Bronchiectasis (bronchiectasis) - pathological sacciform or cylindrical extension of bronchi and bronchioles, provoked a deep destructive lesions of bronchial wall and surrounding tissues.They may be arranged in one segment / lung lobe, or capture one or both lungs.Typically, bronchiectasis was observed in the lower lobes of the lungs.Uniform bronchiectasis called cystoid bronchiectasis and bronchiectasis - cylindrical bronchiectasis.
Features bronchiectasis: bronchi subsegmental level expanded, cylindrical and ampullar expansion fills bronchial secretion capable of easy infection that is a consequence of chronic purulent inflammation.In the case of blockage of the lumen of the bronchi edema its walls and there is a secondary formation of additional blood vessels that often accompanies for causing hemoptysis (coughing fit triggered).In the case of the further development of bronchiectasis seen involvement in the pathological process of the whole lung tissue
Bronchiectasis - Causes
primary cause of bronchiectasis following are borne respiratory disease: cystic fibrosis, tuberculosis, pneumonia, whooping cough, measles, bronchitis and the like. Particularly harmful arerespiratory infections, which were transferred in early childhood, during the formation of the respiratory system.
next group of reasons that can cause this pathology is called traumatic bronchial obstruction, tuberculosis and tumor nature.In some cases the development of bronchiectasis can be caused by diseases of the connective tissue, Sjogren's syndrome and rheumatoid arthritis.
Sometimes there congenital bronchiectasis developing in utero for violations of bronchopulmonary system.There have been documented cases where once in several members of one family were observed bronchiectasis.
In recent years, the emergence of postnatally developing bronchiectasis attach special importance factor "inherent weakness" of the bronchial wall.This is confirmed by the fact that people with this congenital anomaly is often complicated by pneumonia atelectases with the subsequent development of bronchiectasis
Bronchiectasis - Symptoms
In the area of bronchiectasis is often ulcerated mucosa, cartilage, and muscle fibers are subjected to degradation and pinching connective tissue.The pathological process is accompanied by stagnation of secretions in the bronchi and the violation of the drainage function.
Often there are manifestations of diffuse chronic bronchitis.During the microscopic examination is marked infiltration of neutrophils bronchial walls, replacement of ciliated cylindrical or multi-layered.In lung tissue changes observed in the form of areas of fibrosis, atelectasis and pneumonia foci.When amyloidosis observed characteristic changes in liver, kidney and other. Organs can be detected metastatic abscesses character.
Symptoms of acquired and congenital bronchiectasis are often the same and tend to differentiate even with morphological and radiological data is hard enough.The symptomatology depends on the prevalence of bronchiectasis, the degree of expansion of the bronchi, the activity of the infection, the severity of the destruction of the bronchial wall and the length of the flow of the pathological process.
When dry bronchiectasis, when an infection in the affected bronchi does not manifest itself, and in patients with no phlegm, symptoms are very weak or completely absent.Typically, the affected bronchi develops escalating periodically infectious process.
exacerbation of chronic inflammation contribute to pockets of infection in the nasopharynx and oral cavity.Patients with bronchiectasis primarily complain of cough with purulent and / or mucopurulent discharge, which is most clearly expressed in the morning.
during the exacerbation of the patient can go up to 200 ml sputum per day.In the case of long-term stagnation of bronchial secretions, there is a connection of putrefaction, which gives an unpleasant sputum, often fetid smell.
Most patients have hemoptysis, with massive pulmonary hemorrhage is rarely present.A significant number of patients complaining of weakness, fatigue, chest pain, irritability, headache, dyspepsia and depression psyche.During an exacerbation there is increased ESR, evening fever and leukocytosis with neutrophilic shift.
In the initial period of the appearance of the patients has no specific differences.However, to the extent of the disease due to respiratory failure and intoxication toenails and hands often take the form of "time windows" and do your fingers - a form of drum sticks.Skin become sallow, puffy face is observed, reaching to a total depletion of malnutrition.
The X-ray is usually marked tyazhistost roots, increased pulmonary pattern, in some cases, a decrease in the affected area of lung volume (local fibrosis, atelectasis).Carrying bronhografii clarifies the presence of bronchiectasis and shape and volume of lesions.
shown holding differential diagnosis of bronchiectasis with diseases such as lung cancer, lung abscess, tuberculosis and chronic bronchitis.In addition to cytology, bacteriological and radiological studies, the greatest diagnostic value belongs to CT and bronhografii that best demonstrate characteristic lesions of the bronchi
Bronchiectasis - Treatment
Treatment of bronchiectasis is complex, using bronchoscopy, therapeutic and, if necessary, surgical techniques,which is carried out in a hospital or in an outpatient setting.Indications for hospitalization pulmanologicheskoe or therapeutic department is pulmonary heart disease, or exacerbation of infection.When pulmonary hemorrhage patient should be hospitalized immediately in the surgical department.
Conservative treatment of bronchiectasis mainly lies in the elimination and prevention of outbreaks of acute infection.First of all, it is antibacterial therapy and special medical measures to improve the drainage function of bronchi and emptying bronchiectasis.Given the sensitivity of detection of the bacterial flora sputum appointed triad typical of antimicrobials - agents nitrofuran series, sulfonamides and antibiotics.
are the most effective therapeutic bronchoscopy with the removal of the bronchi of pus and the subsequent introduction of mucolytic drugs (Bromhexine, acetylcysteine), proteolytic enzymes (chymotrypsin, trypsin) and antibiotics.Initially, procedures are carried out twice a week, and decreasing purulent - once a week.
to enhance the overall reactivity of the body appointed by the biogenic stimulators, immune stimulants, vitamins, anabolic hormones, physical therapy and blood transfusion (blood products).
Surgical treatment of bronchiectasis is carried out in the case in view of the increasing deterioration of the inefficiency of therapeutic treatment in the case of pulmonary hemorrhage.In case affecting one / both lobe of the local process is performed thoracoscopic or open lung resection.In the case of the local two-way process is carried out a two-stage intervention - first on one lobe of the lung, and after three months in the second.Contraindications to surgical intervention is amyloidosis of internal organs, pulmonary heart disease, and an extensive two-way process.
outlook depends primarily on the prevalence, patterns and frequency of exacerbations, the effectiveness of treatment and complications.Prognosis for common saccular bronchiectasis.Patients with softly pronounced pathological process provided adequate medical treatment (sanitation + bronchi bronchoscopy) may be enough to preserve long-term disability.After the application of radical treatment, clinical recovery was observed in 75% of patients, 15% observed a significant improvement
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