Occupational Lung Disease Flashcards
Silicosis
Granulomatous inflammation
Inhale into airway then lymphocyte and mc phagocytose
Fibroblast nodules
Surfactant irritation
Cause
Quarry ceramic brick stone mason
Acute months
Lz consolidation
Lipoprotein exudate
Subacute
Uz nodules calcify then coalesce forming PMF. Perifissural/pleural nodules
Eggshell calcification
Chronic
Years
Uz calcification, hilar lan, no parenchymal change
Hx
Dust alveoli
Lymphocytes
Layers collagen
Nodules
Lz fibrosis
CX
NTM or TB due to loss mcrophages
Small increase lung ca
Sjogrens or scleroderma renal disease
Tx
Prevention
Beryllosis
Metal for fluorescent lights
Prolonged latency
Acute
Alveolitis and pulmonary oedema
Sob cough cyanosis
Pred
Subacute
HS delay by TC release cytokines form NCG
Cough fever sob night sweats
Creps and clubbing
HLA mediated
CX Ptx fibrosis raised ca
Mx pred
CT like sarcoid
Subpleural Nodules
Thickened septa
Med lan
Peribronchial ncg
Traction bre and honeycombing— Fibrosis
Dx blood or BAL lymphocytes proliferation test - lymphocytes cultured release beso
Mx
Steroids but granuloma don’t always resolve
Coal worker
Simple
Inhaled macrophages pg then release cytokines activate fibroblasts
CT UZ -LN -reticulocyte -focal emphysema + restrictive
Black LN
PMF
Aggregate fibroblast - nodule 10mm- large areas fibrosis
CT upper zone fibrosis and PMF
Mixed pft and loss volume
Mx
Reduce exposure
4m monitor
Compensation
Carbon monoxide poisoning
Co competes for o2 then carboxyhb so left shift curve binds to 02 more
Less energy production
Mild nv headache malaise unsteady
Moderate arrhythmia pul oedema
Severe seizure and coma
Normal spo2
Pao2 low
Cohb high
Hyperbaric o2
Avoid met alkalosis
Pleural plaque
Discrete areas of parietal pleura thickening
Bx hyaline collagen fibrosis
30 yo
Asymptomatic
Uniform thickening on ct can be ca or non ca. lower lung spares apex and CP
Holly leaf cxr
No pet uptake
Mild obstruction
Not eligible for compensation
Rounded atelectasis
Folded lung
Visceral pleura fibrosis twists underlying lung
Dry cough
Ct comet tail sign
No uptake pet
Sx if symptomatic
Benign pleural effusions
Dose dependent asbestosis
UL
Blood stained
Histology normal
Resolve after a month
Diffuse pleural thickening
Fibrous visceral pleura sticks to pleural so obliterates space
Dose related
Sob and cough
Chest pain
Ct diffuse pleural thickening lose cpa. UL or bl. Volume loss.
Restrictive with reduced TLCO
Pleural Bx Dx
16% risk meso 2y
Need to follow up
Compensation
Asbestosis
Interstitial fibrosis due to inhalation of asbestos
Carpenter boiler shipyard
Increased severity due to longer exposure / blue and smoker
Dose related severity!
10y latency
Sob cough and chest pain
Creps and clubbed
CT UIP fibrosis
Parenchymal band
Traction Bronchiectasis
Rounded atelectasis
Interlobular thickening
GGO
Fibrosis
No pet uptake
Restrictive with reduced TLCO
Bal lymphocytes with asbestos bodies
40% meso in 10y
Mesothelioma
Malignant tumour of pleural lining
Nodular pleural thickening involving mediastinal surface and chest wall
Pet avidity
Good pg sarcomatoid
Bad pg epithelial
Early chemo nipo il
Rt local for pain
Effusion vats early then talc vs pic
CX
Local invasion
Svco
Tampomade
According
Distant met
Pneumoconiosis
Less than 5 microns inhaled
Stuck terminal bronchiole and alveoli
Damage epithelial lining so macrophage phagocytose
Coal dust
Caplan syndrome and PMF or bronchitis
Compensation
Silica
Stone work
Asbestosis
Iron siderosis in welder
Basotosis mining
Tin oxide stanosis
———
CT UL nodules, PMF aggregation fibrotic nodules, parenchymal distal emphysema
Caplan syndrome
Seropositive RA
Nodule
Form cavity
Asthma
Sensitiser induced 90%
15% of adult onset asthma
Due to hmw and lmw eg acids cereals animal enzymes
Sensitise then after latency 2y immune response
New asthma pred nasal or conjunctivitis or Atopy after low level exposure
Pefr 3x a day work and home over 4w + specific inhalational gold standard (Pc20 less than 8 diagnostic)
Other feno or specific Ige
Irritant
High level exposure with no latency
Rhinitis conjunctivitis corneal ulcer pharyngeal erythema
No Atopy
Restrictive
Smokers with asbestos
26x risk lung cancer
Byssinosis
Cotton hemp flax
Endotoxin from fibres
Obstruction pft
Fibrosis
Industrial injury claim
Asbestosis
Mesothelioma
Lung cancer
Pleural thickening
Not for effusion or plaques
Types asbestos
- Serpentine CHRYSTLLE
- Amphiboles inc crocidolite blue highest risk mesothelioma
