What is Bronchiectasis, Surgery and Treatment

What is Bronchiectasis, Surgery and Treatment of Bronchiectasis

Bronchiectasis iyileşemiyen bronchi, irreversible expansion of certain. Antibiotics and other drugs, the treatment of lung disease strongly decreased the incidence of bronchiectasis. The disease mostly observed the lower lobes, approximately 30% of bilateral cases.

Pathogenesis

Especially in the early childhood years spent on measles, whooping cough, pneumonia and other complications of bronchiectasis have an important place infeksiyonlann. Bronchial infection and bronchial walls of the holes make it difficult to narrow or purification tıkamakla cause damage or bronchiectasis.

Bronchiectasis is more childhood begins. The main reasons for this: (1) narrow the bronchi in children, obstruction and bronchial walls of the resistance is less convenient, is easily destroyed. (2) Collateral ventilation developed in the lung would be collapsed easily.

Treated or untreated pulmonary tuberculosis missing are relatively frequent complication of bronchiectasis. Bronchi in primary tuberculous hilar lymph nodes prints, devastated by the walls of the bronchial infection spread into the bronchial obstruction and bronchiectasis causes and bronchi. Consists of the upper lobes than in adult tuberculosis bronchiectasis. Upper lobe drainage is better than secondary infection is rare. Therefore, the clinical symptoms of bronchiectasis in these patients is not clear.

Asthma is common in bronchiectasis. Chronic sinusitis, upper respiratory tract infections, especially in infected secretions aspirated during sleep can lead to bronchiectasis. Alcoholics food aspiration, pneumonia, and abscess may be complicated by bronchiectasis. Bronchiectasis, surgical interventions may be a complication of upper respiratory tract.

Foreign body aspiration, adenoma and cancer, blocking the bronchi in bronchiectasis may develop due to infection and drainage difficulties.

Common diseases such as lung parenkimasının widespread fibrosis, granulomatosis, collagen diseases, severe chest deformities and neuropathy, myopathies can cause bronchiectasis. Infection bronchial walls of bronchiectasis devastated by these diseases is the main factor.
Kartagener syndrome is a congenital disease, bronchiectasis, and dextrocardia sinüzitle creates a triad of the disease. Dextrocardia, pulmonary sequestration, unilateral emphysema (Swyer-James Macleod syndrome) also observed a complication of bronchiectasis

Pathology

The walls of the bronchial ulceration, abscesses can cause damage. Fibrous tissue elements takes place has been ruined. Parabronşiyal increases lymph tissue, wipe-your personal possessions damage reduces the strength of the bronchi of purification. These changes are irreversible dilatation of bronchi tone decreased by a loose pipe "bronchiectasis" develops. Bronchial artery thrombosis, hypertrophy, ulceration can cause hemoptysis. Anastomoses between bronchial and pulmonary circulation (artery-vein shunt) occurs with increasing hypoxemia. Bronchial pneumonia around the patient, local emphysema, fibrosis is very common.

Bronchiectasis examined three main groups:

1 - Silendrik Bronchiectasis is a dilatation of the bronchi silendrik, there is a sudden interruption and in a circle. Normally, the bronchi, as there is going incelerek periphery.
2 - varicose bronchiectasis, dilated bronchi İntizamsız re varicose veins is similar to the ends of a curved, cylindrical obstruction of the bronchi suddenly cut yoktur.Perifer bronchiectasis is more.
3 - Saku (cystic) bronchiectasis, bronchial dilation periphery gradually increases. Cyst, in the form of a balloon or sac shows the localization of bronchiectasis subplöral more.

Clinical Symptoms, Symptoms of bronchiectasis

Classic symptoms of chronic cough and purulent sputum of bronchiectasis. Sputum is easy and plentiful, many times the bad smell. The amount of mucus seriousness of the disease, rather than the lesions and the effect of the treatment varies. A serious and untreated patients with bronchiectasis 200-300 per day throughout the year. purulent sputum may occur. Continuous nature of cough and sputum, upper respiratory tract infections increases. For this reason, throat, nose, ear, tooth infections, paranasal sinuses should be examined. 50% of cases of bronchiectasis cases for there hemoptysis. Hemoptysis is usually low. Some cases can be severe. In some cases of bronchiectasis, cough, no sputum. Hemoptysis is a complication of the disease is known for many times. This bronchiectasis "dry bronchiectasis" is called. Buronkopulmoner infections that often occurs in patients with bronchiectasis. These infections often follow an upper respiratory tract infections. Bronchiectasis is a common complication of chronic bronchitis.

The overall situation is good in cases of mild bronchiectasis. Serious and long-term cases, the general condition gradually worsens, lung abscess, eating disorders such as anorexia, anemia, fatigue, weight loss, syanoz and respiratory failure, cor pulmonale develops. Approximately 1 / 3 third of the drum Comag fingertips in the form of hand and foot deformities are seen. Less often consists of amyloidosis and brain abscess.

Examination of the most important finding of the patients or the medium and coarse crepitan ronflan Railer to be heard. Continuous complaints of cough and sputum and hemoptysis in a patient with a history of self in the same place in different time Railer heard this is an important finding for the diagnosis of bronchiectasis. Upon examination, collapse, fibrosis and signs of pneumonia can be monitored. In some cases regarded rai.

Radiological Findings

A segment of the periphery of the lung and bronchus bronchus expanded the shadows disappeared. Bronchial shadows close to each other, crowded peripheral bronchial secretions stuck change-tır.Bu atelectasis lung volumes, volume is reduced. Air-fluid level can be seen in cases of varicose or cystic bronchiectasis. Very serious cases, a rough "honeycomb" appearance followed, surrounded by fibrous tissue emphysema is due to gaps. Computer tomography has an important role in the diagnosis of bronchiectasis. Difficulty in diagnosis and surgical intervention, especially in cases thought to be an objective method bronkografi. Bronchi pneumonia disease may occur temporarily düatasyon qualifications. Bronchiectasis with suspected pneumonia bronkografi such cases should be done after 6 months.
Most of the basal segments of lower lobes tavern-zedir Bronchiectasis. Tuberculosis has an important role in the etiology of the upper lobes bronşektazisinde.

Laboratory Findings

Suitable for the treatment of sputum often made ​​anti-biotic bacteria antibiogramı selected. If the suspicion of tuberculosis and drug sensitivity of Koch bacillus culture should be examined. Infectious exacerbations are leukocytosis, increased sedimentation rate. In cases of chronic bronchitis and bronchiectasis associated with pulmonary function tests show obstructive abnormality.

Anemia occurs in advanced cases. Analysis of urine albumin kuşkulanmalıdır amyloidosis occurs. Definite diagnosis of amyloidosis is made ​​for the rectum, or kidney biopsy.

In advanced cases, lung function tests, arterial blood gas is often measured. Other methods of ECG and cardiac hypertrophy, cor pulmonale and heart failure symptoms is investigated.

Diagnosis and Differential Diagnosis

Clinical and radiological symptoms or kuşkulanılır bronchiectasis is diagnosed. Bronkografıyle definitive diagnosis is provided. Differential diagnosis of tuberculosis, abscesses, lung cancer, adenoma, lung cysts, and foreign body aspiration are considered. Sometimes these are diseases with bronchiectasis.

Complications

The main complications of pneumonia, bronchiectasis, pleurisy, emphysema, lung abscess, pneumothorax, and sinüzittir. In advanced cases, cor pulmonale, heart failure can be monitored. In rare cases of amyloidosis, a complication of brain abscess develops. Which cause infections and bronchiectasis bronchiectasis bronchiectasis with antibiotics and other treatment complications of methods strongly reduced-visits.
Smoking, major complications such as bronchiectasis and chronic obstructive pulmonary disease, infection, anti-nature.

Prevansiyon

Measles, whooping cough, influenza and other infections, preventive vaccination should be done. Antibiotics to treat bacterial infections, bronchopneumonia, and foreign bodies, obstructing lesions of qualifications should be removed.

Treatment

Medical treatment eliminates or alleviates the symptoms of the disease. Surgical treatment of the disease is eliminated. However, many times medical treatment is preferred. Medical treatment, especially drug therapy and postural drainage. Often with bacteria-cal examination (antibiotic) provided the appropriate antibiotic therapy. In some cases, continuous or intermittent antiyotik antibiotic treatment is 7-10 days per month, for example. Postural drainage is based on the accumulated mucus from the bronchi utilizing the principle of gravity is the bronchi, hilusa to provide the correct movement. By removing the ends from the 35-40 foot section of a cot (wooden blocks or bricks are placed) are provided to the trend. The patient, at the head of the cot as close to the ground three minutes back, prone, supine right and left. Total 12-minute postural drainage hospitalization is usually twice a day, morning and night before going to sleep on an empty stomach is applied. Not accept a large part of patients with postural drainage, so the importance of thoroughly explained. Furthermore, smoking cessation, and lung and their place of work to be harmless, are important factors in the success of treatment.

Surgical Treatment

Of a lung lobe or segment resection patients treated for localized bronchiectasis. However, some patients with bilateral bronchiectasis, a disease that is common or lung surgery, or severe pulmonary function abnormalities are another obstacle. There is no indication for surgical intervention in these patients.
Recurrent, treatment-intractable hemoptysis, and bronchial complications such as pneumonia or pleurisy adenoması, contraindication in patients with bronchial cancer are more common in dikasyon or surgical treatment.

Foreign Body Removal

In children, alcoholics, and some foreign body aspiration in patients with bronchiectasis is an important cause of neurological. Bronchotomy pi, or foreign bodies removed by bronchoscopy, in some cases, you must resection.

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