Case study (Bronchioectasis

)

A 35 years old patient complains of chronic Vvvvvvvvvv cough and expectoration of excessive purulent sputum averaging 320 ml/day. The condition partly improves with antibiotics to recur again. Expectoration increases on awakening in the morning and on leaning forwards. The patient also has 3rd degree clubbing. 1- What is the most probable diagnosis? Bronchioectasis 2- Mention other conditions that can give a similar clinical picture? Supurative Lung Diseases(SLD) a- Lung abcess b- Infected cystic lung c- Empyema with bronchoplueral fistula 3- What is the etiology and pathogenesis of this patient s illness? Etiology and pathogenesis a- Congenital bronchiectasis - 1ry idiopathic - 2ry immotile cilia syndrome (bronchiectasis, sinusitis, otitis media, male sterility, kartagner s syndrome) cystic fibrosis immunodeficiency syndrom

*All this etiology stagnation of Secretion bronchial obstruction 2ry infection bronchial dilatation b- Acquired bronchiectasis 1- Bronchial obstruction - Mechanism: a- Partial obstruction allowing air entrance during inspiration but prevent air escape during expiration intrabronchial pressure bronchiectasis/emphysema b- Complete obstruction collapse intra pleural pressure exert traction on bronchus dilatation c- Accumulation of secretion dilatation of bronchus - Caused by: a- In the lumen: FB, thick secretion b- In the wall: tumor, broncho-stenosis c- Pressure from outside: LN, tumor other causes of mediastinal syndrome 2- In fection & fibrosis - Mechanism: a- Severe or recurrent infection leading to destruction of bronchial muscle & elastic fibers dilatation b- Peri-bronchial fibrosis traction on bronchial wall dilatation - Common causes: a- Bronchopneumonia b- Whooping cough

c- TB d- Measles 4- How to treat such patient? a- Medical ttt - Antibiotics (empirical according to C&S) - Postural drainage - Immunization against influenza & pneumococcal pneumonia - Bronchodilator (if obstruction is reversible - Oxygen therapy b- Surgical resection in early childhood disease and single local airway disease

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