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T2: Theme 4: Lungs > Lecture 10: Restrictive lung disease > Flashcards

Lecture 10: Restrictive lung disease Flashcards

1
Q

Reductions in which lung volumes defines restriction?

A

RV, FRC and TLC

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2
Q

What do intralobular septa do?

A

Surround the alveoli, and are a thin layer between the alveoli and capillaries

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3
Q

What do interlobular septa do?

A

Outline the secondary lobules

Where the lymphatics and veins of the lungs are

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4
Q

What is an interstitial lung disease?

A

Diseases which cause inflammation or scarring of the interstitium of the lung

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5
Q

What are the two types of environmental exposure interstitial disease?

A

Allergic responses that affect the interstitium:

  • Hypersensitivity pneumonitis
  • Occupational lung disease, aka pneumoconioses
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6
Q

What may cause hypersensitivity pneumonitis?

A

Mould and bird proteins are the common causes

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7
Q

What are the main causes for occupational lung disease?

A

Coal miners lung (coal dust exposure)

Silicosis (silica exposure)

Asbestosis (asbestos exposure)

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8
Q

What are the three categories of ILD?

A

1: environmental exposure
2: idiopathic
3: systemic inflammatory

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9
Q

What are the two types of inflammatory disease?

A

Autoimmune disease - ILD

Sarcoidosis

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10
Q

What coal miners lung?

A

Very small coal dust particles reach airsacs

Engulfed by macrophages  inflammation

Sometimes  trigger massive fibrosis

Coal dust essentially lasts forever in the lung

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11
Q

What are the three lung diseases that are associated with asbestos?

A

Asbestosis

Mesothelioma

Lung cancer

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12
Q

What is the importance of pleural plaques in the lung?

A

The plaque wont turn into mesothelioma but is indicative of exposure to asbestos

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13
Q

What is mesothelioma?

A

Aggressive, fatal, occurs at high rate

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14
Q

What causes fine peripheral lines +/- “honeycomb” cysts

A

Asbestos

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15
Q

What exposure causes nodular disease?

A

Silica and coal dust

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16
Q

What is a granuloma?

A

Clusters of macrophages (with a few T cells typically in the periphery)

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17
Q

What is the mechanism behind hypersensitivity pneumonitis?

A

Patients breathes something in (mould), picked up by APC, recognised by T cell, creates inflammatory response, form granuloma with T cells on the outside

Granulomas build up in the bronchiole

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18
Q

What conditions can lead to fibrosis?

A

Hypersensitivity pneumonitis

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19
Q

What is idiopathic pulmonary fibrosis?

A

Disease of older age (rare before age 50)
Most patients have smoked, but the disease process is not well understood: “idiopathic”

Mostly affects the lower + peripheral aspects of the lung
Fine peripheral lines + honeycomb cysts
Lots of fibroblast cells (make collagen)

Minimal inflammation

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20
Q

What are the alveolar filling processes?

A

Pulmonary oedema

Pulmonary hemorrhage

Infection (ie pneumonia)

Cancer

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21
Q

What is resorptive atelectasis?

A

Collapse of (otherwise healthy) alveoli

As a result of dwindling alveolar size - eventually lung collapse

22
Q

What is compressive atelectasis?

A

Collapse of (otherwise healthy) alveoli

As result of pleural process or lung mass

23
Q

What are the two types of pneumothorax?

A

Spontaneous

Traumatic: procedural, penetrating trauma, rib fracture, baurotrauma

24
Q

What are the three types of pleural disease?

A

PE

Pneumothorax

Haemothorax

25
What volume of liquid normally cycles through the pleural space?
1L
26
What causes influx of fluid into the pleural space?
Capillary leak (increased hydrostatic pressure or loss of oncotic pressure) Pulmonary interstitium (crosses the visceral pleura) Small holes, or “rents”, in the diaphragm allowing peritoneal fluid (if any is accumulating) to enter the pleural space
27
What causes efflux of fluid into the pleural space?
Lymphatics: resorptive stoma give the pleura large surge capacity (can increase absorption 20x), but if these become blocked (even partially) absorption will slow Resorption is dependent on good oncotic pressure within lymphatics
28
What are the causes of transudative PE?
Congestive heart failure Liver disease with portal hypertension and cirrhosis Low albumin states (eg. nephrotic syndrome)
29
What are the causes of exudative PE?
Infection - TB - Acute bacterial infection: “parapneumonic” effusion or empyema - Parasitic infection Malignant (metastatic cancer) Chylothorax Pleurisy
30
What is the difference between transudate and exudate?
Transudate = leakage of water (doesn't need to be drained) Exudate = Leakage of water and proteins (needs to be drained)
31
What is transudative effusion?
Most common Generally not harmful to patient, although can cause dyspnoea when large The result of a non-pleural disease primary process Will resolve if primary process is fixed (Something wrong with normal fluid balance)
32
What is uncomplicated parapnuemonic effusion?
Altered (pleural) capillary permeability in pneumonia (vasodilatory effect of inflammation) Effusion with increased inflammatory cells but no bugs Drain by tap if effusion is not small
33
What is complicated parapnuemonic effusion?
Increased inflammatory cells with bacteria in the pleural space Not frank pus, but the increased inflammation with bacteria needs to be drained by tube otherwise a pleural rind can form This rind MUST be surgically removed (if left, it will decrease pleural expansion and lead to permanent restriction in that part of the lung)
34
What is empyema?
Frank pus Needs to be fully drained, usually over several days, with a chest tube
35
What is chylothorax?
Due to retrograde spillage of lymphatic materials (which includes lots of fats which have have been absorbed from the GI tract) into pleural space Most commonly this is due to thoracic duct injury
36
What is the definition of haemothorax?
When haematocrit value of at least 50% of the haematocrit of peripheral blood
37
What is pleurisy?
Sterile process of inflammatory cells and fluid accumulating in the pleural space due to autoimmune disease
38
What is a thoracentesis?
Procedure using a needle to sample or drain the effusion
39
How do you prevent re-expansion pulmonary oedema?
Limit drainage to 1.5L/day
40
How do you diagnose exudative effusion?
Light's criteria If one or more of the following criteria are met: • Protein level in pleural fluid divided by level in serum is greater than 0.5 • Lactate dehydrogenase (LDH) level in pleural fluid divided by level in serum is greater than 0.6 • LDH in pleural fluid is more than two-thirds the upper limit of the normal level in serum
41
What are the fluid studies?
Protein and LDH pH and glucose Cell counts with WBC differential Microbial stain and culture studies Cytopathology to evaluate for cancer cells Cholesterol levels and triglyceride (TG) levels Less common: adenosine deaminase (ADA), RF titer, lupus erythematosus cells
42
How do you diagnose hepatic hydrothorax?
Cirrhotic fluid transverses the diaphragm into the pleural space
43
How do you diagnose parapneumonic effusion (complicated)?
Infected pleural space, pH < 7.2 Loculations can form
44
How do you diagnose parapneumonic effusion (uncomplicated)?
Sterile inflammation pH > 7.2 Small / free flowing
45
How do you diagnose haemothorax?
Pleural fluid Hct > 50% of blood Hct
46
How do you diagnose cylothorax?
TG > 110 mg/dL Usually appears milky
47
What is pneumothorax?
Pneumothorax: air collection in the pleural space due to rupture of alveoli near pleural surface Spontaneous pneumothorax Swings in intrapleural pressure and blebs are often invoked Traumatic pneumothorax: procedural, penetrating trauma, rib fracture, baurotrauma
48
What are the causes of chest wall disease?
Weakness and myopathy Skeletal and connective tissue restrictions
49
What are the different types of weakness and myopathy?
Degenerative spinal diseases; eg. motor neurone disease; polio Myasthenia gravis Global weakness
50
What are the causes of skeletal and connective tissue restrictions?
Kyphoscoliosis Extensive burns which affect the chest wall

T2: Theme 4: Lungs (16 decks)

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