Restrictive Lung Diseases Flashcards
Thoracic restriction can be due to causes ……. the lungs
OUTWITH
Name some skeletal causes of thoracic lung restriction.
Vertebrae e.g thoracic kyphoscoliosis
Ankylosing spondylitis
Rib fractures
Name some muscular causes of thoracic lung restriction
Muscle weakness e.g myopathy, neuropathy
MND
Polio
Gulian Barre
Name 2 conditions that can cause compression of the thoracic contents.
Ascites
Obesity
What does thoracic restriction result in?
Chronic alveolar under-ventilation with low PaO2 and raised PaCO2 and reduced lung volumes
Describe the 5 main categories of DPLD.
- Acute DPLD
- Episodic DPLD, all of which may present acutely
- Chronic DPLD due to occupational or environmental agents or drugs.
- Chronic DPLD with evidence of systemic disease
- Chronic DPLD with no evidence of systemic disease
What is DPLD? What is it also know as?
A group of lung diseases affecting the lung parenchymal e.g alveolar lungs/lumen
Interstitial lung disease
What is impaired as a result of DPLD? What does this mean?
Alveolar gas exchange is impaired
There is an alveolar barrier to O2 exchange
What remains normal in DPLD?
Alveolar ventilation
What does the normal alveolar ventilation mean?
CO2 exchange is unimpaired
What is the main cause of DPLD?
Fluid in the alveolar spaces
Name a cardiac condition that could result in fluid in the alveolar spaces. Explain this.
LVF
Raised pulmonary venous pressure due to back pressure from the heart
Accumulation of oedema in alveolar walls and lumen
Name other conditions which could lead to a build up of fluid in the lungs BUT with normal pulmonary pressure.
Leaky vessels, normal pressure Sepsis Trauma ARDS Altitude sickness
DPLD can also be caused by …………. in alveolar spaces
Consolidation
Name some causes of consolidation in alveolar spaces.
Pneumonia
Infarction
Rheumatoid drugs
What kind of infarction can lead to DPLD?
PE
Vasculitis
What different types of pneumonia can cause consolidation in the lungs? Give examples under each heading.
Viral - flu, measles, chickenpox
Bacterial - pneumococcus, TB
Fungal - HIV, pneumocystitis
Inflammatory infiltrate in alveolar walls is another cause of DPLD
TRUE
What is alveolitis?
Inflammatory infiltrate in alveolar walls
Name the 2 main types of granulomatous alveolitis.
Extrinsic Allergic Alveolitis
Sarcoidosis
What can EAA also be called?
Hypersensitivity Pneumonitis
What type of hypersensitivity reaction is EAA?
Type 3
Name a common sign of Sarcoidosis.
Chronic enlargement of lymph nodes
Sarcoidosis is a …..-system disease
MULTI
Name 4 common symptoms that accompany Sarcoidosis.
Erythema Nodosum
Uveitis
Myocarditis
Neuropathy
Alveolitis can also be drug induced. Name some common drugs that cause this condition.
Amiodarone
Gold
Methotrexate
Bleomycin
What toxic gas can cause alveolitis?
Chlorine
Name 3 auto-immune conditions which are associated with Alveolitis.
SLE
Polyarteritis
Wegeners
What is the conditions known as ‘dust disease’?
Pneumoconiosis
There are 2 types of pneumoconiosis, what are they?
Fibrogenic
Non-fibrogenic
Name 2 conditions under the heading of Fibrogenic Pneumoconiosis
Asbestosis
Silicosis
Name 5 signs/symptoms of DPLD.
SOB on exertion Cough Clubbing Inspiratory crackles (base) Central cyanosis
What occurs as an end stage response to inflammation?
Pulmonary fibrosis
The cough in DPLD is associated with a wheeze
FALSE
NO wheeze
Describe what would be heard on auscultation of the lungs in a patient with DPLD.
Fine, inspiratory crackles
Base of lungs
DPLD patients have reduced lung volumes. Describe this.
FEV1 and FVC - DECREASED
Normal ratio >75%
People with DPLD have a normal peak flow
TRUE
Those with DPLD have increased gas diffusion
FALSE - decreased
Describe the arterial oxygen DESATURATION is DPLD.
Decreased PaO2 at rest and during exercise
Outline some other tests that should be done in the diagnosis of DPLD.
- Antibodies
- Serum ACE and Ca
- CXR
- ECHO
- CT
- BAL
- Biopsy
Antibodies
Avian
Fungal
Auto-antibodies
Serum ACE and Ca
Sarcoidosis
CXR
Bilateral diffuse alveolar infiltrates
ECHO
LVF
CT
Inflammatory ground glass
Fibrotic nodular component of alveolar infiltrates
BAL
Infection
TB
Pneumocystitis
Biopsy
Rare
What is always the FIRST step in the treatment of DPLD?
Remove any triggers
e.g dust, drug, allergen
What should be given if the patient is hyperaemic?
O2 obvs
What is the 1st and 2nd line of treatment in DPLD?
- Systemic corticosterone e.g oral Prednisolone
- Oral Azothioprine
- Anti-fibrotic (IPF)
- Anti-oxidant (IPF)
What is the last resort for end stage disease?
Lung transplant
Bilateral nodular lymphadenopathy and lung infiltrates
Sarcoidosis
What type of granulomas are found in Sarcoidosis?
Non-ceseating
