L66 Flashcards
What is another term for diffuse (parenchymal) lung disease?
Interstitial lung disease
Idiopathic pulm fibrosis What is it Path pattern Localized or diffuse? What layer of lung parenchyma is effected Lower or upper lobes?
Diffuse scarring in lungs Worse over time Path = usual interstitial pna 1. Cobble stone pleural surface (fibrosis resulting in retraction) 2. Scar in between normal areas -> fibroblastic foci, heterogeneous 3. Honeycombing = scar remodeling 4. Diffuse + bilateral 5. Subpleural 6. Lower > upper lobes
What type of epithelium lines the remodeling of IPF?
Squamous lined cysts
- Lack of gas exchange contributes to hypoxemia
NOT pneumnocytes
Non-specific interstitial pna
- Speed of progression // prognosis
- Hetero or homogenous
Slower progression = better prognosis
Homogenous - scarring pretty much the same all over
Widened alveolar walls - thickening of alveolar septa w/ chronic inflam
Organizing pna
Path or clinical term
What is it
Pathologic term indicating intra-alveolar healing and fibrosis
Look for spindle cell = reactive fibroblasts
What is the idiopathic form of OP?
Treat
Progression
Cryptogenic OP
Responds to steroids
Might progress to pulm fibrosis
What prior medical history increases your risk for ILD?
Most directly increases risk for UIP, NSIP pattern Connective tissue diseases: Lupus RA Scleroderma
What is sarcoid
Non-infectious, idiopathic granulomas
What are the most common locations for sarcoid granulomas
Hilar LN Skin Uvea Heart Almost any organ
Where do sarcoid granulomas form in the lung?
Central - along airways
- Will move out by following lymphatics
Less common but can create consolidating pna like masses
If pulm sarcoid granulomas obstruct vessels - which vessels will be effected and what are the net results?
Veins
RV and LV hypertrophy
Pulm HTN + cor pulmonale
What cell are you looking for in a granuloma
Multinucleated giant cell
Asteroid body = condensation of protein material
What 4 lung diseases may result from asbestos exposure?
Asbestosis (pulm fibrosis)
Pleural plaques - most common
Carcinoma of the lung
Malignant mesothelioma
What is asbestosis
Diffuse parenchymal lung disease
Inflam + fibrotic
Fe deposited -> asbestos body
What is silicosis
Inhaled crystal silicon dioxide
Inflam + fibrosis that is less diffuse than asbestosis -> discrete nodules in parenchyma and hilar LN
Silicosis increases your risk of developing what infection
TB
What is the name for black pigment in lung lymphatics (most mild form of coal miner’s pneumoconiosis)?
Anthracosis - most people have this from living in cities etc, not exclusive to coal miners
Upper or lower lobes for simple coal miners pneumoconiosis
Upper
What is complicated coal worker’s pneumoconiosis
Progressive massive fibrosis
What is the histo triad for HST pneumonitis
Interstitial inflam
Loosely formed granulomas (no asteroid bodies // well formed of sarcoid)
Bronchiolitis/OP
NO eosinophils or mast cells like asthma
What is smoking related interstitial lung disease? How does it differ from emphysema?
Histo
= macrophage rxn to smoke Net: resp bronchiolitis More scarring than emphysema Histo: 1. Smoker's macrophages in clusters 2. Interstitial fibrosis
What drugs are implicated for drug induced ILD? What does this kind of ILD look like?
MTX Amioderone Bleomycin Daptomycin Can look like everything
What does amiodarone tox look like on histo?
Pneumocytes lining alveolar are large w/ bubbles in cytoplasm
What is pulm alveolar proteinosis?
Acquired vs secondary
Treat
Accumulation of acellular surfactant in alveolar spaces
Acquired = Ab vs granulocyte-macrophage CSF
Secondary due to some underlying other condition duh…
Treat: whole lung + GM CSF
