302 Pathophysiology of cough, sputum, and haemoptysis and pathogenesis of tuberculosis Flashcards
Where is coughed up blood derived from?
The lungs or the bronchial tree
What is a massive haemoptysis?
Over 250mls/24hrs coughed up
What are the mechanisms of bleeding in lungs?
-Inflammation of mucosa causing bronchial arteries hypertrophy and proliferate making them more amenable to erosions and bleeding
-Necrosis and infarction of pulmonary parenchyma
-Direct invasion of blood vessels by tumour
-Rupture of distended pulmonary capillaries eg mitral stenosis LVF
-Intracavitary anastomoses
-Vasculitis of pulmonary vessels
Where do the bronchial arteries originate from?
3-8th thoracic vertebral level
What % of haemoptysis originates from pulmonary arteries?
5%
What are the different causes of haemoptysis?
Neoplastic
-Bronchogenic carcinoma, pulmonary metastatic disease, Kaposi’s sarcoma
Infection
-Bacterial pneumonia, TB, mycetoma, Respiratory viral disease, Parasitic disease
Systemic disease
-Goodpasture’s syndrome, Wegener’s granulomatosis, microscopic polyarteriosis, systemic lupus erythematosus
Airway disease
Primary vascular disease
Coagulopathy
What is Kaposi’s sarcoma?
Kaposi’s sarcoma is a rare type of cancer caused by a virus.
It affects the skin and mouth, and sometimes the internal organs
What is mycetoma?
A disease caused by certain types of bacteria and fungi found in soil and water
It causes a massive infection
What is Goodpasture’s syndrome?
A group of acute illnesses that affects the lungs and kidneys.
It involves an autoimmune disorder where the body makes antibodies against the kidneys and lungs
What is Wegener’s granulomatosis?
An uncommon disorder that causes inflammation of the blood vessels in your nose, sinuses, throat, lungs and kidneys
AKA Granulomatosis with polyangiitis
What are the key features of a history for somebody with haemoptysis?
-Chronic/past respiratory disease
-Cough, when? sputum?
-Fever? chest pain? weight loss?
-Systemic disease or rash?
-Risk of PE or HIV?
-Smoking and travel history
-Careful drug history
-Social history
What are the less common forms of TB?
-Skeletal TB (15-30% of all extrapulmonary cases)
-Genitourinary TB
-TB enteritis
-TB of the eye
-Pericardial TB
-CNS TB Eg. meningitis, arachnoiditis, tuberculoma, spinal cord compression
