interstitial lung disease Flashcards
(16 cards)
-Interstitial lung disease (ILD), This is also known as — lung disease
-Consists of a diverse group of disorders that involve the — and interfere with —
-The descriptive term “interstitial” reflects the – appearance in that the abnormality begins in the — .
diffuse parenchyma
pulmonary parenchyma
gas exchange
pathologic
intersitium
1- unknown causes of ILD:
-IDIOPATHIC PULMONARY — (IPF)
(Most common idiopathic cause)
Other idiopathic types include:
NSIP (Non-specific interstitial pneumonia)
COP (cryptogenic organising pneumonia)
Acute interstitial pneumonia
fibrosis
— is the most common idiopathic cause
Idiopathic Pulmonary Fibrosis (IPF): IPF is defined as a — occurring ( — ) specific form of — —- — limited to the lung.
- its the most common spontaneously occurring – lung disease
- its associated with the characteristic — pattern on both radiology and histology: — foci and — distortion ( — ).
idiopathic pulmonary fibrosis
spontaneously ( idiopathic )
chronic fribosing interstitial pneumonia
parenchyma lung disease
usual interstitial pneumonia (UIP)
fibroblastic foci
architectural distortion
honeycombing
2- known causes of ILD:
- — and — agents
- — indued
- — induced
- 2ndary to —- diseases
occupational and environmental
drug
radiation
connective tissue
1-Occupational and environmental agents, especially exposure to inorganic or organic dusts (silica, coal, asbestos).
2-Drug-induced pulmonary toxicity, such as
Nitrofurantoin (Antibiotic for urinary infections)
Methotrexate (Drug for rheumatoid arthritis)
Amiodarone (Drug for arrhythmias)
Bleomycin (Chemotherapy for cancer)
3-Radiation-induced lung —.
4-ILD can also complicate the course of most of the — tissue diseases (eg, rheumatoid arthritis, systemic lupus erythematosus, scleroderma, mixed connective tissue disease etc.).
injury
connective tissue
3- granulomatous ILD as —- which is a multi system disease characterised by granulamtous — and (non-caseating granulomas)
4- MISCELLANEOUS
CAUSES:
—- causes such as —
Malignancy, Lymphangitic — , —- X
sarcoidosis
inflammation
infective
tb
carinomatosis
histocytosis
pathophysiology of ILD:
- pathogenesis varies by underlying cause
-Usual Interstitial Pneumonia (UIP) pattern (known clinically as idiopathic pulmonary fibrosis IPF) is due to — with little or no — .
-The other causes of ILD are predominated by — and develop — in later stages.
-The interstitial damage and thickeningresults in decreased ability of — to — from the — to the — resulting in reduction of —
-As fibrosis occurs and worsens architectural distortion of the lung, results in — of thelung andrestricted —- .
-IPF (Usual Interstitial Pneumonia) histology is characterised by — foci and — distortion called “ —”.
fibrosis
inflammation
inflammation
fibrosis
02
diffuse
alveolus to capillary
diffusing capacity.
stiffening
movement
firboblastic
architectural
honeycombing
symptoms of ild:
- resp symptoms
- — dyspnea
- — cough
symptoms of connective tissue disease:
Fever, weight loss
Eye symptoms due to inflammation, dry eyes
Joint pain ( arthritis)
Skin rash
Symptoms of Sarcoidosis:
Lofgren’s syndrome most common symptomaticpresentation:
Fever, —- , —- , — nodules on the shin of the legs (erythema nodosum)
progressive
dry
lymphadenopathy
arthralgia
tender
history :
1- Detailed drug history to exclude possibility of drug-induced pulmonary fibrosis.
In some cases, lung disease may occur — to – after the drug has been discontinued
example:
Nitrofurantoin (Antibiotic for UTIs)
Methotrexate (Anti-inflammatory)
Amiodarone (Anti-arrhythmic)
Bleomycin (Chemotherapy for cancer)
2- Very important to enquire of previous — that may have been treated with — or — .
Radiation-induced lung injury is directly related to the — of irradiated lung and the cumulative — of radiation.
3- Review of the home and work environment is invaluable.
listing of the patient’s entire lifelong employment must be sought. aka – history
examples:
Bird racing
Farming
Coal mining
Stone cutting
4- — is an independent risk factor for idiopathic pulmonary fibrosis (IPF)
Uncommon types of ILD such as respiratory bronchiolitis interstitial lung disease (RBILD), desquamative interstitial pneumonia (DIP) and Langerhans’ cell histiocytosis (LCH) occur almost exclusively in smokers
- A positive family history of respiratory disease should be sought.
Both — and — can be familial, but this is rarer
weeks to years
malignancy
radio or chemo
volume and dose
occupational history
smoking
scardosis and IPF ( this falls under fam history )
the 3 c;s of IDL clinical features:
1- the cough is –
2- —
3- crackles are —
signs of idl :
General inspection:
-Tachypnea
-Oxygen supplementation
central myosis
— chest expansion , fine ( velcro) and end-inspiratory —
clubbing and tar staining
signs of cor pulmonale ( complications ) :
Elevated — , loud — , parasternal heave, — regurgitation, pulsatile hepatomegaly, lower limb pitting oedema
signs of underlying connective tissue : iritis , conjunctivitis , dry eye , arthritis and skin rash
dry
clubbing
fine
reduced
crepitations
JVP
p2
tricuspid
clinical features of sarcoidosis :
Important to note that it can mimic many other conditions due to its — nature. It can be considered a differential diagnosis of many conditions.
clinical features explained :
Crackles are interrupted — sounds and result from – of peripheral airways on — . On — , air rapidly enters these distal airways, and the alveoli and small bronchi open abruptly, producing the crackling noise
Similar to the sound heard when gently separating the joined strip of — on the blood pressure cuff (or jogging shoes)
Fine late inspiratory crackles are characteristic of —
systemic
non musical
collaps
expiration
inspiration
velcro
pulmonary fibrosis
clinical features explained:
Hypoxia ( low oxygen level ) will lead to:
Dyspnoea ( shortness of breath)
Tachypnoea ( rapid breathing)
Cyanosis – central + peripheral
-The exact cause of fingers clubbing is not fully understood. It may be produced by growth factors from — and — lodged in nail bed capillaries stimulating vascular — tissue.
When clubbing occurs in the course of ILD, it is typically a — manifestation and suggests — of the lung
megakarocytes and platelets
connective tissue
late
advanced fibrosis
clinical features explained:
Complications: Cor pulmonale is— ventricular dysfunction caused by — lung disease, such as ILD (or any other advanced lung disease causing chronic — , — classically)
right
advanced
hypoxia
COPD
differential diagnosis :
The differential diagnosis can be categorised by – (see aetiology)
ILD can also be categorised by the — it affects, upper vs lower:
1- upper zone DDx: ( — insults)
(3 exceptions; – , – and — spondylitis)
C - Coal
H - Histiocytosis
A - Ankylosing spondylitis
R - Radiation
T - TB
S - Sarcoidosis
2- lower zone DDx:
(—-borne insults)
(1 exception; — )
R - Rheumatoid arthritis
A - Asbestos
S - Scleroderma
I – Idiopathic Pulmonary Fibrosis
O - Other:
Drugs:
AmiodaroneMethotrexate
Nitrofurantoin
Bleomycin
cause
zone
inhaled
sarcoid, radiation and ankylosing spondylitis
blood
asbestos
differential diagnosis for IDL:
Otherdifferential diagnoses of SOB and crackles heard on auscultation :
—- ( Crackles = Both inspiratory and expiratory , coarse, change with coughing)
Chronic — heart failure ( Crackles = Mid-late inspiratory, coarse)
—- oedema( Crackles = Mid-late inspiratory, coarse)
info:
Fine late inspiratory crackles are characteristic of —
brochiestasis
left
pulmonary
pulmoanry fibrosis
key points:
- ILD is a — group of disorders that are classified together because of similar clinical, physiologic, or pathologic manifestations.
- Careful documentation of the past medical — is important in the initial assessment because the cause of the illness is often recognized from the patient’s medical history
- Remember the 3Cs of ILD clinical features : — , — and — that sounds like — !!
- An important part of the physical examination of patients with an undiagnosed ILD is looking for —- evidence of a systemic disease that might be associated with ILD
- Two of the most importantforms of ILD you will see in clinical practice are — and — .
heterogeneous
medical history
cough clubbing and crackles
velcro
extrapulmoanry evidence
IPF snf sacrodsosis
