
secretions,
re"ie%in# air)ay obstr/ctions,
re!o%a" of affected ortions of "/n# by
s/r#ica" re!o%a" or artery e!bo"i4ation
re%entin#co!"ications$
http://en.wikipedia.org/wiki/Infectionhttp://en.wikipedia.org/wiki/Complication_(medicine)http://en.wikipedia.org/wiki/Complication_(medicine)http://en.wikipedia.org/wiki/Infection -
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TREAT2ENT
Theray has se%era" !a5or #oa"s:
/12Tre&!+e#! o$ "#$e!"o#4 p&r!"u%&r%- dur"#' &u!e
e5&er0&!"o#)
/62I+proed %e&re o$ !r&heo0ro#h"&% )ere!"o#)
/,2 Redu!"o# o$ "#$%&++&!"o#
/72 Tre&!+e#! o$ "de#!"$"&0%e u#der%-"#' pro0%e+
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TREAT2ENT
2edica" !ana#e!ent
8.I!ro%in# the draina#e of air)ay
82 epectorant
A2 bronchodilators
G2 postural drainage
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'$ Antibiotic
The choice of antibiotics sho/"d
be acc/rate"y by the res/"ts of
s/t/! c/"t/re and dr/#
sensiti%ity test$
E!irica" theray
666antise/do!ona" antibiotics$
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ANT!B!OT!CS ARE TE CORNERSTONE OF BRONC!ECTAS!S 'ANA(E'ENT
Antibiotics are /sed on"y d/rin# ac/te
eisodes
Choice of an antibiotic sho/"d be #/ided
by #ra!7s stain and c/"t/re of s/t/!
E!iric co%era#e &a!o8ici""in, co6
tri!o8a4o"e,"e%of"o8acin( is often #i%en
initia""y
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B($NC'$%I)!TE(
ronchodi"ators to i!ro%e
obstr/ction and aid c"earance
of secretions are /sef/" in
atients )ith air)ay
hyerreacti%ity and re%ersib"e
airf"o) obstr/ction
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S/r#ica" !ana#e!ent is indicated
9$ Rec/rrent and refractory c"inica"
sy!to!s are d/e to a foca" area
of disease in%o"%e!ent$
'$ 2assi%e he!otysis
2ana#e!ent of he!otysis
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S%r#ical resection
Bronchial arterial embolization Altho%#h resection )ay be
s%ccess%l i disease islocali&ed" e)boli&ation is
preerable $ith $idespread
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N1RSIN 2ANAE2ENT:
History and hysica" e8a!ination
Obtain history re#ardin# a!o/nt
and characteristics of s/t/!
rod/ced, inc"/din# hae!otysis$
A/sc/"tate "/n#s for diff/se rhonchi
and crac*"es$
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N'R%ING &I!GNO%I%
IneHecti+e !iray Clearance related
to tenacious and copious secretions