Flashcards in Interstitial lung disease Deck (34)
what are ILDs ?
this is any disease process affecting lung interstitium (i.e. alveoli, terminal bronchi)
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
it can be...
chronic due to occupational or environmental agents or drugs
chronic with evidence of systemic disease
chronic with no evidence of systemic disease
what is the pathophysiology ?
get impaired gas exchange - alveolar barrier to O2 exchange (i.e. alveolar-arteriolar barrier)
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
what are the clinical features of ILDs?
cough, usually dry, persistent and distressing
what are the features of breathlessness?
usually slowly progressive, insidious onset, acute in some cases
what are the common examination findings?
central cyanosis and signs of right heart failure in advanced disease
what are the features of the crackles?
typically bilateral and basal
where is clubbing common?
in idiopathic pulmonary fibrosis but it is also seen in other types e.g. asbestosis
what is normally see on a CXR?
typically small lung volumes with reticulonodular shadowing but may be normal in early or limited disease
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
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
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
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)
Eosinophilic (Type ⅓ Allergic response
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
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
what are the causes of non-cardiac PO?
sepsis or trauma (ARDS aka shock lung)
may also be altitude sickness
what causes consolidation of alveolar air spaces?
bronchiolitis obliterans organising pneumonia
what are the viral organisms of infective pneumonia causing consolidation of alveolar air spaces in ILD?
influenza, measles, chickenpox
what are the bacterial organisms of infective pneumonia causing consolidation of alveolar air spaces in ILD?
what are the fungal organisms of infective pneumonia causing consolidation of alveolar air spaces in ILD?
what are the parasites organisms of infective pneumonia causing consolidation of alveolar air spaces in ILD?
what may cause infarction?
what is bronchiolitis obliterans organising pneumonia?
a non-infectious pneumonia, just an inflammation of the bronchioles and surrounding tissue in the lungs
what are the causes of ILD by granulomatous alveolitis?
Drug induced alveolitis
Toxic gas/fumes: chlorine
what is EAA?
hypersensitivity pneumonitis type 3 reactions
avian (pigeon budgie)
what is sarcoidosis?
multi system disease
causes lymphadenopathy/ erythema nodosum/ uveitis/ myocarditis/ neuropathy
what drugs cause alveolitis?