Occupational COPY Flashcards
Can enter throat
Inhalable fraction
Irritation
Particle goes past bronchus
Thoracic fraction
ACUTE DZ
Particle reaches alveoli
Respirable fraction
CHRONIC DZ
Low water solubility
Bronchiole, alveoli
NO2, Phosgen
Medium water solubility
Trachea, Bronchi
Ozone
High water solubility
Ammonia, Chlorine, Sulfur dioxide
NOSE, PHARANX, LARYNX
Upper airway exposure
S/s
Short lived
Burning Couching Sputum Sneezing Difficulty breathing Bronchospasm Hemoorrhage
Occupational lung dz
Had asthma but made worse by exposure
CAUSED or EXACERBATED by exposuer
Factors resulting in pathology
Size Solubility Concentration Duration of Exposure Host Factors
Upper airway exposure
Agents
Ammonia
Chlorine gas
Upper airway exposure
Treatment
- remove from area
- Irrigation
- Supplemental O2
- secure airway
- racemic Epi
- +/- steroid
Lower Airway Disease
*Chonic sequelae (Sulfur dioxide, NO) *DOE *+/- early inspiratory crackle *CXR = possibly normal *PFTs= possibly obstructive
(Ex. Burn pits)
?
Bronchiolitis Obliterans (BO)
Lower Airway Dz - BO
DX
Biopsy
Lower Airway Dz - BO
Tx
Systemic steroid = but little help
*Chronic sequelae of irritant gas exposure
*fever, dry cough, DOE
*Late inspiratory crackle
*CXR = bilat patchy infiltrate
*PFT = restrictive,
*DLCO (CO gas exchange test) = low
??
Bronchiolitis Obliterans Organizing Pneumonia (BOOP)
Bronchiolitis Obliterans Organizing Pneumonia (BOOP)
DX
Lung biops
Bronchiolitis Obliterans Organizing Pneumonia (BOOP)
Tx
Systemic steroid
- asthma-like short-term (often single), high intensity exposure
- Onset= hours to a day (NOT LONG AGO)
- Acute damage, desquamation of airway epithelium
- Cough, Wheeze, SOB
??
Reactive Airway Dysfunction Syndrome (RADS)
Reactive Airway Dysfunction Syndrome (RADS)
Tx
Bronchodialators
S/s last for months or permanently
*asthma induced/exacerbated by exposures in the workplace
Occupational Asthma (OA) / Work Related Asthma
Occupational Asthma (OA) / Work Related Asthma
Types
W/ latency
- high molecular weight
- low molecular weight
W/o latency (irritant asthma/RADS)
- chronic daily exposure
- Upper airway irritation
- rhinorrhea
- eye itching
- wheezing
- SOB
- IMPROVE W/ leaving workplace
?
Occupational Asthma (OA) / Work Related Asthma. W/ LATENCY
Occupational Asthma (OA) / Work Related Asthma
Risks
Atopy, smoking
Occupational Asthma (OA) / Work Related Asthma
Path
High mol weight
- IgE attacks (classic hypersensitivity)
- -plants, animal products, insects–
Low mol weight
- IgE against (LMW + Protein)
- -Diisocyanates, anhydrides, wood dust
Occupational Asthma (OA) / Work Related Asthma
Dx
- asthma Dx
- onset after entering work
- associate to work
- Association between s/s + work
- 1-2: tests associated between particle + s/s
Occupational Asthma (OA) / Work Related Asthma
Tx
- avoid exposure
- protective devices
- usual asthma meds not so helpful (CONTINUOUS EXPOSURE)
- continuous exposure may cause damage
- Monday morning fever + chest tightness
- s/s seem to improve upon repeated workers
- may go chronic
*cotton processing workers
Byssinosis
20-30 years of coal exposure
- parynchymal disease
- coal macule –> coal nodule
Coal workers Pneumoconiosis (CWP)
Coal workers Pneumoconiosis (CWP)
Type of coal
Antracite>Bituminous
Coal workers Pneumoconiosis (CWP)
- Asymptomatic
- CXR = W/ small (less than 1cm) nodules in UPPER PART OF LUNG
Simple
Coal workers Pneumoconiosis (CWP)
Tx = stop work
Coal workers Pneumoconiosis (CWP)
DX
*Hx of work in mine
- Historically - needed biopsy
- think cancer? (PMF) = biospsy
- nodules = bleeding w/ biopsy
CXR: small nodule, 1st in upper lobes, then diffuse
PFT: decline in FEV1, FVC; decline in DLCO/hypoxia (advanced)
Coal workers Pneumoconiosis (CWP)
Coal workers Pneumoconiosis (CWP)
Tx
Nothing, stop work
Surveil
Vaccinate
inhalation/reaction of silia dust
Silicosis
- Small round nodular densities in upper lobes
- slow progression w/ PMF exposure
- over decade of exposure to silia
Chronic (classic) silicosis
- 5-10 years high concentration exposure
- fast progression
- Autoimmune dz
Accelerated SIlicosis
- few months - 5 years massive silica exposure
- acute dyspnea
- diffuse lung involvement (lower)
- Rapid progression to respiratory failure/death - no TX but ventilator
Acute Silicosis
DOE Cough sputum Chronic hypoxic failure PMF *up risk of cancer (class 2A)
General s/s?
Silicosis
Watch hemoptysis/weightloss (cancer, TB added)
- silicosis w/ acceleration
* Fever, weight loss, producive cough
W/ TB
- PFT : possibly before radiographic changes
- down DLCO
- restrictive/obstructive/mixed
- decrease DLCO
- Low PaO2
+ history
DX?
Silicosis
Looks like coal
Silicosis
Tx
- Prevention
- complication Tx (TB)
- acute? = whole lung lavage, lung/heart+lung transplant
Silicosis path
- Silica in macrophage
- Macrophate release cytokines
- Fibroblasts come
- Release reticulin/form hyalinized collagen fibers
- Nodule
- coal exposure
- progressive dyspnea/cough/melanoptysis
- crackles
- clubbing
- Pulmonary fibrosis
Complicated CWP
- asbestos exposure
- choronic fibrosing lung dz
- lower lobes (as Base Tosis)
- no PMF
- Smoking AFFECTS
- exposure 20+ yrs or sooner
- trapped in type I cells
Asbestosis
- asbestos exposure
- younger (10-15 years)
- fluid in lungs, clears, then reappears other side
- effusion - exudative, bloody
- RISK - diffuse pleural thickening
Benign asbestosis related Pleural effusion
- asbestos eposure
- cough/sputum
- chest tightness
- wheezing
CXR: reticulonodular pattern in Base (as Base tosis)
PFT: restrictive pattern
Low DLCO
Asbestosis
*parietal lesions = white, raised, focal, irregular
*reaction to mesothelial cells to asbestos
*grow slow, never cancer
PFT : slow FVC delcine
Pleural plaque
Round atelectasis
- asymptomatic, maybe Dyspnea, Cough, pain
- surgery
- men
- asbestos exposure
- from parietal/visceral pleura
- peritoneum
- +/- pleural effusion (+/- large)
- men
Mesothelioma
Mesothelioma
Tx
Surgery (pleurectomy/pneumectomy not good
- chemo
- 8-12 month survival
Most dangerous fiber in mesothelioma
Crocidolite fiber
Grain dust
COPD like symptoms
Productive cough
Obstructive PFT
Flu-like s/s - fever, chills, malaise, mild wheezing
Volatized upon burning
Polymer fume fever
teflon
Exposure
Flu-like symtpoms
Resolve quickly
Welding of steel
Metal fume fever
Zinc oxide
- exposure: drill bits, cutting tools, tech industry
- bronchiolitis, granulatomous/fibrotic dz
- pulm fibrosis s/s NOT occupation asthma (must differentiate)
Hard metal lung dz
Tungsten carbide, cobalt
Tx: steroid
- working in fluorescent light/ computer/electronic industry
- acute relatively large exposure –> tracheo bronchitis
*chronic exposure –> granulomatous parenchymal disease –> like sarcoidosis
CXR: miliary pattern + lymphadenopathy
Berylliosis
Dx: Hz, Lymphocyte Proliferation Test, Beryllium in lung w/ biopsy
*farmer’s lung/bird fancier’s dz/ chemical workers/ many jobs / take care of animals
*inflammatory dz of lung involving alveolar walls + terminal airways w/ repeated exposure (Th1 cell)
*granuloma formation
LAB: IgG antibody
BIOPSY: loose, non-caseating granuloma
??
Hypersensitivity pneumonitis (HP)
Hypersensitivty with Th1 cell vs. Th2 cell
Th1 = HP
Th2 = asthma
- 4-12 hrs after exposure + abrupt onset of viral-like respiratory s/s
- +/- crackles, tachycardia, tachypnea, fever
Acute Hypersensitivity pneumonitis (HP)
Acute Hypersensitivity pneumonitis (HP)
Progress to:
Subacute :
W/ weight loss
Chronic:
Heart failure s/s
Lung failure s/s = cyanosis, clubbing, crackles, peripheral edema
CT : ill-defined nodules
Hypersensitivity pneumonitis (HP)
Hypersensitivity pneumonitis (HP)
Tx
- avoid exposure
- steriod
- chronic- nothing/transplant
*exposure NO2 = bleach smell, reddish brown gas
- Mild exposure: airway irritation, cough, tightness,
- Heavy exposure: p edema, asphyxiation
*sept-october
Silo Filler’s Dz
Benign Asbestos-related Pleural Effusion (BAPE)
Dx
Thoracentesis + Pleural biopsy
Tumor-free interval of 3 years
asbestos body
Yellow-brown on light microscopy
Asbestos fiber in Fe/Ca salt/protein
- coal exposure
- coalesces of small nodules to greater than 1 cm (PROGRESSIVE MASSIVE FIBROSIS)
- before death
Complicated Coal Workers Pneumoconiosis (CWP)
