13ربيع الاول 21112018 Rhinosinusitis To know the epidemiology etiology pathogenesis clinical presentation investigation diagnosis treatment complication prognosis Bronchiolitis ID: 780183
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Slide1
بسم الله الرØمن الرØيم
13ربيع
الاول
21/11/2018
Rhinosinusitis
Slide2To know the epidemiology ,etiology, pathogenesis ,clinical presentation, investigation ,diagnosis ,treatment ,complication ,prognosis
Slide3Bronchiolitis
Bronchioles
are small airways of <2mm diameter,.
increased airway resistance unresponsive to
β2 stimulants.
Pathophysiology
is unclear there is probably an initial injury to the
epithelium of the bronchioles with subsequent inflammation.
Adjacent alveoli are often also involved.
Slide4the commonest situations in which a diagnosis of
bronchiolitis
is useful:
• Viral
bronchiolitis
(e.g. RSV)
• Post-lung transplant.
• Post-bone marrow transplant
• Connective tissue disease (usually RA)
• In association with ILD and airways disease
• Diffuse pan-
bronchiolitis
.
Slide5Clinical features
Insidious onset of cough and
dyspnoea
over weeks to
months.
There may be an associated medical history, such as recent viral illness, transplant, connective tissue disease, or
vasculitis
, or a history of mineral dust or drug exposure.
Slide6Investigations
•
PFTs
•
CXR
•
HRCT
•
Open or
thoracoscopic
lung biopsy may be required.
Slide7Management
• Treat any underlying disorder
• Cough suppressants
• Long-term
macrolide
antibiotics,
• Steroids
Slide8Bronchiectasis
Â
Bronchiectasis means abnormal dilatation of the bronchi.
Chronic suppurative airway infection with sputum production, progressive scarring and lung damage are present, whatever the cause.
Slide9Slide10Pathology
The
bronchiectatic
cavities .
Inflammatory changes in the deeper layers of the bronchial wall and hypertrophy of the bronchial arteries.
Chronic inflammatory and fibrotic changes are usually found in the surrounding lung tissue
Slide11Causes of bronchiectasis
Â
Congenital
Cystic fibrosis
Ciliary dysfunction syndromes
Primary ciliary dyskinesia (immotile cilia syndrome)
Kartagener's syndrome (sinusitis and transposition of the viscera)
Primary hypogammaglobulinaemia
Slide12Acquired: children
Pneumonia (complicating whooping cough or measles)
Primary TB
Inhaled foreign body
Acquired: adults
Suppurative
pneumonia
Pulmonary TB
Allergic
bronchopulmonary
aspergillosis
complicating asthma .
Bronchial tumours
Clinical features Â
Symptoms of bronchiectasis
1-Cough
 Chronic productive cough
worse in mornings and often brought on by changes of posture.
2-Sputum
often copious and persistently purulent.
Halitosis.
Slide14Slide153-Poor general health
weight loss.
anorexia.
lassitude,
low-grade fever,
failure to thrive in children.
4-digital clubbing.
Â
Â
Slide16Pneumonia and pleurisy
fever,
Malaise
Recurrent pleurisy in the same site.
Haemoptysis
Can, be the only symptom in so-called 'dry
bronchiectasis
'
Slide17Slide18Slide19Investigations
Â
Bacteriological and mycological examination of sputum
Â
Radiological examination
Â
C X ray
CT
chest.
Slide20CX RAY
Slide21CT CHEST
Slide22Assessment of ciliary function
Saccharin test
Ciliary beat frequency ….biopsies taken from the nose.
Structural abnormalities of cilia can be detected by electron microscopy.
Slide23Physical signs
in the chest may be
1- unilateral 2- bilateral.
May be
no abnormal
physical signs.
Numerous biphasic coarse crackles heard over the affected areas.
Collapse.
Slide24Management
In patients with airflow obstruction :
inhaled bronchodilators
corticosteroids.
Physiotherapy :
5-10 minutes once or twice daily.
Antibiotic therapy:
Â
same as those used in COPD
larger doses and longer courses are required,.
secondary infection
staphylococci and Gram-negative bacilli, in particular
Pseudomonas
species, antibiotic therapy should be guided by the microbiological sensitivities.
For
Pseudomonas
,
oral ciprofloxacin (250-750 mg 12-hourly) or
ceftazidime
by intravenous injection or infusion (1-2 g 8-hourly) may be required.
Slide26Haemoptysis
treating the underlying infection,
severe cases
percutaneous
embolisation
by an interventional radiologist .
Surgical treatment
Excision of
bronchiectatic
areas.
Prognosis
progressive when associated with ciliary dysfunction and cystic fibrosis,
respiratory failure.
Good if physiotherapy is performed regularly and antibiotics are used .
Prevention
Childhood infection prophylaxis and treatment.
The early recognition and treatment of bronchial obstruction.
Slide28Cystic fibrosis
Â
Genetics, pathogenesis and epidemiology Â
Cystic fibrosis (CF) is the most common fatal genetic disease in Caucasians, with
autosomal
recessive inheritance,.
CF is the result of mutations affecting a gene
Slide29Clinical features
Â
The lungs are macroscopically normal at birth,
bronchiectasis in childhood.
Recurrent exacerbations of bronchiectasis, initially in the upper lobes but subsequently throughout both lungs.
Most men with CF are infertile
Complications of cystic fibrosis
Â
1-Respiratory
Â
Infective exacerbations of bronchiectasis
Spontaneous
pneumothorax
Haemoptysis
Nasal polyps Â
Respiratory failure
Cor pulmonale
Lobar collapse due to secretions
Slide312-Gastrointestinal
Malabsorption and
steatorrhoea
others
Â
3-Others
Diabetes (25% of adults)
Male infertility
Slide32Slide33Thank you
Any Q