Bronkiektasis

Heryanto Andreas / I11111019

Definisi
 Diagnosis anatomis
 Penyakit paru kronik yang
ditandai oleh dilatasi
bronkus irreversibel akibat
destruksi dinding bronkus
dan bronkioulus akibat
infeksi dan inflamasi.
Epidemiology
 ↑usia  ↑insidens
 272/100,000 pada usia ≥75
 Perempuan > Laki-laki
 BE sering ditemui pada
perempuan >50 tahun yang
tidak merokok
 Negara maju  Modern
Bronchiectasis
Etiologi
 Congenital  Bronchial Obstruction
 Cystic fibrosis (CF)  Tumour
 Young’s syndrome  Foreign body
 Primary ciliary dyskinesia  Mucous impaction
 Kartagener’s syndrome
 Post-infection  Other
 Measles  Alergic bronchopulmonary
 Pertusis aspergillosis
 Bronchiolitis  Hypogamma globulinemia
 Pneumonia  Rheumatoid arthritis
 TB  Ulcerative colitis
 HIV  Idiopatic
 Patofisiologi  Vicious Cycle
Infection with
inflammation and
Bacterial mediator release
colonization
Release of
inflammato
ry product

Destruction of
Impairment
mucociliary and
and Loss
supporting
of Ventilatory
structure
function
Morfologi

 Silindris
 Varicose
 Kistik
 Traksi
Gejala Klinis
 Batuk  kronik, produktif
 Sputum tiga lapis
 Hemoptisis
 Sesak napas (dispnea)
 Demam berulang
Diagnosis
 Anamnesis
 Batuk kronik dengan produksi sputum purulen (wet)
 Batuk kronik tanpa produksi sputum  dry
 Malaise
 Nyeri sendi
 Hemoptisis
 Riwayat:
 Onset usia
 Gejala saluran napas atas (sinusitis, otitis media)
 Riwayat infeksi berat
 Riwayat keluarga ( termasuk infertil)
 Gejala GERD
 Asma
Diagnosis (lanjutan)
 Pemeriksaan Fisik
 Inspeksi  Dapat dijumpai
clubbing finger
 Palpasi  Fremitus biasanya
melemah
 Perkusi  Suara sonor hingga
hipersonor
 Auskultasi  Ronki, Wheezing
 Pemeriksaan Penunjang 
Radiologi
 CXR  tidak sensitif
 HRCT
 Bronkoskopi fiberoptik
Tests
 Sputum culture
 CXR  Cystic shadows, thickened bronchial walls
(tramline and ring shadows)  Honey Comb
appearances
 HRCT chest  assess extent and distribution of disease
 Spirometry  obstructive pattern (FEV1 / FCV)
 Bronchoscopy to locate site of haemoptysis, exclude
obstruction and obtain sample for culture
 Other tests: serum immunoglobulins, CF sweat test,
Aspergillus precipitans or skin-prick test
Diagnosis Banding
 Bronkitis kronik
 Tuberkulosis paru
 PPOK
 Asma
Tatalaksana
 Non medikamentosa
 Menciptakan lingkungan
yang baik dan tepat bagi
pasien
 Medikamentosa
 Memperbaiki drainase
sekret bronkus
 Kemoterapi
 Pembedahan
Antibiotik pada BE
 Mengontrol Infeksi
Bronkus
 Mengobatik Eksaserbasi
Akut pada BE
 Keduanya
Komplikasi
 Bronkitis kronik
 Pneumonia
 Pleuritis
 Efusi pleura, empiema
 CPC
Azithromycin
 Daily, twice weekly, and thrice weekly
 Decreased frequency of exacerbations, reductions in sputum
volume, and improvements in quality of life and pulmonary
function and reductions in levels of C-reactive proteins.
 Macrolides have been shown to have several biologic effects
not related to antibacterial effect  nuclear transcription
factors with down-regulation of proinflammatory cytokines,
suppression of iNOS, reduced adhesion molecule expression,
reduced neutrophil chemotaxis and degranulation,
cytoprotection against phospholipids, improvement in mucus
rheology, reduction in bronchial hyperreactivity, effects on
Pseudomonas biofilm production, and quorum sensing function.
Terima Kasih