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T2: Theme 4: Lungs > Lecture 10: Restrictive lung disease > Flashcards

Lecture 10: Restrictive lung disease Flashcards

1
Q

Reductions in which lung volumes defines restriction?

A

RV, FRC and TLC

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2
Q

What do intralobular septa do?

A

Surround the alveoli, and are a thin layer between the alveoli and capillaries

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3
Q

What do interlobular septa do?

A

Outline the secondary lobules

Where the lymphatics and veins of the lungs are

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4
Q

What is an interstitial lung disease?

A

Diseases which cause inflammation or scarring of the interstitium of the lung

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5
Q

What are the two types of environmental exposure interstitial disease?

A

Allergic responses that affect the interstitium:

  • Hypersensitivity pneumonitis
  • Occupational lung disease, aka pneumoconioses
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6
Q

What may cause hypersensitivity pneumonitis?

A

Mould and bird proteins are the common causes

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7
Q

What are the main causes for occupational lung disease?

A

Coal miners lung (coal dust exposure)

Silicosis (silica exposure)

Asbestosis (asbestos exposure)

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8
Q

What are the three categories of ILD?

A

1: environmental exposure
2: idiopathic
3: systemic inflammatory

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9
Q

What are the two types of inflammatory disease?

A

Autoimmune disease - ILD

Sarcoidosis

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10
Q

What coal miners lung?

A

Very small coal dust particles reach airsacs

Engulfed by macrophages  inflammation

Sometimes  trigger massive fibrosis

Coal dust essentially lasts forever in the lung

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11
Q

What are the three lung diseases that are associated with asbestos?

A

Asbestosis

Mesothelioma

Lung cancer

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12
Q

What is the importance of pleural plaques in the lung?

A

The plaque wont turn into mesothelioma but is indicative of exposure to asbestos

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13
Q

What is mesothelioma?

A

Aggressive, fatal, occurs at high rate

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14
Q

What causes fine peripheral lines +/- “honeycomb” cysts

A

Asbestos

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15
Q

What exposure causes nodular disease?

A

Silica and coal dust

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16
Q

What is a granuloma?

A

Clusters of macrophages (with a few T cells typically in the periphery)

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17
Q

What is the mechanism behind hypersensitivity pneumonitis?

A

Patients breathes something in (mould), picked up by APC, recognised by T cell, creates inflammatory response, form granuloma with T cells on the outside

Granulomas build up in the bronchiole

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18
Q

What conditions can lead to fibrosis?

A

Hypersensitivity pneumonitis

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19
Q

What is idiopathic pulmonary fibrosis?

A

Disease of older age (rare before age 50)
Most patients have smoked, but the disease process is not well understood: “idiopathic”

Mostly affects the lower + peripheral aspects of the lung
Fine peripheral lines + honeycomb cysts
Lots of fibroblast cells (make collagen)

Minimal inflammation

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20
Q

What are the alveolar filling processes?

A

Pulmonary oedema

Pulmonary hemorrhage

Infection (ie pneumonia)

Cancer

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21
Q

What is resorptive atelectasis?

A

Collapse of (otherwise healthy) alveoli

As a result of dwindling alveolar size - eventually lung collapse

22
Q

What is compressive atelectasis?

A

Collapse of (otherwise healthy) alveoli

As result of pleural process or lung mass

23
Q

What are the two types of pneumothorax?

A

Spontaneous

Traumatic: procedural, penetrating trauma, rib fracture, baurotrauma

24
Q

What are the three types of pleural disease?

A

PE

Pneumothorax

Haemothorax

25
Q

What volume of liquid normally cycles through the pleural space?

A

1L

26
Q

What causes influx of fluid into the pleural space?

A

Capillary leak (increased hydrostatic pressure or loss of oncotic pressure)

Pulmonary interstitium (crosses the visceral pleura)

Small holes, or “rents”, in the diaphragm allowing peritoneal fluid (if any is accumulating) to enter the pleural space

27
Q

What causes efflux of fluid into the pleural space?

A

Lymphatics: resorptive stoma give the pleura large surge capacity (can increase absorption 20x), but if these become blocked (even partially) absorption will slow

Resorption is dependent on good oncotic pressure within lymphatics

28
Q

What are the causes of transudative PE?

A

Congestive heart failure

Liver disease with portal hypertension and cirrhosis

Low albumin states (eg. nephrotic syndrome)

29
Q

What are the causes of exudative PE?

A

Infection

  • TB
  • Acute bacterial infection: “parapneumonic” effusion or empyema
  • Parasitic infection

Malignant (metastatic cancer)

Chylothorax

Pleurisy

30
Q

What is the difference between transudate and exudate?

A

Transudate = leakage of water (doesn’t need to be drained)

Exudate = Leakage of water and proteins (needs to be drained)

31
Q

What is transudative effusion?

A

Most common

Generally not harmful to patient, although can cause dyspnoea when large

The result of a non-pleural disease primary process

Will resolve if primary process is fixed

(Something wrong with normal fluid balance)

32
Q

What is uncomplicated parapnuemonic effusion?

A

Altered (pleural) capillary permeability in pneumonia (vasodilatory effect of inflammation)

Effusion with increased inflammatory cells but no bugs

Drain by tap if effusion is not small

33
Q

What is complicated parapnuemonic effusion?

A

Increased inflammatory cells with bacteria in the pleural space

Not frank pus, but the increased inflammation with bacteria needs to be drained by tube otherwise a pleural rind can form

This rind MUST be surgically removed (if left, it will decrease pleural expansion and lead to permanent restriction in that part of the lung)

34
Q

What is empyema?

A

Frank pus

Needs to be fully drained, usually over several days, with a chest tube

35
Q

What is chylothorax?

A

Due to retrograde spillage of lymphatic materials (which includes lots of fats which have have been absorbed from the GI tract) into pleural space

Most commonly this is due to thoracic duct injury

36
Q

What is the definition of haemothorax?

A

When haematocrit value of at least 50% of the haematocrit of peripheral blood

37
Q

What is pleurisy?

A

Sterile process of inflammatory cells and fluid accumulating in the pleural space due to autoimmune disease

38
Q

What is a thoracentesis?

A

Procedure using a needle to sample or drain the effusion

39
Q

How do you prevent re-expansion pulmonary oedema?

A

Limit drainage to 1.5L/day

40
Q

How do you diagnose exudative effusion?

A

Light’s criteria

If one or more of the following criteria are met:
• Protein level in pleural fluid divided by level in serum is greater than 0.5
• Lactate dehydrogenase (LDH) level in pleural fluid divided by level in serum is greater than 0.6
• LDH in pleural fluid is more than two-thirds the upper limit of the normal level in serum

41
Q

What are the fluid studies?

A

Protein and LDH

pH and glucose

Cell counts with WBC differential

Microbial stain and culture studies

Cytopathology to evaluate for cancer cells

Cholesterol levels and triglyceride (TG) levels

Less common: adenosine deaminase (ADA), RF titer, lupus erythematosus cells

42
Q

How do you diagnose hepatic hydrothorax?

A

Cirrhotic fluid transverses the diaphragm into the pleural space

43
Q

How do you diagnose parapneumonic effusion (complicated)?

A

Infected pleural space, pH < 7.2

Loculations can form

44
Q

How do you diagnose parapneumonic effusion (uncomplicated)?

A

Sterile inflammation

pH > 7.2

Small / free flowing

45
Q

How do you diagnose haemothorax?

A

Pleural fluid Hct > 50% of blood Hct

46
Q

How do you diagnose cylothorax?

A

TG > 110 mg/dL

Usually appears milky

47
Q

What is pneumothorax?

A

Pneumothorax: air collection in the pleural space due to rupture of alveoli near pleural surface

Spontaneous pneumothorax
Swings in intrapleural pressure and blebs are often invoked

Traumatic pneumothorax: procedural, penetrating trauma, rib fracture, baurotrauma

48
Q

What are the causes of chest wall disease?

A

Weakness and myopathy

Skeletal and connective tissue restrictions

49
Q

What are the different types of weakness and myopathy?

A

Degenerative spinal diseases; eg. motor neurone disease; polio

Myasthenia gravis

Global weakness

50
Q

What are the causes of skeletal and connective tissue restrictions?

A

Kyphoscoliosis

Extensive burns which affect the chest wall

T2: Theme 4: Lungs (16 decks)

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