بسم الله الرحمن الرحيم - PowerPoint Presentation

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بسم الله الرحمن الرحيم

13ربيع

الاول

21/11/2018

Rhinosinusitis

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To know the epidemiology ,etiology, pathogenesis ,clinical presentation, investigation ,diagnosis ,treatment ,complication ,prognosis

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Bronchiolitis

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.

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the 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

.

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Clinical 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.

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Investigations

•

PFTs

•

CXR

•

HRCT

•

Open or

thoracoscopic

lung biopsy may be required.

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Management

• Treat any underlying disorder

• Cough suppressants

• Long-term

macrolide

antibiotics,

• Steroids

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Bronchiectasis

 

Bronchiectasis means abnormal dilatation of the bronchi.

Chronic suppurative airway infection with sputum production, progressive scarring and lung damage are present, whatever the cause.

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Pathology

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

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Causes of bronchiectasis

 

Congenital

Cystic fibrosis

Ciliary dysfunction syndromes

Primary ciliary dyskinesia (immotile cilia syndrome)

Kartagener's syndrome (sinusitis and transposition of the viscera)

Primary hypogammaglobulinaemia

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Acquired: 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

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Clinical features  

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.

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3-Poor general health

weight loss.

anorexia.

lassitude,

low-grade fever,

failure to thrive in children.

4-digital clubbing.

 

 

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Pneumonia and pleurisy

fever,

Malaise

Recurrent pleurisy in the same site.

Haemoptysis

Can, be the only symptom in so-called 'dry

bronchiectasis

'

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Investigations

 

Bacteriological and mycological examination of sputum

 

Radiological examination

 

C X ray

CT

chest.

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CX RAY

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CT CHEST

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Assessment of ciliary function

Saccharin test

Ciliary beat frequency ….biopsies taken from the nose.

Structural abnormalities of cilia can be detected by electron microscopy.

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Physical 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.

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Management

In patients with airflow obstruction :

inhaled bronchodilators

corticosteroids.

Physiotherapy :

5-10 minutes once or twice daily.

Antibiotic therapy:

 

same as those used in COPD

larger doses and longer courses are required,.

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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.

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Haemoptysis

treating the underlying infection,

severe cases

percutaneous

embolisation

by an interventional radiologist .

Surgical treatment

Excision of

bronchiectatic

areas.

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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.

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Cystic fibrosis

 

Genetics, pathogenesis and epidemiology  

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

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Clinical features

 

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

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Complications of cystic fibrosis

 

1-Respiratory

 

Infective exacerbations of bronchiectasis

Spontaneous

pneumothorax

Haemoptysis

Nasal polyps  

Respiratory failure

Cor pulmonale

Lobar collapse due to secretions

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2-Gastrointestinal

Malabsorption and

steatorrhoea

others

 

3-Others

Diabetes (25% of adults)

Male infertility

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Thank you

Any Q