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3 - Respiratory > Interstitial Lung Disease > Flashcards

Interstitial Lung Disease Flashcards

1
Q

What is interstitial space?

A
  • A potential space between alveolar cells and the capillary basement membrane which is only apparent in disease states, where it may contain fibrous tissue, cells or fluid
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2
Q

What is interstitial lung disease?

A
  • Group of diseases with a variety of cuases that have similar pathophysiological effects and clinical features
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3
Q

What is the pathophysiology of interstitial lung disease?

A
  • Fibrous tissue develops in the interstitium, making lungs less compliant (restrictive defect)
  • Diffusion path between alveolar air and blood impairs gas exchange. O2 uptake affected selectively
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4
Q

What are the clinical features of interstitial lung disease?

A

Shortness of breath
Reduced exercise tolerance
Dry cough

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5
Q

Give four signs of Interstitial Lung Disease

A
  • Tachypnoea
  • Tachycardia
  • Reduced chest movement
  • Coarse crackles
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6
Q

Give five causes of interstitial lung disease?

A
  • Occupational
  • Treatment related
  • Connective tissue disease • Immunological • Idiopathic
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7
Q

Give three occupational causes of interstitial lung disease

A
  • Asbestosis
  • Silicosis
  • Pneumoconiosis
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8
Q

Give three treatment related causes of Interstitial Lung Disease

A
  • Radiation
  • Methotrexate
  • Nitrofurantoin
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9
Q

Give three connective tissue disease

A

• Rh. Arthritis • Polymyositis • Scleroderma

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10
Q

Give two immunological causes of Interstitial Lung Disease

A

• Sarcoidosis • Hypersensitivity pneumonitis

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11
Q

What is fibrosing alveolitis?

A
  • Progressive inflammatory condition of unknown cause
  • Increased activated alveolar macrophages
  • Attract neutrophils and eosinophils
  • Local lung damage due to ROS and proteases
  • Tissue destruction and fibrosis
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12
Q

What do patients present with when they have fibrosing alveolitis?

A
  • Progressive shortness of breath on exercise, often combined with a productive cough
  • Finger clubbing
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13
Q

What does the chest x ray of someone with fibrosing alveolitis show?

A

Small lungs with micro-nodular shadowing predominating in the lower lobes, with ragged heart borders

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14
Q

How is fibrosing alveolitis treated, and what are the limitations of this treatment?

A

Treated with high dose oral steroids in the early stages

Less effective once fibrosis has developed

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15
Q

How is treatment of fibrosing alveolitis monitored?

A

• By repeated lung function tests

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16
Q

What is extrinsic allergic alveolitis?

A

• Inhalation of organic material which triggers an allergic reaction in alveoli and bronchioles

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17
Q

What are two states of the condition?

A

• Can be acute or chronic

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18
Q

Outline acute extrinsic allergic alveolits

A

Farmers lung

  • Thermophilic actinomycetes found in mouldy hay
  • Inhalation causes influenza like illness 4-9 hours later with a dry cough and dyspnoea on exertion.
  • Fine mid and late inspiratory crackles
  • Wheeze
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19
Q

Outline chronic extrinsic allergic alveolitis

A
  • Long term antigen exposure = Faeces of pidgeons/budgies
  • Insidious malaise
  • Dry cough and breathlessness over months and years
  • Inspiratory crackles
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20
Q

What sign does not occur in any types of allergic alveolitis?

A

• Finger clubbing

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21
Q

What does the x-ray show in acute extrinsic allergic alveolitis?

A

Diffuse micro-nodular infiltrate denser towards the hila

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22
Q

What does the x-ray show in chronis extrinsic allergic alveolitis?

A

Normal, may progress to fibrosis

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23
Q

What will a lung function test show in extrinsic allergic alveolitis?

A

Lung function test will show reduced compliance and reduced gas transfer

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24
Q

What is asbestosis?

A
  • Inhalation of asbestos fibres causes a disease to develop long after exposure
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25
Q

Give three different types of disease as a result of asbestos inhalation

A
  • Benign pleural plaques
  • Asbestosis
  • Mesothelioma
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26
Q

What do asbestos fibres do in the lungs?

A
  • Penetrate to the alveoli, causing alveolitis
  • Causes an influx of macrophages which produce distinctive asbestos bodies
  • Alveolitis progresses to fibrosis
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27
Q

What are the symptoms of asbestos related disease?

A
  • Patient breathless on exertion and a dry cough

- Inspiratory crackles at the lung base, which rise as the disease advance

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28
Q

What do lung function tests of someone with asbestos related lung disease show?

A

• Small lungs, reduced compliance and impaired gas transfer

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29
Q

What is sarcoidosis characterised by?

A

• Non-caseating granulomas in multiple organs and body sitesMost commonly found in the lungs

30
Q

What occurs in the airways in sarcoidosis?

A

• Fluid is collected by lavage of the airways and alveoli contain lots of cells, including macrophages and lymphocytes

31
Q

In what ethnicities is sarcoidosis the most common?

A

• Afro-Carribean and Asians than in CaucasiansGenetic predisposition

32
Q

When is the highest incidence of sarcoidosis?

A

• 30’s and 40’s with more female cases

33
Q

What are the two main symptoms of sarcoidosis?

A

• Cough • Dyspnoea

34
Q

How is sarcoidosis graded?

A

On a scale of severity of 1-4

35
Q

What does X-ray show in sarcoidosis?

A

Miliary and nodular shadowing and diffuse fibrosis

36
Q

How can sarocidosis be treated?

A

Steroids

37
Q

What does the lung function test in sarcoidosis show?

A
  • Small lungs
  • Reduced compliance
  • Impaired gas transfer
    May be evidence of air flow obstruction
38
Q

Give four diseases associated with the work place

A
  • Asthma
  • Diffuse fibrosis
  • Nodular fibrosis
  • Alveolitis
39
Q

In what occupation and after what exposure does one get Asthma

A

Lab worker

Rat urine

40
Q

In what occupation and after what exposure does one get diffuse fibrosis

A

Boiler/Pipe Lagger

Railway/Construction - Asbestos

41
Q

In what occupations (3) and after what exposure does one get nodular fibrosis (pneumoconiosis)

A

Coal miner, miner, demolition Coal dust, silica, asbestos

42
Q

In what occupation and after what exposure does one get alveolitis

A

Farmer - fungal spores from hay

Pigeon fancier - Avian antigens

43
Q

Name five types of intersitial lung disease

A

• Fibrosing alveolitis • Extrtinsic allergic alveolitis (acute) • Extrinsic allergic alveolitis (chronic) • Sarcoidosis • Asbestosis

44
Q

Give the plain film x-ray found in fibrosing alveolitis

A

• Small lungs • Micro-nodular shadowing (lower lobes) • Ragged heart border

45
Q

Give the x-ray appearance of sarcoidosis

A

Miliary and nodular shadowing

Diffuse fibrosis

46
Q

Give the x-ray appearance of asbestosis

A

Plaques
Fibrosis
Mesothelioma

47
Q

What is the pleura?

A

A serous membrane consisting of a single layer of mesothelial cells with a thin layer of underlying connective tissue
Made up of parietal and visceral pleura

48
Q

What does the parietal pleura line?

A

The inside of each hemithorax

49
Q

What does the visceral pleura line?

A

The outside of the lung

50
Q

Where are the visceral and parietal pleura continous?

A

At the hilum of the lung

51
Q

What is the pleural cavity?

A

A potential space between two layers of pleura

52
Q

What does the surface tension of the pleural fluid provide?

A

The cohesion that keeps the lung surface in contact with the thoracic wall
As a result, when the thorax expands, the lungs expand with it and fill with air

53
Q

What is the normal turnover of pleural fluid per day

A

15ml turnover per day

54
Q

What are the two methods by which pleural fluid is modified?

A

Added by capillary filtration at the parietal pleura

Absorbed via lymphatic drainage

55
Q

What four factors affect the rate at which fluid is added to the pleural fluid?

A
  1. Increase in lung interstitial fluid
  2. Increase in hydrostatic pressure (heart failure)
  3. Increase in permeability (Inflammation, sepsis or malignancy)
  4. Increased by decreased oncotic pressure (liver failure)
56
Q

What two facts factors affect the rate at which fluid is removed from the pleural cavity?

A

Decreased by lymphatic blockage

Decreased by systemic venous pressure

57
Q

What is a transudate?

A

Low protein content

58
Q

What is an exudate?

A

High protein content

>30g/l

59
Q

Give three causes of increased transudate in the pleural space

A
  • Increased hydrostatic pressure
  • Decreased capillary oncotic pressure
  • Hypoalbuminaemia
60
Q

Give four causes of an exudate pleural effusion

A
  1. Neoplasms
    - Cancer involving pleural surface
    - Secondary mets from breast, lung, ovarian, GI and lymphoma
    - Primary tumour of the pleura
  2. Infection
    - Pneumonia
    - TB
  3. Immune disease
    - Connective tissue disease
  4. Abdominal
    - Pancreatitis
    - Ascites
    - Subphrenic abscess
61
Q

What is pleurisy?

A

Inflammation of the pleura

- Causes sharp pain on inspiration

62
Q

What is a characteristic sign of pleurisy?

A

Pleural rub, a creaking noise heard through a stethoscope with respiratory movements

63
Q

Why do patients with pleurisy get shoulder pain?

A

Irritation of diaphragmatic pleura

64
Q

Give five causes of pleurisy

A 
Infection 	
Autoimmune	
Lung cancer	
Pneumothorax	
Pulmonary embolism
65
Q

What are the two types of infection which cause pleurisy?

A

TB

Pneumonia

66
Q

What are the two types of autoimmune disease which cause pleurisy?

A
  • Systemic Lupus Erytematosus

- Rheumatoid arthritis

67
Q

What is pleural fibrosis?

A
  • Unabsorbed pleural effusion may lead to fibrosis of the pleura
  • A small degree of thickening has no effect, but widespread fibrosis restricts expansion with a measurable reduction in lung volumes and compliance
68
Q

What is the most common type of pleural tumour?

A

Malignant mesothelioma

  • Early symptoms are loss of pleural effusion, but with a duller pain
  • Signs are the of a large pleural effusion
69
Q

Name two chest wall abnormalities which cause significant functional impairment of the thoracic cage

A

Scoliosis and kyphosis may produce significant functional impairment of the thoracic cage

70
Q

Give an acquired chest wall abnormality which can cause breathing abnormalities

A

Broken rib

71
Q

Give a muscular defect and two nervous defects which can cause trouble breathing

A
  1. Muscular dystrophy
  2. Motor neurone disease
  3. Polio
72
Q

What does muscle weakness cause in terms of breathing?

A

Respiratory failure with lower resistance to respiratory tract infections because of poor clearance of secretions

3 - Respiratory (20 decks)

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