Diffuse Parenchymal Lung Disease Flashcards Preview

MODHIII - Unit 3 > Diffuse Parenchymal Lung Disease > Flashcards

Flashcards in Diffuse Parenchymal Lung Disease Deck (36)
1

What can effect the interstitium

- edema
- malignancy
- infections
- inflammation and fibrosis (INTERSTITIAL LUNG DISEASE)

2

Mechanism of interstitial lung disease

1. lung injury: environment, autoimmune, unknown (can lead to 2 or 3)
2. inflammation: this can lead to possible resolve or 3
3. lung fibrosis

3

Causes of primary interstitial lung disease (ILD)

- idiopathic interstitial pneumonias
- sarcoidosis

4

Causes of secondary ILD

- drugs
- exposures/occupations
- radiation
- aspiration
- connective tissue disease related ILD (autoimmune)
- smoking-related

5

Important aspect to diagnosing ILD

- taking a good history

6

Types of diffuse parenchymal lung disease

- smoking related
- environmental exposure
- granulomatous
- autoimmune
- idiopathic interstitial pneumonias

7

Signs of sarcoidosis

- uveitis
- erythema nodosum (bruises on shins)
- noncaseating granulomas

8

Person to first diagnose someone with sarcoidosis & when

J. Hutchinson - 1878

9

Systems effected by sarcoidosis

- multisystem disease: every system can be effected
- most common: lung (95%), eyes, lymph nodes, liver, skin

10

Who gets sarcoidosis

- all ages, gender, races
- familial

11

Incidence/Prevalence of sarcoidosis

- highest in african american women
- norther european african americans (sweden)

12

Clinical manifestations of sarcoidosis by country

- US/Europe: respiratory disease
- Japanese: cardiac & eye disease

13

What defines sarcoidosis

- granuloma with no identifiable bug

14

What is a granuloma

- macrophages, epitheliod cells, multinucleated giant cells
- surrounded by CD4 T cells (Th1) w/ few CD8 and B cells

15

How do patients present w/ sarcoidosis

- skin abnormality
- fevers, night sweats, fatigue, weight loss
- cough, shortness of breath
- chest pain, palpitations, arrhythmia
- NO symptoms at all**

16

Aspects needed to diagnose sarcoidosis

- clinical symptoms
- radiograph
- biopsy w/ pathology
****MUST RULE OUT ANY OTHER CAUSE: infections, cancer, foreign bodies, inhalations****

17

Meaning behind staging of sarcoidosis

- doesn't mean you have a worse prognosis
- deals with how you will treat the patient

18

Clinical course of sarcoidosis

- spontaneous remission: 50-70%
- wax and wane-chronic and persistent: 30-50%
- progressive: 1-5%

19

Treatment of sarcoidosis

- lacking evidence
- vital organ involvement such as eye, cardiac, neuro: corticosteroids
- other immunosuppressants

20

Clinical case of fibrosis

- old age
- chronic

21

Physical exam findings of fibrosis

- low O2 when walking
- VELCRO crackles w/ NO wheezing
- mild clubbing

22

Percentage of idiopathic pulmonary fibrosis (IPF) patients that have crackles

80%

23

Percentage of IPF patients that have clubbing

50%

24

Pulmonary function test results of IPF patients

- low FVC, FEV, total lung capacity, diffusing capacity

25

Type of lung disease in IPF

- restrictive lung disease w/ severely reduced diffusing capacity

26

Radiograph findings of IPF patient

- reduced lung volume
- honeycombing
- lower lobe predominance

27

Diagnosing idiopathic pulmonary fibrosis (IPF)

- exclude other known causes of pulmonary fibrosis
- abnormal pulmonary function tests
- features of pulmonary fibrosis on CT scan
- usual interstitial pneumonia an open lung biopsy

28

Other causes of pulmonary fibrosis

- medications: amiodarone, nitrofurantoin, cocaine/heroin, mineral oil, chemo, anti TNF
- medical history: autoimmune disease

29

Social history showing possible causes of IPF

- smoking, occupation, hobbies, inhalations, drugs, mold exposure, pets (BIRDS ARE BAD), hot tubs (mycobateria)

30

Mechanism of injury in IPF

insult to epithelium and basement membrane--aberrant wound healing or vascular injury--fibrotic foci (fibroblast proliferation, collagen deposition)--Fibrosis (circulating fibroblasts also contribute)
***INFLAMMATION does NOT play a roel***

31

Does inflammation play a role in IPF

NO INFLAMMATION DOES NOT PLAY A ROLE

32

Another name for idiopathic pulmonary fibrosis

usual interstitial pneumonia

33

Median survival of patient w/ IPF

3-5 years

34

Treatment for IPF

- anti fibrotics: prifenidone, nintedanib
- pulmonary rehab
- oxygen
- lung transplant

35

Diffuse parenchymal lung disease types and treatments

- smoking related: stop smoking
- environmental exposure: remove exposure
- granulomatous: steroids/immunosuppressants
- idiopathic interstitial pneumonias: steroids/immuno/ANTIFIBROTIC
- autoimmune/collagen vascular disease: steroids/immuno

36

How is the type of interstitial lung disease determined

- by the type, amount, location of cells