Thursday, June 9, 2011

Lung Transplantation and Bronchoscopy: how to diagnose a refusal

at 2:00 PM
What is a Bronchoscopy?
Patients who received a lung transplant is know too well what a Bronchoscopy. For those on the waiting list who never had one; don't worry you will get to know. A Bronchoscopy is usually done by a pulmonologist (lung physician) and consists of a small camera at the end of a narrow probe long enough to fit through the respiratory tract. It can be inserted through the nose or mouth and also through the breathing tube is that the patient is still breathing machine (ventilator). That camera is inserted all the way down in both lungs while slightly sedated patient. The patient receives usually what few hospitals called "conscious sedation". That basically means that you're awake enough to breath and gag but sleepy, just think what is happening is just a bad dream.
Indications after lung transplantation
There are mainly 2 reasons physicians will bronchoscopies after lung transplantation. The first reason is for diagnostic purposes, where the doctor may or may not suspect something wrong but he needs to find out. A Bronchoscopy occurs at scheduled intervals after transplantation to see if the body is rejecting the lungs. A rejection is a sign that the body is not to accept the organ and is trying to get rid of it, just as if it were a bacterium. Needs immediate medical treatment once diagnosed. Biopsies will be taken from several different places in the lungs to try possible rejection. A biopsy is a wee bit removal of lung tissue and directly under the microscope. Usually your doctor will repeat that 6-8 times each Bronchoscopy depending on how the patient tolerate it and how much it bleeds. It takes about 24 hours to know if lung biopsy showed a rejection or not.
Another reason for making a diagnostic bronch is when a patient shows some signs of lung infection and a culture should be performed. Performing a culture, the respiratory therapist will be able to identify the bug (bacteria, viruses or fungi) that has invaded the new lung treatment accordingly. Unfortunately, a lot of lung transplant patients is infected with "superbugs" that require powerful antibiotics because they have adapted and become resistant to those weaker as Cyprus or Levaquin.
Another purpose of a Bronchoscopy has therapeutic intentions. In other words means to treat a condition found in the lungs where the patient is experiencing complications of lung transplantation. The principal that we see are an accumulation of thick mucus that sometimes they occlude the lung. The doctor use the scope and real go and rinse well. The actual term used for the occlusion is a plug of mucus. Usually a patient feels 100% better once this problem has been resolved.
Rarer complications after lung transplantation is called bronchial stenosis. Stenosis means narrowing. Bronchial stenosis therefore means that the bronchi are become narrow and is more difficult for air to pass through. That usually happens at the site where the surgeon connected together the new lung of patients with bronchia. The scar tissue that forms makes the narrower air passage. The condition is diagnosed during a Bronchoscopy and can be treated with 2 ways quite similar to what you will do a cardiologist to clear blockages in the heart. The first step is to use a balloon that is inflated to narrow spot to open it. If it opens and stays like that, it is good. If you close backup, a stent may be deployed to keep it open. Just like in your heart. The difference is what happens in the lung, not into the bloodstream.
These were the main reasons bronchoscopies are made on lung transplant patients. The number one thing that always suspected soon after transplanting, regardless of whether the patient has any symptoms is rejection. That's why bronchoscopies performed so routine, taking them at the beginning.
Learn how the transplants from behind the scene as experts from a transplant Coordinator.
Being an informed patient.