ILD Flashcards
What can you be exposed to that cause ILD?
Environmental (Inorganic dusts, asbestos), Drug induced, Radiation, Smoking, Oxygen
What are systemic diseases that cause ILD?
Connective tissue disease,
Inflammatory bowel disease,
Sarcoidosis
What are idiopathic unknown causes of ILD?
Idiopathic pulmonary fibrosis,
Nonspecific interstitial pneumonitis,
Cryptogenic organizing pneumonia,
Hamman-Rich Syndrome,
Eosinophilic Granuloma
What is the pathophysiology of ILD?
Lung is injured and repairs, its the repair is incorrect
Increased interstitial tissue (especially connective tissue) replaces normal alveoli, capillaries and healthy interstitium
Fibroblasts in interstitium produce collagen
Fibrotic cystic airspaces are produced
What are the signs and symptoms of ILD?
Excertional dyspnea
nonproductive cough
May have Pulmonary Hypertension, leading to Cor Pulmonale
How can you diagnose ILD?
Inspiratory Crackles, diminished BS
Occasionally wheezing - if airway involved (like sarcoidosis)
CXR: low lung volume with bilateral nodular opacities / ground glass
PFT: show restrictive disease: All volumes are reduced, FEV1/FVC = Normal
What would an ABG look like in ILD?
Arterial PaO2 and PaCO2 are reduced, pH normal, greater Hypoxemia with exertion
At the alveolar level, What happens to gas exchange in ILD?
Diffusion impairment contributes to hypoxemia on exercise.
Physiologic dead space and physiologic shunt and VQ mismatch are increased.
There is marked reduction in diffusing capacity due to thickening of blood gas barrier and VQ mismatch.
Whats is asbestosis? what does it cause in the lung?
Asbestosis - environmental
Pleural plaques, fibrosis, effusions,
atelectasis and parenchymal scarring
how long after exposure does it take for asbestosis to be seen? What can we do to improve it slow the progression?
Exposure usually many years before disease
No therapy to improve / decrease progression
Tell me about silicosis, and what other disease it makes more active
Silicosis - Environmental
From chronic exposure to inhaling Silica particles (sand, quartz)
Mining, tunneling, sandblasting,
Increased risk of lung CA and TB (2 to 30 fold more active TB)
Tell me about Coal Workers Pneumoconiosis, whats the treatment?
Coal Minors - very similar to Silicosis
Simple CWP can be asymptomatic with + CXR finding and not progress
No true therapy other than alleviating symptoms and exposure
What is hypersensitivity Pneumonitis?
Hypersensitivity Pneumonitis- environmental
Immune reaction to inhaled antigens
Organic or inorganic
What are organic hypesensitivity Pnumonitis?
Bacteria or Fungus: Farmer’s Lung - Moldy Hay Humidifier Lung - Home Humidifier systems Bird breeder’s lung Mushroom Worker’s lung
What is an inorganic hypersensitivity Pneumonitis?
Vaporized paints and plastics
What are the 2 phases of hypersensitivity Pneumonitis?
Acute:Present with Sudden SOB, Chest pain,
Chronic = months or years and can be difficult to distinguish from other ILD
How can we assess hypersensitivity Pneumonitis in patients?
By History taking (hobbies, work, etc)
we can assess their exposure to antigens
What can we use to treat hypersensitivity pneumonitis?
Steroids
What are antibiotics that can cause ILD?
Nitrofuratoin and Sulfasalazine
What are anti-inflammatory drugs that can cause ILD?
Asprin and methotrexate
What are cardiovascular drugs that can cause ILD?
Amniodarone and Tocainide
What are chemotheraputic drugs that can cause ILD?
Belomycin and Methotrexate
What illicit drugs can cause ILD?
Methadone, Heroin, Propoxyphene
What is the treatment for ILD caused by drugs?
Treatment supportive, corticosteroids and of course, stop the drug
How do we spot of radiation treatment is causing ILD? What can we do to treat it?
Treatment for CA can result in ground glass at site and beyond
Treatment is supportive only
What are some diseases that are linked with ILD?
Scleroderma, Rheumatoid arthritis, Sjogren’s syndrome, Polymyositis, Dermatomyositis,
Systemic Lupus Erythematosis
What is Sarcoidosis?
non casiating granuloma
Multisystem granulomatous inflammatory disorder usually involving the lung
Inflammatory cells create granulomas in several organs, most commonly in the lung
MOST COMMON ILD in US AFFECT younger
What are the symptoms of Sarcoidosis?
Symptoms can include chest pain and wheezing, Inflammation of iris, adenopathy
What is Idiopathic Pulmonary Fibrosis?
Progressive fibrotic lung disease isolated to lung
Usually older than 60 with smoke, hairdressing chemical, farming or metal dust exposure
How do you diagnose Idiopathic Pulmonary Fibrosis?
Lung Biopsy
What is Cryptogenic organizing PNA?
Inflammation of the bronchioles and surrounding lung tissue
Often presents after failed PNA tx with antibiotics
What happens to 02 sats in patient?
in MILD ILD There usually is desatting on exertion even after starting with normal stats at rest.
Giving oxygen can improve quality of life
What vent setting should we give patients with ILD?
Compliance is very low, so expect high PIPs
Vt 4-8 ml/kg
Rate 20-35
I time .5 - .8
What can the lung look like in end stage ILD?
Honeycomb cystic
What are generalized treatments for ILD?
Give Oxygen
Mechanical vent
