Diffuse Lung Disease Flashcards
What is diffuse lung disease?
Collection of lung conditions featuring
- Dyspnoea
- Cough
- CR showing diffuse lung involvement
What anatomical structures does diffuse lung disease involve?
Either/both
- Alveoli
- Interstitium
What is the cough usually like in diffuse lung disease?
Dry
Rarely produce sputum
What are examples of diseases occurring in the airways?
Asthma
COPD
What can collect in the alveoli, causing disease?
Pus
Blood
Fluid
What are examples of diseases occurring in the vessels of the lungs?
Pulmonary embolism
Pulmonary hypertension
What happens in the alveolar compartment in diffuse lung diseases?
Inflammatory cells
Fibrin
Pulmonary oedema
What happens in the interstitial compartment in diffuse lung diseases?
Chronic inflammatory cells
Collagen deposition
Fibrosis
What happens ink the vascular compartment in diffuse lung diseases?
Capillary inflammation
Leak
What are the symptoms of airways diseases?
Wheeze
Cough
Sputum
Dyspnoea
What are the symptoms of diffuse lung diseases?
Cough
Dyspnoea
Wheeze unusual
What are the symptoms of pulmonary vascular diseases?
Dyspnoea
Pleuritic chest pain
Haemoptysis
What makes up the interstitium?
Alveolar lining cell Epithelial basement membrane Connective tissue - Passing and fixed cell populations - Fluid Endothelial basement membrane Endothelial lining cell
What influences the presentation of diffuse lung diseases?
Amount of inflammation
Speed at which inflammation occurs
What kinds of processes cause an acute diffuse lung pattern?
Water - from altered Starling forces in pulmonary oedema
Inflammation
- Toxic fumes
- Drug toxicity
- Infection
Blood - diffuse leakage from inflamed vessels in vasculitis
What are the symptoms of acute diffuse lung diseases?
Stiff lungs > increased work of breathing Tachypnoea Cough Severe dyspnoea Hypoxia due to severe V/Q mismatch
What kinds of processes cause a subacute or chronic diffuse lung pattern?
Many interstitial disease
Present over months-years
What are the relevant points in the history that help narrow down the cause of dyspnoea and cough?
Onset Time course Intensity Aggravating and relieving factors Occupational history Medication history Associated features - Weight loss - Chest pain - Fever - Joint symptoms - Rashes
What are the relevant points in the examination that help narrow down the cause of dyspnoea and cough?
Crackles Clubbing Signs of connective tissue disease Signs of pulmonary hypertension Oxygen saturation - At rest - Whilst patient walks until they become breathless
What are the investigations that can be conducted to narrow down the cause of dyspnoea and cough?
Respiratory function tests High resolution CT of chest Blood tests - Systemic illness - Connective tissue diseasse Echocardiogram - Left ventricular dysfunction - Pulmonary hypertension Lung biopsy - Not required in all cases
What is a restrictive pattern on spirometry?
Reduced vital capacity
Normal/high FEV1:FVC ratio
What shows impaired gas exchange on a respiratory function test?
Reduced CO diffusion capacity
How is alveolar opacity on CXR described?
Fluffy
Cotton wool-like
Cloud-like
What are the four basic interstitial lung patterns on chest x-ray?
Linear = septal lines (Kerley lines) Reticular = mesh-like appearance, lines in all directions Nodular = discrete opacities Reticulonodular = combination of reticular and nodular
