Internal illnesses. Bronchiectasis (most important)

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Internal illnesses. Bronchiectasis (most important)

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29. BRONCHIOECTATIC DISEASE

Regional expansion of the bronchi with a predominant localization of the process in the lower parts of the lungs, manifested by chronic endobronchial suppuration.

The disease is associated with genetic defects in the development of the bronchi observed in children and adults. Men get sick more often. Bronchiectasis does not include secondary bronchiectasis, in which damage to the lung tissue predominates due to an active inflammatory process.

Etiology. Etiological factors include bronchopulmonary infections, aspiration of foreign bodies, bronchial stenosis with secretion retention and constant suppuration distal to the stenosis, bronchial malformations, congenital predisposition (Sievert-Kartagener syndrome).

Pathogenesis. Bronchial patency is disrupted (formation of obstructive atelectasis), inflammation of the bronchi occurs, intrabronchial pressure increases, the elasticity and mechanical stability of the bronchi decreases, and obstruction of the small bronchi occurs (cystic fibrosis).

Clinic. The main manifestations of the disease are: productive cough, mainly in the morning, with the release of a significant amount of mucopurulent or purulent sputum, hemoptysis. Sputum production depends on the position of the body - it increases in a state of orthopnea. Patients note intoxication, weight loss, increased body temperature, puffiness of the face, an earthy tint of diffuse cyanosis, and retraction of the affected side of the chest. Fingers in the shape of drumsticks, nails in the shape of watch glasses (a sign of hypoxia). During percussion, the mosaic nature of the percussion sound is determined (a low-specific sign). Auscultation reveals harsh breathing, pockets of persistent moist medium- and coarse-bubbling rales, and loud dry rales.

Diagnostic study. A general blood test is performed, which reveals anemia, neutrophilic leukocytosis with a shift to the left, and an increase in ESR. A general urine test, a biochemical blood test (dysproteinemia: hypoproteinemia, albuminemia, hypergammaglobulinemia), and sputum examination (macro- and microscopic study of the flora: three-layered, many leukocytes) are also performed. During bronchoscopy, a lot of sputum is found in the lumen of the bronchi, hyperemia of the mucous membrane, and a continuous flow of sputum are noted. With bronchography - bronchiectasis of various shapes, with radiography - a decrease in the volume of the affected lung, a cellular pattern of the lungs. A functional study of the lungs is being carried out.

Treatment. Patients are prescribed diet No. 15, active positional drainage according to B. E. Votchal. Antibacterial drugs are prescribed (parenterally and intrabronchially), repeated sanitary bronchoscopy, bronchodilator therapy, mucolytics, desensitizing agents, anabolic hormones, vitamins (groups B, C), with frequent exacerbations and the prevalence of bronchiectasis in no more than one lobe, surgical treatment (segmental resection) is indicated , lobectomy).

Flow. Progressive, long-term remissions are possible.

Forecast. With a limited lesion - favorable, and with a widespread process and the presence of complications - unfavorable.

Prevention. Timely treatment of lung infections, smoking cessation, systematic positional drainage, treatment of complications.

Author: Myshkina A.K.

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