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Flashcards in Interstitial Lung Disease - Goya Deck (17):
1

What is Interstitial Lung Disease (ILD)?

comprised of a diverse group of lung infiltrates that cause disruption of the alveolar structures and have common clinical, radiographic and physiological consequences

scarring of lung and SOB and restrictive pattern on PFTs

incidence of ILD varies with diseases
-scleroderma 100%
-RA 33%
-sarcoidosis 33%
-idiopathic pulmonary fibrosis 30-40%

2

What is interstitium?

the space between the basement membranes of the alveolar lining epithelium and the capillary endothelium

3

What drugs can cause ILD?

Nitrofurantoin
Amiodarone**
Gold
Dilantin
Bleomycin (chemo)
Cytoxan (chemo)
Radiation

4

What are the 2 idiopathic interstitial pneumonias that we have to know? What are their prognoses?

Usual Interstitial Pneumonia (UIP)
-poor prognosis --> more fibrosis and scarring

Nonspecific interstitial pneumonia (NSIP)
-treatable
-cellular level

5

What are the 5 most common interstitial lung diseases?

Usual interstitial pneumonia

Nonspecific interstitial pneumonia

Connective tissue Disease

Hypersensitivity Pneumonitis

Sarcoidosis

6

What is the common presentation of ILD?

Typical patients are middle aged presenting with progressive dyspnea & nonproductive cough

other symptoms depend on the underlying process
-connective tissues affect women > men (except RA)
-pneumoconiosises affect men more

long latency from exposure --> disease



7

What are some PE findings associated with ILD?

-bibasilar rales

-clubbing of fingers (except in sarcoidosis)

-pulmonary HTN and cor pulmonale in advanced diseases

8

What x-ray findings will be seen in ILD?

reticular or reticulonodular pattern is the most common

honey-combing is a late finding (seen better on CT)

*CXR goof for suggesting presence of ILD but not the stage

9

What is a great test for suspected early ILD?

high resolution CT scan

start as sub pleural patch leading to diffuse fibrosis "honeycomb lung"

10

What will PFTs for ILD show?

-decrease in TLC --> restrictive

-decrease in FVC

-increase in FEV1/FVC ratio

11

How will the bronchoalveolar lavage differ in the causes of ILD? When is this done?

Lymphocytes-hypersensitivity pneumonitis & sarcoidosis

Neutrophils increased in IPF & asbestosis

*only done in suspected infectious causes of ILD

12

When would a lung biopsy be used to diagnose ILD?

to exclude neoplastic and infectious processes

useful in diagnosing UIP, nonspecific interstitial pneumonia

13

What may be the initial procedure of choice in ILD? What causes are good yield?

bronchoscopy

good yield:
-sarcoidosis
-hypersensitivity pneumonitis
-eosinophilic pneumonia
-lymphanngitic carcinomatosis

14

What is the major goal of management of ILD?

identify and aggressively treat the inflammatory process (many causes are not responsive to treatment)

remove the offending agent

15

What are some treatment options for ILD?

Immunosuppressants (Azathioprine, Cytoxan, Cyclosporin)

Corticosteroids* (suppress the alveolitis)

16

When should a lung transplant be considered?

Failure to medical therapy

Worsening oxygen desaturation with minimal exercise

Resting hypoxemia

Worsening pulmonary function testing

normally only do a single lung transplant

17

What is crucial to diagnosis of ILD?

HISTORY*