MindMap Gallery Internal Medicine-Bronchiectasis
This article mainly introduces the etiology, pathological development, clinical manifestations, related auxiliary examinations and result interpretation, diagnostic standards and differential diagnosis, and treatment methods of bronchiectasis. Can be used as a reference for review in related majors.
Edited at 2024-04-02 16:22:31This article discusses the Easter eggs and homages in Zootopia 2 that you may have discovered. The main content includes: character and archetype Easter eggs, cinematic universe crossover Easter eggs, animal ecology and behavior references, symbol and metaphor Easter eggs, social satire and brand allusions, and emotional storylines and sequel foreshadowing.
[Zootopia Character Relationship Chart] The idealistic rabbit police officer Judy and the cynical fox conman Nick form a charmingly contrasting duo, rising from street hustlers to become Zootopia police officers!
This is a mind map about Deep Analysis of Character Relationships in Zootopia 2, Main content: 1、 Multi-layer network of relationships: interweaving of main lines, branch lines, and hidden interactions, 2、 Motivation for Character Behavior: Active Promoter and Hidden Intendant, 3、 Key points of interaction: logic of conflict, collaboration, and covert support, 4、 Fun Easter eggs: metaphorical details hidden in interactions.
This article discusses the Easter eggs and homages in Zootopia 2 that you may have discovered. The main content includes: character and archetype Easter eggs, cinematic universe crossover Easter eggs, animal ecology and behavior references, symbol and metaphor Easter eggs, social satire and brand allusions, and emotional storylines and sequel foreshadowing.
[Zootopia Character Relationship Chart] The idealistic rabbit police officer Judy and the cynical fox conman Nick form a charmingly contrasting duo, rising from street hustlers to become Zootopia police officers!
This is a mind map about Deep Analysis of Character Relationships in Zootopia 2, Main content: 1、 Multi-layer network of relationships: interweaving of main lines, branch lines, and hidden interactions, 2、 Motivation for Character Behavior: Active Promoter and Hidden Intendant, 3、 Key points of interaction: logic of conflict, collaboration, and covert support, 4、 Fun Easter eggs: metaphorical details hidden in interactions.
bronchiectasis
treat
Treatment principles
Prevent and treat recurrent respiratory infections; maintain smooth respiratory tract drainage
treatment method
control infection
Mild disease
Ampicillin, amoxicillin, first/second generation cephalosporins, fluoroquinolones
severe
Especially for Pseudomonas aeruginosa, combined medication is often required - third-generation cephalosporins + aminoglycosides
Combined anaerobic infection
Metronidazole or clindamycin
Promote expectoration
expectorant
Ammonium chloride, bissopine, mucosolvan
Bronchodilators
Aminophylline, Suflumet, Chuanlenin and Chuankangsu spray, Aiquanle spray
postural drainage
Fiberoptic bronchoscopy: suctioning sputum, topical medication
Management of hemoptysis
Medication, if ineffective, bronchial artery embolization
Surgical treatment
Those with recurrent infections, repeated massive hemoptysis, unsatisfactory medical treatment, but the scope is limited and the general condition is good
Diagnosis and Differential Diagnosis
diagnosis
Based on the history of repeated coughing of purulent sputum, hemoptysis, and previous history of respiratory infections that induce bronchiectasis, if HRCT shows abnormal imaging changes of bronchiectasis, bronchiectasis can be clearly diagnosed.
Differential diagnosis
chronic bronchitis
It mostly occurs in patients over middle age. In winter and spring, when the climate is changeable, cough and sputum are obvious. They cough up white mucus sputum. Purulent sputum may appear during acute infection, but there is no history of repeated hemoptysis.
During auscultation, scattered dry and wet rales can be heard in both lungs.
lung abscess
The onset is sudden, with high fever, cough, and a large amount of purulent and smelly sputum.
X-ray examination shows localized dense inflammatory shadows with cavities and fluid levels.
tuberculosis
Symptoms of tuberculosis toxicity such as low fever, night sweats, fatigue, and weight loss are common
Dry and wet rales are mostly limited to the upper lungs
Diagnosis can be made by chest X-ray and sputum examination for tuberculosis bacteria
congenital pulmonary cyst
X-ray examination shows multiple round or oval shadows with fine borders, thin walls, and no inflammatory infiltration in the surrounding tissues.
Chest CT and bronchography can aid in diagnosis
Film degree exam
X-ray examination
Early stage: increased and thickened texture in the lower lung field on one or both sides
Typical: Irregular honeycomb or curly hair-like shadows may appear in the lower lung fields on one or both sides
CT
Main signs
Signet ring sign; double track sign; subpleural bronchus; tree-in-bud sign; finger cuff sign
secondary signs
Thickening of bronchial walls; reduced lung volume; mosaic sign
High-resolution chest CT is an effective means of diagnosing bronchiectasis
Infectious bronchiectasis: diffuse bronchiectasis and bronchial wall thickening can be seen
Cystic bronchiectasis: bullae and mucus plugs may be seen in the lungs
Bronchiectasis: Ring sign, bronchial wall thickening and fluid levels may be seen
fiberoptic bronchoscope
Mainly used for treatment (endoscopic hemostasis, sputum suction, etc.) and differential diagnosis
Bronchography
Clarify the location, morphological range and severity of the lesion, providing an important reference for deciding whether to undergo surgical resection and the extent of resection.
clinical manifestations
Medical history characteristics
Chronic process, with a history of pneumonia, measles and other related infections in childhood
Predisposed areas
Left lobe, left lower lobe more than right lower lobe, left lower lobe and tongue lobe at the same time, right middle lobe
symptom
Chronic cough with large amounts of purulent sputum
Sleeping at night or turning around in the morning can induce or aggravate excessive phlegm. Leave it alone and divide it into three layers.
The upper layer is foam; the middle layer is mucus; the lower layer is purulent and necrotic tissue
Sputum has a foul odor when accompanied by anaerobic infection
Repeated hemoptysis
Repeated hemoptysis as the only symptom is called dry bronchiectasis; it is common in tuberculosis
secondary lung infection
Fever, chest pain
Symptoms of chronic infection and poisoning
Anemia, weight loss, decreased appetite, affected growth and development of children
physical signs
Early days
May be asymptomatic
When the lesions are severe and infections occur repeatedly
Wet rales can be heard in the lower chest and back, and sometimes dry rales can be heard. Chronic patients with a longer course of disease may have clubbing fingers
Causes and pathology
Cause
Bronchial - lung infection
Whooping cough, measles, bronchopneumonia in children
Infect
Smooth muscle and elastic fiber destruction
lose support
peribronchial fibroplasia
Pull the wall
Bronchial deformation and dilation
Bronchial obstruction
a variety of factors
Bronchial obstruction
Atelectasis
Stretch the bronchus
branch enlargement
Congenital bronchial developmental defects and genetic factors
Hypoplasia of bronchial cartilage and ciliated cells
Kartagener syndrome: with paranasal sinusitis, dextrocardia
People with cystic fibrosis
Hereditary a1-antitrypsin deficiency
pathology
Bronchiectasis is often the destruction and inflammatory changes of the segmental or subsegmental bronchial wall. The structures of the affected wall, including cartilage, muscle and elastic tissue, are destroyed and replaced by fibrous tissue, resulting in three different types.
① columnar dilation; ② cystic dilation; ③ irregular dilation
pathophysiological changes
Depends on the number of bronchial lesions and the extent of concurrent lung parenchymal changes
Early stage: Respiratory function test is normal
When the disease range is large
Mixed ventilatory dysfunction, mainly obstructive; hypoxemia; further development into pulmonary hypertension, pulmonary heart disease, and heart failure
Overview
Bronchiectasis refers to the abnormal expansion of proximal bronchial tubes with a diameter greater than 2 mm due to the destruction of muscle and elastic tissue in the tube wall.
Pathological destruction of the bronchial wall tissue structure, irreversible expansion and deformation of the bronchial lumen
Chronic bronchial purulent disease; clinical manifestations include long-term cough, large amounts of purulent sputum, and repeated hemoptysis. It is more common in children and young people.