Interstitial Lung Disease Flashcards Preview

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Flashcards in Interstitial Lung Disease Deck (72):
1

What is interstitial space?

- A potential space between alveolar cells and the capillary basement membrane which is only apparent in disease states, where it may contain fibrous tissue, cells or fluid

2

What is interstitial lung disease?

- Group of diseases with a variety of cuases that have similar pathophysiological effects and clinical features

3

What is the pathophysiology of interstitial lung disease?

- Fibrous tissue develops in the interstitium, making lungs less compliant (restrictive defect)

- Diffusion path between alveolar air and blood impairs gas exchange. O2 uptake affected selectively

4

What are the clinical features of interstitial lung disease?

Shortness of breath
Reduced exercise tolerance
Dry cough

5

Give four signs of Interstitial Lung Disease

- Tachypnoea
- Tachycardia
- Reduced chest movement
- Coarse crackles

6

Give five causes of interstitial lung disease?

- Occupational
- Treatment related
- Connective tissue disease • Immunological • Idiopathic

7

Give three occupational causes of interstitial lung disease

- Asbestosis
- Silicosis
- Pneumoconiosis

8

Give three treatment related causes of Interstitial Lung Disease

- Radiation
- Methotrexate
- Nitrofurantoin

9

Give three connective tissue disease

• Rh. Arthritis • Polymyositis • Scleroderma

10

Give two immunological causes of Interstitial Lung Disease

• Sarcoidosis • Hypersensitivity pneumonitis

11

What is fibrosing alveolitis?

- Progressive inflammatory condition of unknown cause
- Increased activated alveolar macrophages
- Attract neutrophils and eosinophils
- Local lung damage due to ROS and proteases
- Tissue destruction and fibrosis

12

What do patients present with when they have fibrosing alveolitis?

- Progressive shortness of breath on exercise, often combined with a productive cough
- Finger clubbing

13

What does the chest x ray of someone with fibrosing alveolitis show?

Small lungs with micro-nodular shadowing predominating in the lower lobes, with ragged heart borders

14

How is fibrosing alveolitis treated, and what are the limitations of this treatment?

Treated with high dose oral steroids in the early stages
Less effective once fibrosis has developed

15

How is treatment of fibrosing alveolitis monitored?

• By repeated lung function tests

16

What is extrinsic allergic alveolitis?

• Inhalation of organic material which triggers an allergic reaction in alveoli and bronchioles

17

What are two states of the condition?

• Can be acute or chronic

18

Outline acute extrinsic allergic alveolits

Farmers lung
- Thermophilic actinomycetes found in mouldy hay
- Inhalation causes influenza like illness 4-9 hours later with a dry cough and dyspnoea on exertion.
- Fine mid and late inspiratory crackles
- Wheeze

19

Outline chronic extrinsic allergic alveolitis

- Long term antigen exposure = Faeces of pidgeons/budgies
- Insidious malaise
- Dry cough and breathlessness over months and years
- Inspiratory crackles

20

What sign does not occur in any types of allergic alveolitis?

• Finger clubbing

21

What does the x-ray show in acute extrinsic allergic alveolitis?

Diffuse micro-nodular infiltrate denser towards the hila

22

What does the x-ray show in chronis extrinsic allergic alveolitis?

Normal, may progress to fibrosis

23

What will a lung function test show in extrinsic allergic alveolitis?

Lung function test will show reduced compliance and reduced gas transfer

24

What is asbestosis?

- Inhalation of asbestos fibres causes a disease to develop long after exposure

25

Give three different types of disease as a result of asbestos inhalation

- Benign pleural plaques
- Asbestosis
- Mesothelioma

26

What do asbestos fibres do in the lungs?

- Penetrate to the alveoli, causing alveolitis
- Causes an influx of macrophages which produce distinctive asbestos bodies
- Alveolitis progresses to fibrosis

27

What are the symptoms of asbestos related disease?

- Patient breathless on exertion and a dry cough
- Inspiratory crackles at the lung base, which rise as the disease advance

28

What do lung function tests of someone with asbestos related lung disease show?

• Small lungs, reduced compliance and impaired gas transfer

29

What is sarcoidosis characterised by?

• Non-caseating granulomas in multiple organs and body sitesMost commonly found in the lungs

30

What occurs in the airways in sarcoidosis?

• Fluid is collected by lavage of the airways and alveoli contain lots of cells, including macrophages and lymphocytes

31

In what ethnicities is sarcoidosis the most common?

• Afro-Carribean and Asians than in CaucasiansGenetic predisposition

32

When is the highest incidence of sarcoidosis?

• 30's and 40's with more female cases

33

What are the two main symptoms of sarcoidosis?

• Cough • Dyspnoea

34

How is sarcoidosis graded?

On a scale of severity of 1-4

35

What does X-ray show in sarcoidosis?

Miliary and nodular shadowing and diffuse fibrosis

36

How can sarocidosis be treated?

Steroids

37

What does the lung function test in sarcoidosis show?

- Small lungs
- Reduced compliance
- Impaired gas transfer
May be evidence of air flow obstruction

38

Give four diseases associated with the work place

- Asthma
- Diffuse fibrosis
- Nodular fibrosis
- Alveolitis

39

In what occupation and after what exposure does one get Asthma

Lab worker
Rat urine

40

In what occupation and after what exposure does one get diffuse fibrosis

Boiler/Pipe Lagger
Railway/Construction - Asbestos

41

In what occupations (3) and after what exposure does one get nodular fibrosis (pneumoconiosis)

Coal miner, miner, demolition Coal dust, silica, asbestos

42

In what occupation and after what exposure does one get alveolitis

Farmer - fungal spores from hay
Pigeon fancier - Avian antigens

43

Name five types of intersitial lung disease

• Fibrosing alveolitis • Extrtinsic allergic alveolitis (acute) • Extrinsic allergic alveolitis (chronic) • Sarcoidosis • Asbestosis

44

Give the plain film x-ray found in fibrosing alveolitis

• Small lungs • Micro-nodular shadowing (lower lobes) • Ragged heart border

45

Give the x-ray appearance of sarcoidosis

Miliary and nodular shadowing
Diffuse fibrosis

46

Give the x-ray appearance of asbestosis

Plaques
Fibrosis
Mesothelioma

47

What is the pleura?

A serous membrane consisting of a single layer of mesothelial cells with a thin layer of underlying connective tissue
Made up of parietal and visceral pleura

48

What does the parietal pleura line?

The inside of each hemithorax

49

What does the visceral pleura line?

The outside of the lung

50

Where are the visceral and parietal pleura continous?

At the hilum of the lung

51

What is the pleural cavity?

A potential space between two layers of pleura

52

What does the surface tension of the pleural fluid provide?

The cohesion that keeps the lung surface in contact with the thoracic wall
As a result, when the thorax expands, the lungs expand with it and fill with air

53

What is the normal turnover of pleural fluid per day

15ml turnover per day

54

What are the two methods by which pleural fluid is modified?

Added by capillary filtration at the parietal pleura
Absorbed via lymphatic drainage

55

What four factors affect the rate at which fluid is added to the pleural fluid?

1. Increase in lung interstitial fluid
2. Increase in hydrostatic pressure (heart failure)
3. Increase in permeability (Inflammation, sepsis or malignancy)
4. Increased by decreased oncotic pressure (liver failure)

56

What two facts factors affect the rate at which fluid is removed from the pleural cavity?

Decreased by lymphatic blockage
Decreased by systemic venous pressure

57

What is a transudate?

Low protein content

58

What is an exudate?

High protein content
>30g/l

59

Give three causes of increased transudate in the pleural space

- Increased hydrostatic pressure
- Decreased capillary oncotic pressure
- Hypoalbuminaemia

60

Give four causes of an exudate pleural effusion

1. Neoplasms
- Cancer involving pleural surface
- Secondary mets from breast, lung, ovarian, GI and lymphoma
- Primary tumour of the pleura
2. Infection
- Pneumonia
- TB
3. Immune disease
- Connective tissue disease
4. Abdominal
- Pancreatitis
- Ascites
- Subphrenic abscess

61

What is pleurisy?

Inflammation of the pleura
- Causes sharp pain on inspiration

62

What is a characteristic sign of pleurisy?

Pleural rub, a creaking noise heard through a stethoscope with respiratory movements

63

Why do patients with pleurisy get shoulder pain?

Irritation of diaphragmatic pleura

64

Give five causes of pleurisy

Infection
Autoimmune
Lung cancer
Pneumothorax
Pulmonary embolism

65

What are the two types of infection which cause pleurisy?

TB
Pneumonia

66

What are the two types of autoimmune disease which cause pleurisy?

- Systemic Lupus Erytematosus
- Rheumatoid arthritis

67

What is pleural fibrosis?

- Unabsorbed pleural effusion may lead to fibrosis of the pleura
- A small degree of thickening has no effect, but widespread fibrosis restricts expansion with a measurable reduction in lung volumes and compliance

68

What is the most common type of pleural tumour?

Malignant mesothelioma
- Early symptoms are loss of pleural effusion, but with a duller pain
- Signs are the of a large pleural effusion

69

Name two chest wall abnormalities which cause significant functional impairment of the thoracic cage

Scoliosis and kyphosis may produce significant functional impairment of the thoracic cage

70

Give an acquired chest wall abnormality which can cause breathing abnormalities

Broken rib

71

Give a muscular defect and two nervous defects which can cause trouble breathing

1. Muscular dystrophy
2. Motor neurone disease
3. Polio

72

What does muscle weakness cause in terms of breathing?

Respiratory failure with lower resistance to respiratory tract infections because of poor clearance of secretions