Respiratory Conditions Flashcards
Define sarcoidosis
- Condition where chronic inflammation granulomas form.
- Granulomas are inflammatory nodules full of macrophages.
- Granulomas form over various organs, including liver, heart, lungs, eyes and kidneys
Eye symptoms of sarcoidosis
CON U
Conjunctivitis
Optic neuritis
Uveitis
Liver symptoms of sarcoidosis
Liver nodules
Cirrhosis
Cholestasis
Sarcoidosis systemic symptoms
Fever
Fatigue
Weight loss
Heart symptoms of sarcoidosis
British heart Market
Bundle branch block
Heart block
Myocardial muscle involvement
Kidney symptoms of sarcoidosis
Kidney stones (due to hypercalcaemia)
Nephrocalcinosis
Interstitial nephritis
CNS symptoms of sarcoidosis
Nodules
Pituitary involvement (diabetes insipidus)
Encephalopathy
PNS symptoms of sarcoidosis
Facial nerve palsy
Mononeuritis multiplex
Bones symptoms of sarcoidosis
Arthralgia
Arthritis
Myopathy
Lofgren’s Syndrome
This is the triad which is typically assoicated with sarcoidosis.
-Erythema nodosum
-Bilateral hilar lymphadenopathy
-Polyarthralgia (joint pain in multiple joints)
what blood tests are used to investigate sarcoidosis?
Raised angiotensin-converting enzyme (ACE) (often used as a screening test)
Raised calcium (hypercalcaemia)
imaging for sarcoidosis
Chest x-ray may show hilar lymphadenopathy
High-resolution CT scanning may show hilar lymphadenopathy and pulmonary nodules
MRI can show central nervous system involvement
PET scan can show active inflammation in affected areas
Tests for sarcoidosis
U&Es for kidney involvement
Urine albumin-creatinine ratio to look for proteinuria
LFTs for liver involvement
Ophthalmology assessment for eye involvement
ECG and echocardiogram for heart involvement
Ultrasound for liver and kidney involvement
what is the managment of sarcoidosis?
1st line
-steroids
- bisphosphonates
2nd line
- Methotrexate
severe managment
- lung transplant
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- Interestingly, Sarcoidosis can resolve itself (50% of patients) within two years.
Sarcoidosis progression
- pulmonary fibrosis and pulmonary hypertension.
- 10% rate of mortality
-20-40 year old
-black female
-presenting with a dry cough
-shortness of breath.
-Has painful red lesions on shins
- typical presentation of sarcoidosis
Syndromes associated with sarcoidosis
Lofgren’s syndrome is an acute form of the disease characterised by bilateral hilar lymphadenopathy (BHL), erythema nodosum, fever and polyarthralgia. It usually carries an excellent prognosis
In Mikulicz syndrome* there is enlargement of the parotid and lacrimal glands due to sarcoidosis, tuberculosis or lymphoma
Heerfordt’s syndrome (uveoparotid fever) there is parotid enlargement, fever and uveitis secondary to sarcoidosis
*this term is now considered outdated and unhelpful by many as there is a confusing overlap with Sjogren’s syndrome
what is the electrolyte abnormality associated with sarcoidosis?
hyperkalemia
- macrophages in the granulmoa cause increased conversion of vitamin D to its active form (1,25-dihydroxycholecalciferol)
Heerfordt’s syndrome (uveoparotid fever)
parotid enlargement, fever and uveitis secondary to sarcoidosis
what are the stages of sarcoidosis?
clue: 4 stages
A chest x-ray may show the following changes:
stage 0 = normal
stage 1 = bilateral hilar lymphadenopathy (BHL)
stage 2 = BHL + interstitial infiltrates
stage 3 = diffuse interstitial infiltrates only
stage 4 = diffuse fibrosis
Step one management of asthma (newly diagnosed)
Short acting beta agonist (Saba)
Salbutamol