Interstitial Lung Disease Flashcards Preview

*Medicine: Respiratory > Interstitial Lung Disease > Flashcards

Flashcards in Interstitial Lung Disease Deck (8)
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1

What happens in diffuse parenchymal lung diseases (=intersitital lung diseases)?

  • large group of conditions characterised by inflammation centres on the interstitium of alveolar walls
  • interstitium becomes expanded by inflammatory cell infiltrate ('pneumonitis' or 'alveolitis')
  • impairs gas exchange + causes breathlessness
  • episodes of alveolitis may be followed by complete regeneration without residual damage to alveoli

2

With interstitial lung disease where most inflammation may completely regenerate, sometime the inflammation is followed by repair with scarring.

What happens here?

  • macrophages release fibrogenic cytokines
  • stimulate fibroblasts in interstitium
  • secrete collagen (scar tissue)
  • thickened alveolar walls are ineffective at gas exchange
  • resulting in worsening breathlessnes

 

4

What is meant by the terms 'pneumonitis', 'alveolitis' and 'pneumonia'?

  • pneumonitis - inflammation of lung parenchyma ie. the alveoli (alveolitis is an alternative name) - usually due to non-infective causes. Inflammation is limited to interstitium
     
  • pneumonia - inflammation of the lung parenchyma due to an infective agent - characterised by consolidation - acute inflammatory exudate filling alveolar spaces.

5

There are 200+ DPLDs. They can be caused by anything which sets up chronic inflammation within the interstitial space of alveolar walls.

What are the 5 basic categories that can divide up the causes?

  • unknown cause (idiopathic intersitital lung disease)
     
  • pneumoconioses (inhaled inorganic/mineral dusts), eg. coal dust, silica, asbestos
     
  • extrinsic allergic alveolitis (inhaled organic) eg. bird fancier lung, farmer's lung
     
  • side-effects of treatment - eg. therapeutic chest radiation, certain drugs (amiodarone)
     
  • multisystem diseases involving lung eg. sarcoid, SLE, RA, scleroderma

6

How is interstitial lung disease diagnosed?

  • history + exam
    • a meticulous history vital in identifying cause
  • CXR -> reticulation
  • spriometry -> restrictive
  • high-res CT -> reticulation
  • lung biopsy sometimes necessary 

7

What are signs and symptoms of interstitial lung disease?

  • dry cough, progressive dyspnoea, wheeze, chest pain
  • clubbing
  • reduced chest wall expansion bilaterally
  • dull percussion note
  • inc vocal resonance
  • bronchial breathing
  • fine, late-pan inspiratory crackles

Also depends on the underlying cause

8

How do DLPDs such as pulmonary fibrosis cause cor pulmonale (right heart failure due to lung disease)?

  • important cause of cor pulmonale
  • fibrosis of lung tissue obliterates pulm arterioles + caps 
  • -> gradual development of pulmonary hypertension
  • right ventricule undergoes compensatory right ventricular hypertrophy
  • eventually, right ventricle decompensates
  • right heart failure ensues

 

9

What is the management of intersitital lung disease?

  • oxygen
  • pulmonary rehabilitation
  • corticosteroids, cycophosphamide, azothiaprine
  • lung transplantation