Multiple bronchiectasis

Bronhoektatical disease - a disease caused by expansion of the bronchi, with long progressing and a tendency to purulent complications. Expansion of the bronchi - bronchiectasis - can develop as a result of recurrent inflammation in the bronchi with subsequent changes in the lungs or as a complication of a number of lung diseases (chronic pneumonia, cancer, abscess, syphilis, tuberculosis, and so on). Congenital bronchiectasis are rare. Bronhoektatical disease affects people of all ages, most men.
The main role in the etiology of multiple bronchiectasis belongs to bacterial and viral infections. Essential due to infection inflammatory and destructive processes in the bronchial wall, severe coughing spells, repetitive and often resulting in an increase intrabronchial pressure. Some importance disorders bronchial obstruction, as well as supply and innervation of the bronchial walls with the subsequent defeat of muscle and elastic office of the bronchus.
Pathological anatomy. bronchiectasisBronchiectasis occur more often in lower lobes of the lungs and are an extension of the cavity of the bronchi with a gleam of irregular shape. Wall-sometimes thickened, sometimes thinned. In some cases, in the wall of bronchiectasis are stored in one way or another structural unit of the bronchi (cartilage rings, glands, muscles), prevails in other granulation, scar tissue.
Sometimes there ulceration and polypous expansion that is the source of bleeding, and changes in blood vessels and nerves. Affected and lung tissue surrounding the bronchiectasis. There are cylindrical and saccular bronchiectasis (Fig).
The clinical picture. The disease develops gradually and is characterized by a great variety of symptoms. Often, multiple bronchiectasis is manifested in the form of chronic bronchitis. Patients complain of cough, emerging attacks in the morning, often with the change of position of a body; the release of a large amount of Muco-purulent sputum "mouthful" (500 ml or more per day), sometimes unpleasant smell and streaked with blood. Periods of a slight increase in temperature short-term. The General condition satisfactory, out of exacerbations patients consider themselves healthy. The long ill objective examination observed zianoz lips, change fingers as drum sticks, emphysematous extended chest, limited mobility of pulmonary edge, a box shade of percussion sound, hard breathing, often scattered dry rales, sometimes wet in a limited area. Radiographically - lung fields of increased transparency, teistest, acuestate pulmonary pattern, sometimes seen circle shadow of the liquid level. The big help in the diagnosis have bronhografiya (see) and bronchoscopy. When sputum during acute find a lot of leukocytes and abundant flora. In blood moderate neutrophilic leucocytosis, accelerated ROHE.
More severe course there is the combination of multiple bronchiectasis with repeated peribronchial, the atelectasis and inflammatory processes in the lungs. In these cases, the periods of exacerbation of the process over the long-term (2-5 weeks); on the background of a box shade of percussion sound define the regions blunting, over which listen decreased breath, moist rales, sometimes the friction noise of the pleura. Radiographically, along with the described changes sites are identified homogeneous darkening with bronchiectasis in circumference. More pronounced changes in the peripheral blood. As a rule, there are the symptoms of heart failure (shortness of breath, tachycardia, muted tones), vessels (hypotension), as well as liver and kidney toxic nature. Even more severe bronchial ecstatic disease is observed in the presence of diffuse the pneumosclerosis (see) and chronic pneumonia (see). With progressive multiple bronchiectasis in some cases develop complications: bleeding, lung abscesses, and sometimes amyloidosis.
The prognosis for a full recovery is unfavorable, the ability to work is reduced. In addition to violations functions of breathing, define and change the function of the cardiovascular system.
The treatment is complex and includes bed or pruposely mode depending on the severity of the condition, regular airing of the rooms, quite nutritious food, rich in protein and vitamins. With worsening process - antibiotics, first identifying the sensitivity of microflora to him and individually selecting dose, or sulfonamides (etazol or norsulfazol for the first reception 2 g, and then on 1 g every 4-6 hours before the fall of temperature, further to 1 g in 6-8 hours. With the purpose of improvement of drainage function of bronchi - ephedrine inside 0,025 - 0,05 g 2-3 times a day, suction pus from the bronchi bronchoscope , etc. Symptomatic funds - cardiovascular (kordiamin - 15-20 drops 2-3 times a day, in cases of severe violations of the cardiovascular system 1 ml of 1 to 2 times a day under the skin); expectorants (extract termopsisa 1 tab. 3 times a day). In periods of remission breathing exercises, sanatorium-resort treatment. For certain indications advisable direction to the resorts with a dry, warm climate, for example, the steppe areas of treatment (Bashkiria, Orenburg region), the resorts of Central Asia and the southern coast of Crimea. In advanced cases, with frequent relapses of multiple bronchiectasis shown operative removal of a lesion in the lung.
Surgical treatment of bronchiectasis are shown with frequent exacerbations inflammatory phenomena, the growing intoxicationand when complications of lung abscess, or by the formation of cavities. Apply destruction of the lung, its share or only the affected segment (see Light, operations). Preoperative preparation: bed rest, restorative treatment, the introduction of antibiotics through bronchi or through the chest wall (puncture). In critically ill limited opening purulent cavities and its drainage (see). Sometimes used and pnevmonit (see).
Prevention of bronchial ecstatic disease is reduced to a thorough treatment of infections, contributing to its emergence (bronchitis, pneumonia, and so on), to eliminate sources of inflammation in the upper respiratory tract and oral cavity, tempering of the organism.

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