Bronchiectasias

Description:

Bronchiectasias it is irreversible local bronchiectasias with change of structure of their walls. The shape of expanded bronchial tubes is various, also saccular bronchiectasias are more often observed cylindrical. They can be limited (in one segment or a lung lobe) or extended (take the whole lung and even both lungs). More often bronchiectasias are observed in the lower shares of lungs.
Distinguish the inborn and acquired bronchiectasias.

Symptoms of Bronchiectasias:

The clinical picture at the inborn and acquired bronchiectasias often happens identical, and it is, as a rule, difficult to differentiate them. Symptoms are defined generally by degree and prevalence of a bronchiectasia, expressiveness of destruction of bronchial walls, activity of an infection, duration of pathological process. At so-called dry bronchiectasias when displays of an infection in the affected bronchial tubes are not expressed and patients have no phlegm, clinical symptoms often are absent; there can sometimes be pulmonary bleeding. However in most cases in the affected bronchial tubes periodically escalating infectious process develops. Patients complain of cough with a mucopurulent or purulent phlegm sometimes plentiful, • "a full mouth" (children up to 7 years usually swallow a phlegm). A certain regularity of emergence of attacks of productive cough is quite often observed — it disturbs patients in the mornings, at a rising, and in the evenings, in a bed; in the rest of the time of days cough can be absent. At aggravations of infectious process the quantity of a phlegm increases and reaches 50 — 100 ml a day and more. In some cases the phlegm gets unpleasant, sometimes a fetid smell, contains blood impurity. When upholding such phlegm is divided into three layers: below dense pus, in the middle — muddy-greenish serous liquid, from above — mucopurulent foam accumulates. Aggravations of infectious process are followed by rises in body temperature, especially in the evenings, a leukocytosis with neutrophylic shift, increase in SOE. Are quite often observed the asthma amplifying in process of progressing of a disease, development of chronic bronchitis and emphysema of lungs, weight loss, deterioration in appetite, cyanosis of lips. As a result of purulent intoxication and respiratory insufficiency nails get a form of hour glasses, and trailer phalanxes of fingers of hands — a form of drum sticks, up to 2 years these signs occur at children seldom. At it is long ill at percussion quite often reveal a bandbox shade or a dullness, at auscultation — rigid breath, scattered dry rattles, sometimes wet on the limited site of a lung. Some patients periodically have a pulmonary bleeding. At the long-term course and progressing of a disease the amyloidosis  of internals, a pulmonary heart from the outcome can develop in a pulmonary heart.

Reasons of Bronchiectasias:

Inborn bronchiectasias arise at disturbance of development of bronchopulmonary system in the pre-natal period; sometimes they are combined with other malformations — the return arrangement of internals, the arrow-shaped sky, splitting of an upper lip. The acquired bronchiectasias develop, as a rule, after various bronchopulmonary diseases (first of all after pneumonia and tuberculosis) and at a syndrome of bronchial obstruction of any genesis. Changes of walls of bronchial tubes usually begin with inflammatory process and come to an end with destruction of their muscular and connective tissue framework, a thickening and is frequent an ulceration of a mucous membrane. Increase in intra bronchial pressure is caused by narrowing of bronchial tubes, accumulation in them of a secret, long cough. In emergence of bronchiectasias at children also disturbance of post-natal development of bronchopulmonary system matters. It quite often happens is connected with postponed at early children's age (when yet formation of bronchopulmonary system did not end) pneumonia, measles, whooping cough, etc. Sometimes aspirirovanny foreign bodys are the reason of development of bronchiectasias in children. Other possible way of emergence of bronchiectasias — a mechanical bronchiectasia at development of an atelectasis of a lung or reduction of volume of a parenchyma with the subsequent accession of consecutive infection.

Treatment of Bronchiectasias:

Treatment of patients with bronchiectasias complex, with use therapeutic, bronchoscopic, and if necessary — surgical methods.

Indications to hospitalization in therapeutic or specialized pulmonary department are the aggravation of purulent process, a serious general condition of the patient. At pulmonary bleeding of the patient it is necessary to hospitalize urgently in specialized surgical department. In a planned order send patients to whom surgical treatment of bronchiectasias is shown to the same departments.

Conservative treatment consists mainly in prevention of an infection and elimination of its flashes. It is for this purpose important to provide good emptying of a bronchial tree from pathological contents by means of breathing exercises, percussion and vibration massage and a postural (position) drainage. The postural drainage is carried out by giving to a body of sick situation at which under action vultures of weight the otkhozhdeniye and expectoration of contents of expanded bronchial tubes is facilitated. For example, at bronchiectasias in the lower share of the right easy patient stack on the left side, raise the foot end of a bed. For the purpose of fluidifying of a dense and viscous phlegm appoint iodine drugs, atsetiltsisteinovy acid, inhalations of alkaline and proteolytic means. Apply antibiotics of a broad spectrum of activity (ampicillin, tetracycline) and sulfanamide drugs (Biseptolum) to fight against an infection; definition of sensitivity of microflora to them is optimum. The most effectively directed introduction of antibiotics to the affected bronchial tubes on the catheter which is carried out through a nose (the provision of a catheter in case of need control by means of roentgenoscopy).

Sanitation of bronchial tubes at a bronkhoskopiya is of great importance: from bronchial tubes suck away pathological contents, then wash out them warm solution of antiseptic agents and antibiotics. The expressed positive effect of this treatment usually happens temporary.

Radical treatment of bronchiectasias is possible only in the operational way. Usually resort to an operative measure when conservative therapy is inefficient, or at development of pulmonary bleeding. Contraindications to it are extensive bilateral bronchiectasias, a pulmonary heart, an amyloidosis of internals. Typical operations at bronchiectasias consist the struck segments, shares at a distance (sometimes all lung). At bilateral defeats operation can be made at first on one, then on other lung at an interval of several weeks or months. In certain cases at bronchiectasias perform the palliative operations consisting at a distance only the most affected areas of a lung. Before operation at patients with signs of an aggravation of purulent process and allocating a large number of a phlegm preoperative preparation with use of therapeutic and bronchoscopic methods is necessary.