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MindMap Gallery Internal Medicine-Bronchiectasis

Internal Medicine-Bronchiectasis

This is a mind map of Chapter 5 of Internal Medicine, Bronchiectasis. Contains etiology and pathogenesis, pathophysiology, clinical manifestations, auxiliary examinations, treatment prognosis, etc. If you are a medical student, it can help you review better, and if you are a teacher, it can help you teach better!

Edited at 2023-12-22 13:00:21

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Internal Medicine-Bronchiectasis

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Outline

bronchiectasis

definition

Mainly refers to a general term for a heterogeneous disease that occurs repeatedly after acute and chronic respiratory tract infections and bronchial obstruction, causing bronchial purulent inflammation, causing structural destruction of the bronchial wall, thickening of the bronchial wall, and causing abnormal and persistent dilation of the bronchus.

Etiology and pathogenesis

It can be divided into congenital and secondary, but congenital is rare, and some cases may have no obvious cause.

The above diseases impair the host's airway clearance and defense functions, making infection and inflammation prone to occur. Recurrent bacterial infections can enlarge, scar, and twist the airways. The bronchial walls thicken due to edema, inflammation, and cardiovascular formation. Destruction of surrounding interstitial tissue and alveoli leads to fibrosis and emphysema.

Pathology and pathophysiology

Causes of formation: Bronchiectasis is often due to destruction and inflammatory changes in the wall of the segment or subsegment bronchus. The affected wall structures, including cartilage, muscle and elastic tissue, are destroyed and replaced by fibrous tissue.

① Column dilation: The bronchi expand in a uniform tube shape and suddenly become narrower in one place, and the small airways in the distance are often blocked by secretions.

② Cystic dilatation: The dilated bronchial lumen changes into a cystic shape, and the blind end of the bronchus also presents an unrecognizable cystic structure.

③Irregular dilation: the bronchial lumen shows irregular changes or bead-like changes

clinical manifestations

The main symptoms

Repeated coughing, phlegm, or purulent phlegm

Dyspnea and wheezing: suggestive of widespread bronchiectasis and COPD

Increased sputum volume and fever: bronchial infection worsens or lesions involve the lung parenchyma, causing pneumonia.

Hemoptysis can occur in 50% to 70% of cases. Major bleeding is often caused by erosion of small arteries or destruction of proliferating blood vessels.

Physical examination

Excessive airway secretions: crackles and dry rales

Severe lesions accompanied by chronic hypoxia, cor pulmonale, right heart failure: clubbing of fingers, signs of right heart failure

Auxiliary inspection

Film degree exam

Chest X-ray (lack of specificity)

"Double track sign" in longitudinal section and "circular shadow" in transverse section

HRCT (main diagnostic method)

Bronchial sac columnar changes, airway wall thickening (inner diameter <80% outer diameter), mucus obstruction, tree-in-bud sign, mosaic sign

Bronchiodol angiography (invasive)

Bronchiectasis can be diagnosed, but because it is an invasive examination, it is now replaced by high-resolution CT

laboratory tests

Blood routine and inflammatory markers

White blood cell count, neutrophil differential, and C-reactive protein may be elevated

Serum immunoglobulin

People with combined immune deficiency may develop (IgG, IgA, IgM) deficiencies

blood gas analysis

Determine whether hypoxemia and hypercapnia are combined

microbiological examination

Medication guidance

other

fiberoptic bronchoscope

Crater-like changes can be seen

Sampling for etiological and pathological diagnosis

Local lavage, etc.

Pulmonary function test

Confirm airflow limitation and guide clinical use of bronchodilators

Diagnosis and Differential Diagnosis

diagnosis

①Medical history: Repeated coughing up sputum and hemoptysis, history of respiratory tract infection that induced bronchiectasis in the past

②Abnormal imaging changes in HRCT

Evaluate

Used to assess disease progression and guide drug treatment

Sputum test

Sputum smear, sputum culture, drug sensitivity

Lung CT follow-up

Cavity in the lungs, unexplained hemoptysis or blood in sputum, poor treatment, and repeated exacerbations

Blood gas analysis and judgment

Hypoxemia, CO2 retention

Differential diagnosis

①Chronic bronchitis

Cough, white mucus sputum, and no recurring hemoptysis in winter and spring

②Lung abscess

Acute onset, high fever, cough, and large amounts of purulent and smelly sputum

③Tuberculosis

Low-grade fever, night sweats, fatigue, weight loss

④Congenital pulmonary cyst

X-ray shows multiple slender round or oval shadows with borders

prognosis

BIS score

Depends on the extent of bronchiectasis and presence of complications

Massive hemoptysis can also seriously affect the prognosis

Combined with lung parenchymal damage: patients with emphysema and bullae have a poor prognosis

Mortality increases in patients with COPD

treat

①Treat basic diseases

For pulmonary tuberculosis with bronchiectasis, active anti-tuberculosis treatment and hypoimmunoglobulinemia can be treated with immunoglobulin replacement.

②Control infection

Free of Pseudomonas aeruginosa

Empirical anti-Haemophilus influenzae

ampicillin/sulbactam

amoxicillin/clavulanic acid

Second generation cephalosporins, third generation cephalosporins (ceftriaxone sodium, cefotaxime)

Moxifloxacin, levofloxacin

There are high risk factors for Pseudomonas aeruginosa

β-lactams

Ceftazidime, cefepime, piperacillin/tazobactam, cefoperazone/sulbactam

carbapenems

Imipenem, Meropenem

Aminoglycosides

Quinolones

Ciprofloxacin, Levofloxacin

Meet 2 conditions

1. Recently hospitalized

2. Use antibiotics every 4 years or more or within the past 3 months

3. Severe airflow obstruction (FEV1<30% predicted value)

4. Daily oral prednisone <10 mg in the past 2 weeks

③Improve airflow restriction

Routine follow-up of lung function changes

long-acting bronchodilator

β2 receptor agonist

Long-acting anticholinergic drugs

inhaled corticosteroids

④ Clear airway secretions

Physical expectoration

Lower your head, raise your hips, and pat your back

Phlegm-reducing drugs

Immunomodulators, hemoptysis treatment, surgical treatment, prevention, etc.

dry bronchiectasis

The patient presented with repeated hemoptysis as the only symptom

phlegm

Mucus, mucopurulence, and purulence; can be yellow-green; after collection, they are layered: the upper layer is foam, the middle is turbid mucus, the lower layer is purulent, and the bottom layer is necrotic tissue.