Lecture 13: Interstitial Lung Disease Flashcards
what makes up the interstitium
- alveolar endothelium
- capillary endothelium
- basement membrane
- connective tissue
what can the interstitium be thickened by
- fluid
- cells
- fibrosis
what are functions of the extracellular matrix
- tensile strength / elasticity
- low resistance for effective gas exchange
- tissue repair / modelling
what are the main types of interstitial lung diseases
- sarcoidosis
- connective tissue diseases
- hypersensitivity pneumonitis
- idiopathic pulmonary fibrosis
presentation of idiopathic pulmonary fibrosis
- symptoms appear gradually
- slowly progressive exertional dyspnoea
- non-productive cough
- inspiratory crackles
- potential clubbing
what can you see on a CT scan with idiopathic pulmonary fibrosis
- basal distribution
- subpleural
- traction bronchiectasis
- honeycombing
which people does idiopathic pulmonary fibrosis tend to affect
- median age 66 years
- more common in men
- more likely to occur in smokers
what is medication for idiopathic pulmonary fibrosis and their side effects
- pirfenidone
- nintedanib
- weight loss
- GI upset
- photosensitivity
what is hypersensitivity pneumonitis
diffuse inflammation of parenchyma in response to inhaled antigen
presentation of hypersensitivity pneumonitis
acute
- SOB, cough, fever, crackles
subacute
- gradual onset of symptoms with weight loss
chronic
- incomplete resolution with removal of antigen
- may lead to irreversible fibrosis
how can you diagnose hypersensitivity pneumonitis
serum precipitins
how can hypersentivity pneumonitis be managed
steroids
which drugs are known to induce interstitial lung diseases
- nitrofurantonin
- amiodarone
- methotrexate
histroy of connective tissue disease related ILDs
- dry eyes / mouth (sicca)
- raynaud’s
- joint pain / swelling
- rashes
management of connective tissue disease related ILDs
- biologics
- steroids
- immunosuppression
what do blood tests show in hypersensitive pneumonitis
- antinuclear antibodies
- rheumatoid factor
what would a chest x ray show in case of ILD
reticular shadowing
what would the FEV1/FVC ratio be like in a patient with ILD
normal or high
what is sarcoidosis
multisystem granulomatous disorder
who does sarcoidosis affect more
- 3x more common in afro-caribbeans
- 75% of cases are aged 30-60
how do you diagnose sarcoidosis
- do biopsy
- look for non-necrotising / non-caseating granuloma
presentations of sarcoidosis
- cough, SOB, wheeze
- anterior uveitis on eyes
- lymph node biopsy performed
- hypercalcaemia
- lofgren’s syndrome
what is lofgren’s syndrome
- erythema nodosum
- bilateral hilar lymphadenopathy
- arthralgia
systemic symptoms of pulmonary sarcoidosis
- fatigue
- weight loss
- fevers
- sweats
- arthralgia
