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Bronchiectasis is a disease characterised by permanent dilatation of bronchi and bronchioles caused by destruction of the muscle and elastic tissue.
CONGENITAL:Cystic fibrosis,Kartageners syndrome POST-INFECTIOUS:as a complication of pneumonia BRONCHIAL OBSTRUCTION:due to foreign body,tumor,mucus impaction
Obstruction and Infection are the two major influences MORPHOLOGY Affects lower lobes ,bilaterally The bronchi and bronchioles are dilated upto 4 times the normal size - Cylindrical or tube like - Fusiform - Saccular or sac like -
The bronchioles are markedly dilated and extend upto the pleural surface HISTOLOGY The walls of the bronchi and bronchiles show dense inflammation,with desquamation and ulceration of the wall. Fibrosis of the wall in chronic cases
CLINICAL COURSE Persistent cough, with foul smelling bloody sputum Dyspnea COMPLICATIONS Cor pulmonale(Heart failure) Lung abscess,metastatic abscess Amyloidosis
Defined clinically Presence of persistent cough with sputum production for atleast 3 months in atleast 2 consecutive years,in the absence of any other identifiable cause.
Simple chronic bronchitis Asthmatic bronchitis-with associated wheezing Obstructive bronchitis-with associated features of emphysema
4-10 times more common in heavy smokers Smoke and other irritants cause Hypertrophy of submucosal glands--hypersecretion of mucus Increase in goblet cells predisposition to infection
Bronchi and bronchioles show hyperemia,edema and are covered by mucopulurent secretions Microscopy: Enlargement of submucous glands and and chronic inflammation Reid index :normally 0.4 In chronic bronchitis
COMPLICATIONS Cor pulmonale
Is a chronic inflammtory disorder of the airways that causes recurrent episodes of wheezing,breathlessness,chest tightness and cough,particularly at night and /or in the early morning. Widespread BRONCHOCONSTRICTION Due to INFLAMMATION which causes increased hyper responsiveness to variety of stimuli.
Gentic predisposition to Type I hypersensitivity Acute and chronic inflammation of airways Bronchial hyper-responsiveness TH2 Helper T cells –secrete Interleukinsstimulate B cells –IgE Antibodies
What is Asthma? Hypersensitivity – Allergy , Type I of airways of lungs - Bronchi Allergens – in the air, mast cell IgE ab. Inflammation of airways – Bronchitis. Genetic, Environmental, Race, Age. High in industrial cities 4-19%, Increasing incidence …!
• Allergy • Inflammation Of Bronchi • Obstruction • Mucous Plugs
Lung in Asthma with Mucous plugs
Mucous plug in asthma:
Asthma Microscopic Pathology
Obstructed Inflammed Bronchi
Asthma - Bronchial morphology
inflammation Eosinophils Gland hyperplasia Mucous plug in lumen Hypertrophy of muscle layer
Immune system – Humoral, Cell Med, Non-sp Antigen & Antibody Primary & Secondary Response (slow/rapid) Hypersensitivity/Autoimm
Chronic Bronchitis Bronchiectasi s Asthma
Mucous gland hyperplasia, Hypersecretion
Etiology Tobacco Air pollutants Persistent infection
Cough sputum Cough, purulent Sputum, fever Episodic wheezing , Cough, dyspnoe a
Dilatation of bronchi and bronchioles Smooth muscle hyperplasia, excess mucus inflammation
immunologi c or undefined cause
Dilatation of acinus
Tobacco Air pollutants
Cough, dyspnoe a
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