00:00
Chronic bronchitis.
00:02
If bronchiectasis will have
more sputum production,
more likely to then have
infection such as Pseudomonas
As we go to the differentials,
and when you have bronchiectasis, you
will be producing a lot more sputum
hence that cup becomes really important
to distinguish between the two
and its infection that you're going
to find with bronchiectasis,
maybe such as Pseudomonas and that's
something that you should be thinking about
in a patient that has a
chromosome 7 CFTR type of issue
You're thinking about
your chloride channel,
Pseudomonas oftentimes is a bacteria that's
affecting such patients causing pneumonia even
Now ABPA stands for Aspergillus
Bronchopulmonary Type of Issues, Asthma
And them MAI which stands for
Mycobacterium avium intracellulare
Now these are infections
that also might be present,
if it's MAI, then you might be thinking
about a patient that's immunocompromised
and Allergic Bronchopulmonary Aspergillosis,
well this is maybe taking advantage of a
pre-cavitation from TB perhaps
treat separately and the differential
diagnosis less of an issue
it's more important to know the
cause, the cause, the cause
So once you find such an issue
taking place in productive cough,
and you know that this infection's
setting in, please find the cause
don't fight over the diagnosis, and for
Pete's sakes get rid of the organism
through proper antibiotics,
either antipseudomonal,
or whatever that the infection might be,
either antifungal, so on and so forth.
01:33
Now, with bronchiectasis
and further differentials,
cystic fibrosis, well here you're
thinking about a young child
but what's cystic fibrosis?
Well there might be plugging
up of all of your ducts,
it might not only with the patient
then appear with having
issues in the lung and may
result in bronchiectasis
but then it may also have
issues in the pancreas.
01:54
In fact, one of the common causes
of acute pancreatitis in a child
will be cystic fibrosis,
usually Caucasian.
02:02
Bronchopulmonary infections such
as staph and tuberculosis
sometimes will occur in COPD
and immunodeficient patients
oftentimes prone to infections as well.
02:14
Some risk factors that all
come in here in bronchiectasis
Remember, secondary,
secondary, secondary,
as far as differentials are concerned
your primary importance at that point
is to make sure that you are taking
care of the underlying cause
versus battling
over the diagnosis.
02:29
And then secondary is, what exactly is
causing the increased mucus production
therefore predisposing your patient
to infection then setting in
Hereditary diseases, continue
risk factors, for example:
say that your patient doesn't have proper
cilia or your primary ciliary dyskinesia
something like Kartagener Syndrome, we
have dextrocardia embryologically speaking
can't properly get
rid of substances,
atypical mycobacterium infections and once
again, allergic bronchopulmonary aspergillosis
right middle lobe syndrome, yellow
nail syndrome and pay attention here,
this is inflammatory bowel diseases
often associated with bronchiectasis
Inflammatory bowel diseases
then of course you're saying,
Dr. Raj that this could be association with
Crohn's, or maybe perhaps ulcerative colitis?
This is true clinically, keep
this in mind: Bronchiectasis, IBD
Wat else, Prevention.
Really, no perfect method of preventing.
03:36
But you have to find the cause, once you
find that cause, then it will go away
so prevention is rather
difficult with bronchiectasis.
03:42
Routine chest x-ray may show clouding of
bronchial marking and "Tram tracking"
In other words, the
membrane becoming affected.
03:50
If the sputum sample shows
pseudomonas, then at this point,
Well, you're thinking about
antipseudomonal immediately
Next, the diagnostic study of choice is
high resolution CT (HRCT) of the chest
Bronchiectasis, what
are you looking for?
Those dilated, dilated bronchi.
04:12
Treatment.
04:13
Well, you should begin by looking
for the underlying cause,
We talked about MAI, immune deficient
patients with all kinds of infections
and Allergic bronchopulmonary
aspergillosis
Frequent antibiotics directed
against the organism in the sputum
but the resistance is something is
what you're always worried about.
04:30
Anyway clearance with manual percussion
and then you have vest therapy,
Yeah, other ways in which maybe
perhaps your objective at this point
is to clear, clear your airways because
of the increased mucus production.