17. Small Group: Interstitial Lung Disease Flashcards
COPD: obstructive or restrictive disease?
obstructive
COPD: will we see clubbing?
no, clubbing is not associated with COPD. it is associated with lung cancer, interstitial lung disease, chronic hypoxia….
what is IPF?
idiopathic pulmonary fibrosis – a clinical-pathologic-radiologic sx
what is UIP?
usual interstitial pneumonitis. pathologic findings characteristic of IPF.
what measurement will confirm the presence of restriction?
TLC. restriction is characterized by a normal or increased FEV1/FVC ratio, and confirmed by TLC REDUCTION.
what are erythema nodosum? what disease process do they indicate?
red nodules on the shins. indicate sarcoidosis.
What breathing pattern would you see in pts with ILD and other interstitial diseases?
rapid shallow breathing, to minimize work of breathing – because lungs are less compliant, and the more they are stretched, the more difficult it is.
what is the problem with rapid shallow breathing?
more of your effort goes to the anatomic dead space.
what does honeycombed lung refer to? is it reparable?
formation of cystic spaces in lung parenchma. characteristic of advanced interstitial lung disease. not reversible with treatment.
what is another reason that might account for rapid shallow breathing?
there are receptors in the lung parenchyma (C-fibers) that may be stimulated by the interstitial process, and the stimulation of these incr resp rate.
why is there a drop in the resp rate of patients with ILD when they sleep?
because part of their rapid/shallow breathing is due to stimulation of the C-fibers in the interstitium, which is less noticed during sleep.
why is TLC diminisned with restrictive process?
elastic recoil is much increased (ie compliance is decreased) and thus the insp muscles are unable to inflate the system to as great a volume.
Honeycombing: what disease process does it suggest?
end stage ILD. basically permanent lung fibrosis.
why does the DLCO decrease with ILD?
loss of alveolar surface (due to epithelial metaplasia perhaps, or reduced lung volume overall), and thickening of the alveolar-capillary membrane.
why is the resting SaO2 ok, but exercising SaO2 diminishes a lot?
due to decr time in capillary: does not have time to equilibrate. fibrotic lung needs full (resting) timeframe to do gas exchange.
