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Lucy Knox - Year 2 > 219 - Haemoptysis > Flashcards

219 - Haemoptysis Flashcards

1
Q

What is haemoptysis?

A

Coughing up blood or bloody sputum

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2
Q

What pH would haemoptysis be if you tested it?

A

Alkaline

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3
Q

What pH would haematemesis be if you tested it?

A

Acidic

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4
Q

Where could the blood have originated in haemoptysis?

A

Bronchial arteries - despite small proportion of CO, they are at high pressure, so lots of blood could come from them.
Capillaries
Pulmonary arteries - receive all the CO but at very low pressure

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5
Q

What investigations would you do for someone with haemoptysis?

A

CXR
FBC + clotting
ABG
Sputum

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6
Q

What would you do in a situation of massive haemoptysis?

A 
Emergency - risk of aspiration
protect airway
O2
IV access
FBC, clotting, X match
CXR
reverse any coagulopathy
maintain Bp <100 systolic
  • give: tranexamic acid, nebulised adrenaline
  • nurse on bleeding side down
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7
Q

What 3 classes of disease could cause haemoptysis?

A

Airway disease
Vascular disease
Parenchymal disease

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8
Q

What types of airway disease could cause haemoptysis?

A 
Bronchitis - esp. smokers
Bronchogenic carcinoma
Metastatic cancer
Bronchiectasis
Sarcoidosis
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9
Q

What types of vascular disease could cause haemoptysis?

A

Pulmonary infarction

Increase in pul venous pressure- heart failure, mitral stenosis

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10
Q

What parenchymal diseases may cause haemoptysis?

A

Infection - TB, pneaumonia, aspergilloma

Autoimmune - vasculitis, CVD

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11
Q

What is the most common cause of maternal death in the UK?

A

Thromboembolic disease

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12
Q

What makes up virchow’s triad of thrombosis risk?

A

Venous stasis
Injury to vessel wall
Increased blood coaguability

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13
Q

Where do most thromboemboli come from?

A

75% from deep venous system in legs and pelvis

= DVT

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14
Q

What score can you use for DVT risk?

A

Well’s score

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15
Q

What are the signs of a DVT?

A 
Local pain/tenderness 
eg. Calf tenderness
Swelling
Pain on dorsiflexion - Homan's sign
Fever?
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16
Q

What investigations are done for a ? DVT?

A

Doppler U/S
CT scan
D-dimer blood test

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17
Q

How do you manage someone with a DVT?

A

LMWH - eg. clexane (enoxaparin)

Warfarin - 3/12 if known cause, 6/12 if unknown

18
Q

What is a Pulmonary embolism?

A

Obstruction of a blood vessel in the lung by a clot or foreign substance

19
Q

How likely is it for a DVT to embolise?

A

20%

20
Q

What are the symptoms of a PE?

A 
SOB
Pleuritic pain
Haemoptysis (usually small amounts)
Dizziness
Syncope
Anxiety
21
Q

What are the signs of a PE?

A 
Dyspnooea
tachycardia
Pleuritic pain
Cyanosis
Pyrexia
AF
low BP
Raised JVP
22
Q

What investigations would you do for a ? PE

A

ABG
CXR
ECG
D-Dimer

Then probably do
CT pulmonary angiogram

Could do
V/Q scan
Bedside echo
Pul arteriogram

23
Q

What are the outcomes of a massive PE?

A

Big clot, lodges in bifercation of PA - haemodynamically compromised
- high mortality

24
Q

What are outcomes of an acute minro PE?

A

Smaller clot so wedges more distally - can cause a wedge infarction - pleuritic pain + fever

25
Q

What are paradoxical emboli?

A

IF the pt has an atrial septal defect the clot could get into the systemic circulation - cause stroke, go into kidneys, cause acute limb infarction.

26
Q

What is the mamagement of a PE?

A

Acutely - O2, fluids, analgesia, heparin (clexane), ?tPA if massive. Rarely sugery - embolectomy

LT: warfarin. ? IVC filter

27
Q

What prophylaxis is there for PE?

A

Clexane for all immobile pts
Stockings
Stop HRT/pill post op

28
Q

What is bronchiectasis?

A

Abnormal/permenant dilation of 1 or more bronchi

29
Q

How id bronchiectasis diagnosed?

A

Radiologically - broncho bigger than vessel next to it

30
Q

What are the symptoms/signs of bronchiectasis?

A 
Chronic bronchial sepsis - sputum
breathlessness
polyphonic wheeze
clubbing
coarse mid insp crackles
Respiratory failure?
31
Q

What causes bronchiectasis?

A

cycle of lung injury -> infection -> inflammation

  • Inherited: Cystic fibrosis, kartangers (immotile cilia)
  • Acquired: childhood pneumonia, chronic obstruction (foreign body), aspiration, ABPA - allergic broncho-pul aspergillosis…
32
Q

What is the treatment for bronchiectasis?

A

Physio
Antibiotics for exacerbations
bronchodilators

33
Q

Pulmonary hypertenstion can be classified into 4 main groups, what are they?

A
  • PAH - Pul. arterial hypertension
  • Pulmonary venous hypertension
  • Pul hypertension assoc with hypoxemia
  • Pul hypertension due to chronic thromboembolic disease
34
Q

What is Pul arterial hypertension?

A

Narrowing of blood vessels connected to and withint he lungs - causes fibrosis - this increases the work load on the R ventricle and causes RHF - “cor pulmonale”

35
Q

What are the symptoms of pul. arterial hypertension?

A 
Usually silent until RHF develops
Dyspnoea
fatigue
palpitations
chest pain
cough
syncope
36
Q

How do you diagnose pul. arterial hypertension?

A

Measure the pressures using a venous catheter

Mean pul. arterial pressure >25mmHg
Pulmonary capillary wedge pressure 3 wood units

37
Q

What treatment options are there for pulmonary arterial hypertension?

A

Remodelling therapy - endothelin receptor antagonist
Vasodilation - O2, calcium channel blockers
Anti-inflammatory - NO donors, prostacyclins
Anticoagulatns

38
Q

What is pulmonary venous hypertension?

A

L sided heart disease of valvular disease means the heart isn’t pumping as efficiently, so blood pools int he lungs + a back pressure is created in the pulmonary system

-> get pulmonary oedema + Pleural effusions

39
Q

What is pul hypertension assoc. with hypoxemia?

A

A protective response to low o2 - stops blood going to that bit of the lung - constricts.

due to COPD, interstitial lung disease, sleep-disordered breathing, high altitude chronically

40
Q

What is pulmonary hypertension due to chronic thomboembolic disease?

A

After multiple obstructions from thrombi - causes vessels to constrict - increases pressure.

41
Q

What can cause a cavitating lung mass?

A 
Carcinoma
Lung abscess
Rheumatoid nodule
Septic embolus
Vasculitis with granulomatosis
Bronchogenic cyst
Hydatid cyst
42
Q

What could consolidation on a CXR be caused by?

A 
Infection
Water/Oedema
Blood
Inflammation
Tumour
Proteinaceous fluis

Lucy Knox - Year 2 (17 decks)

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