Non-neoplastic lung disease Flashcards
What is bronchiectasis? What are the main causative agents?
Permanent dilatation of bronchi and bronchioles due to obstruction or severe inflammation
Main agents: H influenzae, strep pneumoniae, staph aureus, pseudomonas aeurigonasa
Is bronchiectasis more common in developed or underdeveloped countries?
Underdeveloped countries due to high incidence of severe childhood pulmonary infections
In developed countries, bronchiectasis is usually associated with what? (2)
Obstruction such as tumour or foreign body or in association with CF.
Presentation of someone with bronchiectasis? (symptoms and signs)
Chronic cough, large amounts of foul smelling sputum, flecked with blood.
Signs: clubbing, coarse inspiratory crackles and wheeze.
How do we manage bronchiectasis?
Airway clearance techniques
Antibiotics according to bacterial sensitivity
Bronchodilators for those with asthma, COPD etc.
What is chronic bronchitis?
Is there any main trigger?
Chronic inflammation of the bronchi.
Causes a productive cough for 3m in 2 consecutive years. There is mucus hyper secretion with bronchial mucus gland hypertrophy.
Mainly in middle aged tobacco smokers and symptoms typically improve when they stop smoking
What is a blue bloater and a pink puffer?
- Cyanosis (blue bloaters) - have decreased alveolar ventilation with a low PaO2 and a high PaCO2. They are cyanosed but not breathless and can develop cor pulmonale. They rely on the hypoxic drive to maintain respiratory effort so additional oxygen should be given with care.
- Pink puffers - have increased alveolar ventilation a near normal PaO2 and a normal or low PaCO2. They are breathless but not cyanosed. They might progress into type I respiratory failure.
what is emphysema
enlarged alveolar airspaces with destruction of elastin walls (instead of many small alveoli, the walls thin and get destroyed leading to bigger holes instead of smaller alveoli)
what effects can emphysema have on the patient
gas trapping effect prevents full exhalation of air
risk of pulmonary hypertension and poor oxygen delivery to tissues
What is interstitial lung disease
it is a group of conditions where there is an increased amount of lung tissue (thickness)
there is increased stiffness in the lungs and decreased compliance.
in interstitial lung disease, is there a restrictive or obstructive pattern? Effects on FEV1, FEV1/FVC and PEFR.
restrictive pattern with reduced TCO, VC and FEV1 but a relatively normal FEV1/FVC ratio and PEFR
what is adult respiratory distress syndrome?
direct injury to the lung tissue (aspiration, radiation, drugs) cause problems and thickening of interstitium of the tissue and a reduction in lung function.
what are some causes of acute interstitial disease?
shock trauma infections severe gas inhalation narcotic drug abuse cytotoxic drugs (ending in -imibs)
Clinical features of acute interstitial disease (adult respiratory distress syndrome)
What is the fatality rate?
- Cyanosis
- Tachypnoea
- Tachycardia
- Peripheral vasodilation
- Pulmonary oedema
- Bilateral fine inspiratory crackles
- Diffuse alveolar damage with hyaline membranes
- Many different clinical conditions all associated with severe injury to alveolar-capillary walls
- Fatal in 50% cases
Management of acute interstitial disease?
Admit to ITU and give supportive therapy and treat underlying cause
Resp support: CPAP with 40-60% oxygen but most need mechanical ventilation
Sepsis: identify organism and treat
Overall mortality: 50-75%
