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Flashcards in Interstitial lung disease Deck (34)
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1

what are ILDs ?

this is any disease process affecting lung interstitium (i.e. alveoli, terminal bronchi)

2

what are the key features of ILD?

interferes with gas transfer- this is why patients present with breathlessness

shows a restrictive lung pattern

Symptoms: breathlessness and dry cough

3

it can be...

acute
episodic
chronic due to occupational or environmental agents or drugs
chronic with evidence of systemic disease
chronic with no evidence of systemic disease

4

what is the pathophysiology ?

get impaired gas exchange - alveolar barrier to O2 exchange (i.e. alveolar-arteriolar barrier)

5

what happens to the CO2 exchange?

CO2 exchange unimpaired as alveolar ventilation normal (CO2 is very soluble and blown off)

so get decreased PaO2 (decreased SaO2) normal PaCO2

6

what are the clinical features of ILDs?

cough, usually dry, persistent and distressing

breathlessness

7

what are the features of breathlessness?

usually slowly progressive, insidious onset, acute in some cases

8

what are the common examination findings?

crackles
clubbing

central cyanosis and signs of right heart failure in advanced disease

9

what are the features of the crackles?

typically bilateral and basal

10

where is clubbing common?

in idiopathic pulmonary fibrosis but it is also seen in other types e.g. asbestosis

11

what is normally see on a CXR?

typically small lung volumes with reticulonodular shadowing but may be normal in early or limited disease

12

what is normally seen on a HRCT?

combinations of ground glass changes, reticulonodular shadowing, honeycomb cysts and traction bronchiectases, depending on the stage of disease

13

what are the features of pulmonary function?

typically restrictive ventilatory defect with reduced lung volumes and impaired gas exchange

exercise tests assess exercise tolerance and exercise related fall is Sa O2

14

what are the categories of ILD?

ILD of known cause e.g. drugs or association

idiopathic interstitial pneumonia -Main ones
- idiopathic pulmonary fibrosis (IPF)
- IIP other than IPF
1. respiratory bronchiolitis interstitial lung disease
2.desquamative interstitial pneumonia
3. acute interstitial pneumonia
4.cryptogenic organising pneumonia
5. lymphocytic interstitial pneumonia
6. nonspecific interstitial pneumonia

Granulomatous ILD e.g. sarcoidosis, EAA

other forms of ILD e.g. LAM

15

what are the causes of ILD?

Fluid in the alveolar spaces

Consolidation of Alveolar Air Spaces

Inflammatory Infiltrate of Alveolar Walls (i.e. Alveolitis): Granulomatous Alveolitis

Dust Disease (Pneumoconiosis)

Carcinomatosis

Eosinophilic (Type ⅓ Allergic response

16

what can cause fluid in the alveolar space?

cardiac Po oedema due to raised venous pressure i.e. let heart failure

and non cardiac Po oedema- this means that there is normal po venous pressure but leaky Po capillaries

17

what may cause Cardia Po oedema

congestive heart failure that leads to PO may be cause by:

heart attack or any disease of the heart that weakens or stiffens the heart muscle

leaking or narrowed heart valves (mitral or aortic valves)

sudden, severe hypertension

18

what are the causes of non-cardiac PO?

sepsis or trauma (ARDS aka shock lung)

may also be altitude sickness

19

what causes consolidation of alveolar air spaces?

infective pneumonia

infarction

bronchiolitis obliterans organising pneumonia

rheumatoid disease

drugs

cryptogenic

20

what are the viral organisms of infective pneumonia causing consolidation of alveolar air spaces in ILD?

influenza, measles, chickenpox

21

what are the bacterial organisms of infective pneumonia causing consolidation of alveolar air spaces in ILD?

pneumococcus, TB

22

what are the fungal organisms of infective pneumonia causing consolidation of alveolar air spaces in ILD?

HIV/ pneumocystic

23

what are the parasites organisms of infective pneumonia causing consolidation of alveolar air spaces in ILD?

toxocara, filaria

24

what may cause infarction?

PE

vasculitis

25

what is bronchiolitis obliterans organising pneumonia?

a non-infectious pneumonia, just an inflammation of the bronchioles and surrounding tissue in the lungs

26

what are the causes of ILD by granulomatous alveolitis?

EAA

sarcoidosis

Drug induced alveolitis

Toxic gas/fumes: chlorine

fibrosing alveolitis

autoimmune

27

what is EAA?

hypersensitivity pneumonitis type 3 reactions

farmers lung

avian (pigeon budgie)

28

what is sarcoidosis?

multi system disease

causes lymphadenopathy/ erythema nodosum/ uveitis/ myocarditis/ neuropathy

29

what drugs cause alveolitis?

amiodarone
Bleomycin, Methotrexate
Gold

30

what is firbosing alveolitis?

rheumatoid, Cryptogenic (IPF)