219 - Haemoptysis 2 (Pulmonary circulation) Flashcards Preview

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Flashcards in 219 - Haemoptysis 2 (Pulmonary circulation) Deck (24):
1

what is haemoptysis and what can it be confused with?

coughing up of blood/bloody sputum from respiratory tract below the larynx (blood is bright red & acidic)
confused with haematemesis (blood from GIT usually coffee ground colour & acidic) & epistaxis (ENT source)

2

haemoptysis always warrants invesitgation, what tests should a GP organise?

CVR (mandatory), bloods (FBC, clotting screens & MC&S), ABGs, sputum (MC&S, AFB (acid fast bacilli) & cytology)

3

what can cause small and massive haemoptysis?

*bronchitis in smokers, pneumonia (lobular usuallt streptococcus pneumonia), tuberculosis, bronchiectasis, lung cancer, heart failure, PE, anticoagulation
*massive haemoptysis (>100ml emergency) - bronchiectasis, lung CA, TB, aspergilloma, vascular abnormalities, vasculitis

4

what can cause cavities and are prone to opportunistic infections?

TB, sarcoidosis, aspergilloma

5

what is bronchiectasis?

abnormal & permanent dilation of the proximal bronchioles due to inflammation leading to the destruction of elastic/muscular components of walls. Occurs after damage by resp infections/cystic fibrosis & bronchioles dilate with damaged cilia & mucous stasis. infections occur as a result and further damage - cycle

6

what are the signs and symptoms of bronchiectasis?

*persistent productive cough with symptoms of chronic bronchial sepsis (foul smelling, purulent sputum)
*dyspnoea, polyphonic wheeze, finger clubbing, coarse mid inspiratory crackles, haemoptysis

7

what are the inherited and acquired causes of bronchiectasis?

*inherited - cystic fibrosis, immotile cilia syndromes (kartagener's)
*acquired - childhood pneumonia (pertusis, measles, TB), chronic bronchial obstruction, chronic aspiration, allergic bronchopulmonary Aspergillosis (ABPA), IG deficiency, HIV, RA, UC

8

what is aspergillosis?

mould (fungal) infection seen in asthmatics & Cystic fribrosis with fungus ball in cavity. S&S - flitting pulmonary consolidations, blood & sputum eosinophilia & ↑IgE and apergillus precipitins. Tests - skin prick test

9

what investigations can be done for suspected bronchiectasis?

*sputum - MC&S, bloods
*imaging - CT/MRI - cygnet ring - large lilated bronchiloles next to arterioles

10

what treatment should be given for bronchiectasis?

abx to treat infection
*physiotherapy
*bronchodilatiors

11

what is the difference between a non massive and massive PE?

*non-massive - px haemodynamically stable, small distal infarction causes pleuritic pain, SOB, fever, haemoptysis
*massive - px haemodynamically unstable, PE at bifurcation of PAs with ↑RR, ↓O2, systolic BP<90 or 40mm drop, ↑JVP, AF

12

what is a paradoxical emboli?

caused by atrial septal defect causing systemic manifestation

13

what is virchow's triad?

a presdisposition to thrombosis caused by:
*venous stasis
*injury to vessel wall
*↑blood coagulability

14

what are the risk factors for a PE?

*prothrombotic states - post surgery, pregnancy, malignancy
*immobility - fracture, paralysis, bed rest
*previous VTE

15

how might a px with a PE present?

*often asymptomatic
*chest signs - pleuritic pain, dyspnoea, haemoptysis (in s sign (calf pain on dorsiflexion)

16

how might you assess the risk of a PE in a px?

Wells score - high >6 mod 2-6

17

what investigation can be carried out on a px with a suspected PE?

*bloods - D-Dimer (breakdown of cross linked fibrin ↑in thromboembolism) - only excludes those with low prob as can also be due to trauma, post surgery, liver/renal disease, pregnancy, ca, heart disease. ABG low CO2 & ↑pH (hyperventilation. FBC & clotting screen
*ECG - S1Q3T(inv)3, RIght ventricular strain (ST depress & T wave in rt side (V1-V,II, III, aVF)), New right bundle branch block
*CT Pulmonary angiogram 1st line
*bedside echo - show RV overloaded

18

what treatment would you give for a PE?

*O2 therapy
*resuscitation + fluids
*anticoagulant therapy - Low molecular weight heparin - stop when INR 2.5 then warfarin
*Thrombolysis in haemodynamic instability. warfarin for 3m if clear cause, 6m if no clear cause

19

what other causes are there for a PE?

fat embolism (long bone fracture), tumour emblism, septic embolism (iv drug users - usually strphylococci)

20

what causes a cavitating mass?

*carcinoma (Squamous cell)
*lung abscess
*rheumatoid nodule
*embolus (septic)
*vasculitis with granulomatosis - chronic ENT symptoms, systemic symptoms, renal failure, +ve cANCA, high ESR
*bronchogenic cyst
*hydratic cyst

21

what can cause pulmonary arterial hyperternsion?

collagen vascular disease, pulmonary shunts, portal hypertension, drugs/toxins, HIV. mean PAP>25mmHg...needs R+LHC to confirm

22

what can cause pulmonary venous hyperternsion?

L sides atrial or ventricular heart disease / valvular disease

23

what can cause pulmonary hyperternsion with hypoxia?

COPD, instititial lung disease, OSA

24

what can cause pulmonary hyperternsion due to chronic thromboembolic disease?

thromboembolic obstruction pf proximal/distal PA, tumor, foreign material