Ovid: Oxford Handbook of Clinical Medicine Pathology Chronic infection of the bronchi and bronchioles leading to permanent dilatation of these airways. Main organisms: H. influenzae; Strep. pneumoniae; Staph. aureus; Pseudomonas aeruginosa. Causes Congenital: CF; Young’s syndrome; primary ciliary dyskinesia; Kartagener’s syndrome. Post-infection: measles; pertussis; bronchiolitis; pneumonia; TB; HIV. Other: Bronchial obstruction (tumour, foreign body); allergic bronchopulmonary aspergillosis (ABPA p160); hypogammaglobulinaemia; rheumatoid arthritis; ulcerative colitis; idiopathic. Clinical features Symptoms: persistent cough; copious purulent sputum; intermittent haemoptysis. Signs: finger clubbing; coarse inspiratory crepitations, wheeze (asthma, COPD, ABPA). Complications: pneumonia, pleural effusion; pneumothorax; haemoptysis; cerebral abscess; amyloidosis. Tests Sputum culture. CXR: cystic shadows, thickened bronchial walls (tramline and ring shadows). HRCT chest: (p150) to assess extent and distribution of disease. Spirometry often shows an obstructive pattern; reversibility should be assessed. Bronchoscopy to locate site of haemoptysis or exclude obstruction. Other tests: serum immunoglobulins; CF sweat test; Aspergillus precipitins or skin-prick test. Management â€¢Postural drainage should be performed twice daily. Chest physiotherapy may aid sputum expectoration and mucous drainage. â€¢Antibiotics should be prescribed according to bacterial sensitivities. Patients known to culture Pseudomonas will require either oral ciprofloxacin or IV antibiotics. â€¢Bronchodilators (eg nebulized salbutamol) may be useful in patients with asthma, COPD, CF, ABPA (p160). â€¢Corticosteroids (eg prednisolone) for ABPA. â€¢Surgery may be indicated in localized disease or to control severe haemoptysis.
- Acute Subdural Haematoma
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