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Y3 Conditions > Asbestos-related lung disease > Flashcards

Asbestos-related lung disease Flashcards

1
Q

Asbestos-related lung disease

What 2 conditions are known to be caused by asbestos exposure?

A

asbestosis
mesothelioma

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2
Q

Asbestos-related lung disease

What tissue change is asbestosis characterised by?

A

chronic and progressive interstitial fibrosis of the lungs, particularly in the lower lobes in the area underneath the pleura

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3
Q

Asbestos-related lung disease

How do asbestos fibres cause fibrosis of the lungs?

A
  • direct damage (macrophage activation)
  • indirect damage (ROS)
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4
Q

Asbestos-related lung disease

What might a pt history of asbestosis be like?

A
  • occupation (boilermaker, 2 or 3 decades ago)
  • insidious onset of SOB and hypoxoaemia (first w/ exercise, then an rest too)
  • benign unilateral plueral effusion may occur before development of interstitial fibrosis

Cough, wheezing and sputum production not characteristic of asbestosis

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5
Q

Asbestos-related lung disease

What might be found on physical examination?

A
  • End-inspiratory crackles (up to 65% of patients)
  • Clubbing (up to 40% of patients)
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6
Q

Asbestos-related lung disease

Give 3 differntials of asbestosis

A
  • Idiopathic pulmonary fibrosis
  • Usual interstitial pneumonia (UIP)
  • Hypersensitivity pneumonitis
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7
Q

Asbestos-related lung disease

What might be some findings on pulmonary function tests for asbestosis?

A

Reduced VC and TLC
Reduced DLCO
Normal FEV1:FVC spirometry

DLCO = diffusing capacity for carbon monoxide

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8
Q

Asbestos-related lung disease

What would be seen on a CXR of a pt with asbestosis?

A

bilateral “ground glass” irregular opacities in the lung parenchyma along with pleural plaques.

Honeycombing occurs in the later stages.

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9
Q

Asbestos-related lung disease

What scan is more sensitive than CXR is detection of abnormalities for asbestosis?

A

High-resolution computed tomography (HRCT)

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10
Q

Asbestos-related lung disease

What test investigation do we do for pt with suscpected asbestosis but CXR/HRCT inconclusive?

How is the test interpretted?

A

Bronchoalveolar lavage (BAL)

  • the number of asbestos bodies in fluid correlates with the number of asbestos bodies in the lungs
  • BAL is used for patients for which CXR and HRCT are not diagnostic and whose diagnosis is uncertain (malignancies or infection in differential diagnosis)
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11
Q

Asbestos-related lung disease

What would be found on histopathological examination of a pt with asbestosis?

A
  • Asbestos bodies: asbestos fibres coated by iron or protein
  • Fibrosis in asbestos is different from usual interstitial pneumonia (UIP) as it is not characterised by fibroblast foci and fibrosis also involves the visceral pleura with characteristic plaques
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12
Q

Asbestos-related lung disease

How do we treat asbestosis? (prescribing)

A
  • no pharm treatment
  • O2 therapy for hypoxic pt
  • prevention and supportive management
  • vaccination for pneumococcus and influenza recommended
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13
Q

Asbestos-related lung disease

How do we treat asbestosis? (non-prescribing)

A
  • surgery to remove dcsr tissue
  • lung transplant
  • thoracentensis may help release any discomfort from pleural effusion
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14
Q

Asbestos-related lung disease

What is a malignant mesothelioma?

A

an aggressive epithelial neoplasm arising from the mesothelial lining of the lung, abdomen, pericardium or tunica vaginalis

Malignant pleural mesothelioma accounts for the vast majority of malignant mesotheliomas

It is one of the few cancers directly related to an environmental exposure; asbestos being the chief agent, with a 20- to 40-year latency period between exposure and development of malignancy.

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15
Q

Asbestos-related lung disease

Name 3 risk factors for developing a malignant mesothelioms.

A
  • asbestos exposure
  • BAP-1 mutation
  • radiation exposure
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16
Q

Asbestos-related lung disease

What occupations expose people to asbestos?

A
  • shipyard worker
  • construction
  • maintenance
  • vehicle brake mechanic
  • insulation
  • production of tiles, shingles, gaskets or textiles
17
Q

Asbestos-related lung disease

What are some symptoms of mesothelioma

A
  • Shortness of breath
  • Dry, non-productive cough
  • Chest pain
  • Fatigue
  • Anorexia
  • Weight loss

Symptoms are usually related to the presence of intrathoracic disease and some non-specific symptoms

18
Q

Asbestos-related lung disease

What are some findings on physical examination for malignant mesothelioma? What is the reason for these findings?

A
  • Decreased breath sounds
  • Reduced chest expansion
  • Dullness to percussion on the affected side

Abdominal distension may either indicate ascites from malignant peritoneal mesothelioma or intra-abdominal extension of malignant pleural mesothelioma

most commonly related to the presence of pleural effusions

19
Q

Asbestos-related lung disease

What is the initial investigation for malignant mesothelioma?
What would the findings be?

A

CXR

unilateral pleural effusion, pleural thickening, reduced lung volumes or parenchymal changes (lower zone interstitial fibrosis or pleural calcification)

However, chest-x-rays tend to poorly visualise the pleura and can miss subtle changes.

20
Q

Asbestos-related lung disease

What is a more sensitive imaging test that can be done after CXR to investigate for malignant mesothelioma?

A

contrast-enhanced CT of the chest and upper abdomen

21
Q

Asbestos-related lung disease

Imaging alone is not sufficient to make a diagnosis of malignant mesothelioma.

What other investigations need to be done?

A

further tests:
thoracentesis
performed to determine whether an effusion is an exudate or transudate and to obtain pleural fluid for cytology

to confirm diagnosis:
biopsies of suspicious sites of pleural lining with VATS

other tests:
PET scanning
- Performed once a diagnosis of malignant mesothelioma has been reached to assess for regional or distant disease
Pulmonary function tests
- FEV1 and DLCO should be performed on all patients with mesothelioma who are being evaluated for surgery

22
Q

Asbestos-related lung disease

How do we manage mesothelioma? (prescribing)

A

chemotherapy (preoperatively for resectable, palliatively for recurrent/non-resectable)

23
Q

Asbestos-related lung disease

What chemotherapy agents have proven efficacy in malignant mesothelioma?

3

A
  • Cisplatin
  • Carboplatin
  • Pemetrexed
24
Q

Asbestos-related lung disease

What are some associated side effects of cisplatin?

What is it often substituted with and why?

A
  • nephrotoxicity
  • nausea
  • vomitting

Carboplatin is often substituted for cisplatin-based on its favourable safety profile and ease of administration.

25
Q

Asbestos-related lung disease

What is the definitive treatment for malignant mesothelioma?

A

surgery
1. extra-pleural pneumonectomy
2. pleurectomy with decortication

26
Q

Asbestos-related lung disease

What are some other non-prescribing managements for malignant mesothelioma that is not surgery?

A

radiotherapy
palliative procedures
- thoracocentesis
- pleurodesis

Pleurodesis is the artificial obliteration of the pleural space and is performed to prevent re-accumulation of pleural fluid. Talc is a commonly used agent.

27
Q

Asbestos-related lung disease

What is pleural fluid aspiration?

A

Removal of a portion of the pleura for staining and microscopy

28
Q

Asbestos-related lung disease

What is pleurodesis?

A

Artificial obliteration of the pleural space

29
Q

Asbestos-related lung disease

What is tunnelled pleural catheter placement and what is its use?

A

Insertion of a soft silicone tube to allow drainage of pleural fluid

30
Q

Asbestos-related lung disease

What is this procedure called?
Removal of the parietal and visceral pleura of the affected lung

A

extra-pleural pneumonectomy

31
Q

Asbestos-related lung disease

What is this procedure called?
Removal of only the visceral pleura from the affected lung

A

pleurectomy with decortication

32
Q

Asbestos-related lung disease

What is this precedure called?
Artificial obliteration of the pleural space

A

pleurodesis

Y3 Conditions (55 decks)

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