Lectures

Bronchiectasis: Pathogenesis

by Carlo Raj, MD
(1)

Questions about the lecture
My Notes
  • Required.
Save Cancel
    Learning Material 2
    • PDF
      Slides ObstructiveLungDisease Bronchiectasis RespiratoryPathology.pdf
    • PDF
      Download Lecture Overview
    Report mistake
    Transcript

    00:02 Now I come to our last little specific disease of obstructive However I do need you to keep the topics that are upcoming as more or less a continuum of things that we've looked at With obstructive, 3 major ones that you have to keep in mind and we discussed this as an overview so we're concluding our discussion of obstructive is your asthma, chronic bronchitis and your emphysema We'll take a look at here, we'll begin by looking at is bronchiectasis First dissect the name bronchi- and -ectasis and this will then give you your defiinition or your presentation of a dilated bronchi Persistent inflammation of the airways can cause an abnormal dilatation of the bronchi By definition, that is what you have your bronchiectasis Interesting enough, could this then be associated with other issues and other COPD differentials that we've seen where the airways are becoming inflamed? Of course, such as chronic bronchitis with mucus production.

    01:10 Now this is, the prime operative word here is, secondary to the impaired clearance of the airways which cause a vicious cycle of infection, inflammation, obstruction What does this mean? So say that infection has now kicked in.

    01:30 If infection has kicked in, you can then only imagine that the type of breath that this individual's going to have would be rather foul-smelling or even the sputum more importantly that you end up gathering is going to be foul smelling, isn't it? Bronchiectasis.

    01:49 Inflammation and obstruction.

    01:50 Well say that there's enough obstruction as such that's taking place Are you then going to result in bronchiolitis obliterans? Sure, with the development of fibrosis.

    02:00 Keep all that in mind as we move forward here through the discussion of bronchiectasis On your left, is a normal bronchus What we have here is the wall of the bronchi, the mucus glands, the cilia, the air passage and the mucus itself You find the mucus to be quite, quite minimal and you find that the airway passage is quite open so that you allow for air to move in and out Whereas with the pathology of bronchiectasis, you end finding quite a bit of increase in mucus Now would you please take a look at the lumen that you see there which is light pink and quite warped.

    02:39 And so therefore the lumen here of the airway is extremely small, you can only imagine that you're having difficulty with properly getting out your air Welcome to a type of obstruction, welcome to bronchiectasis.

    02:52 Tell me about the cilia, the cilia gets smothered therefore your mucociliary clearance then is not functioning properly I'll be very careful, before I move on, I wish to be very clear with you about chronic bronchitis in which you might find here bronchiectasis In chronic bronchitis, it's definition that you're paying attention to, three months of productive cough, over two consecutive year span and the fact that we talked about the different histologic changes that are taking place in the upper airways such as squamous metaplasia and mucus production and the fact that we'll look at Reid index Whereas here, we have issues with mucus but you don't have the same type of definition and coughing but you might have, well we'll take a look at the laboratory investigations.

    03:36 Alright, now here, we'll take a look at the CT of bronchiectasis, We'll find that the, for sure the bronchi are dilated.

    03:45 You see a picture like this and you don't find the definition of chronic bronchitis, you'd choose bronchiectasis, and hopefully they've given you a little bit more more in terms of a secondary type of issue, such as infection then resulting in dilation With bronchiectasis, let's now take a look at the all-important clinical manifestations what I like for you to keep in mind are the differentials of chronic bronchitis and also asthma.

    04:12 Patients typically present with episodes of well, dyspnea- nonspecific fever, once again you could find that in a few issues now chronic productive cough and a frequent respiratory infections Those are two that you're definitely paying attention to a lot more of these respiratory infections, whereas chronic bronchitis, more associated with smoking irritation.

    04:34 With chronic bronchitis, three and two, three months of productive cough over two (years)span and be careful because this patient here in terms of symptoms and the way that he or she might be expressing his or her symptoms might seem like it's chronic bronchitis infection which you're paying attention to If there's enough damage, with the coughing then there might be hemoptysis, and there's blood that's actually coming from your respiratory tree, might then seem a little foamy, right? that's because you have involvement and well, composed of a little bit of sputum perhaps, right? whereas if it was hemoptysis and it was clear blood without foam then that would be like emesis originating from your GI system Now giving your patient sputum cup might them help them to quantify how much sputum that they're producing a day and that's useful for you and as far as sputum is concerned, you're worried about infection.


    About the Lecture

    The lecture Bronchiectasis: Pathogenesis by Carlo Raj, MD is from the course Obstructive Lung Disease.


    Included Quiz Questions

    1. Persistent inflammation of the airways causing permanent dilatation of bronchi secondary to impaired clearance.
    2. Permanent dilatation of bronchioles due to airway obstruction.
    3. Dilation of the pleural space due to the accumulation of air.
    4. Acute inflammatory exudates in the lung.
    5. Enlarged cavity at the junction of lower end of upper lobe and upper end of lower lobe.
    1. Hepatization of the lung
    2. Loss of cilia
    3. Increased mucus in production
    4. Bronchial wall destruction
    5. Decrease in lumen size
    1. Non-productive cough
    2. Hemoptysis
    3. Foul smelling sputum
    4. Fever
    5. Productive cough
    1. Pseudomonas auerginosa
    2. Moraxella catarrhalis
    3. Histoplasma capsulatum
    4. Mycobacterium Tuberculosis
    5. Rhinosporidiosis

    Author of lecture Bronchiectasis: Pathogenesis

     Carlo Raj, MD

    Carlo Raj, MD


    Customer reviews

    (1)
    5,0 of 5 stars
    5 Stars
    5
    4 Stars
    0
    3 Stars
    0
    2 Stars
    0
    1  Star
    0