BRONCHIECTASIS PATHOLOGY FOR NURSES.pptx

This lecture describes in detail the pathology of Bronchiectasis . The lecture is prepared for sem 3 nursing students. It includes types of bronchiectasis , its types, etiopathogenesis, gross morphology an dmicroscopic morphology.

1. Pathology of BRONCHIECTASIS By: Ms. Saili Gaude Principal Shivam College of Nursing

2. DEFINITION Abnormal and irreversible dilatation of the bronchi and bronchioles developing secondary to inflammatory weakening of the bronchial wall.

3. ETIOPATHOGENESIS 2 basic mechanisms ENDOBRONCHIAL OBSTRUCTION INFECTION

4. 1) ENDOBRONCHIAL OBSTRUCTION Obstruction of the bronchi by foreign body, tumors , enlarged ,lymph nodes

5. 2) INFECTION

6. ETIOLOGY Both mechanisms are widely seen in various clinical settings 1) HEREDITY 2) OBSTRUCTION 3) SECONDARY COMPLICATION

7. 1) HEREDITY 1) Congenital bronchiectasis – caused by developmental defect of the bronchi 2) Cystic fibrosis – defect of the exocrine glands causing increased mucus secretion leading to bronchiectasis 3) Hereditary Immune Deficiency diseases- high incidence of bronchiectasis 4) Immotile cilia syndrome- ultrastructural changes in the cilia leads to ineffective airway clearance 5) Atopic bronchial asthma – leads to bronchiectasis in some cases

8. 2) OBSTRUCTION 1) Foreign body obstruction 2) Endotracheal Tumors 3) Compression by enlarged lymphnodes 4) Post inflammatory scarring of bronchi

9. 3) SECONDARY COMPLICATIONS Bronchiectasis may occur as a result of the complication of many respiratory disorders. Pneumonia Tuberculosis Bronchitis

10. PATHOGENESIS

11. MORPHOLOGICAL FEATURES GROSS MORPHOLOGY Lungs maybe involved segmentally or diffusely Bilateral involvement of lower lobes Left airway more involved than right Pleura is fibrotic Pleura is thick with adhesions to the chest wall Cut section of affected lobes shows honey combed appearance Bronchi are very dilated near the pleura Thickened bronchial wall. Bronchia tube is filled with mucus

12. BRONCHOGRAPHIC APPEARANCE OF THE AIRWAYS 1) CYLINDRICAL – tube like bronchial dilation 2) FUSIFORM- spindle shaped bronchial dilation 3) SACCULAR- rounded sac like bronchial dilation 4) VARICOSE- irregular shaped bronchial dilation

13. MICROSCOPIC FEATURES Bronchial epithelium – normal, ulcerated or metaplastic Bronchial wall- infiltrated with inflammatory cells Destruction of normal muscle and elastic tissues Replaced by fibrosis Lung parenchyma shows fibrosis Interstitial pneumonia Adherent pleura with fibrous tissue

14. CLINICAL FEATURES Persistent productive cough Thick tenacious sputum Clubbing of fingers Crackles Wheezing Airway obstruction

15. DIAGNOSTIC TESTS Clinical history Radiographic features X ray HRCT thorax Pulmonary function test- reveals obstructive pattern , reduced FEV1 and FVC Cough test – ability , strength and effectiveness of coughing checked Bronchial biopsy Sputum culture and sensitivity Alpha anti trypsin levels

16. TREATMENT Antimicrobial therapy Maintenance of hygiene Clearance of secretions by postural drainage Mucolytics Anti inflammatory therapy Bronchodilation – corticosteroids and bronchodilators Resection of affected lung