Restrictive Lung Dz Flashcards
Acute respiratory distress syndrome (ARDS)
Acute lung injury w/ acute and persistent lung inflammation and increased vascular permeability.
4 clinical features of ARDS
Acute onset
Bilateral infiltrates w/ pulmonary edema
Hypoxemia
No evidence of elevated atrial pressure
Some causes of ARDS
Sepsis Trauma Pneumonia Severe trauma Drugs, alcohol
ARDS Patho
Inflammatory injury to alveoli results in diffuse alveolar damage.
Lungs receive disproportionate amount of cardiac output.
Surfactant is lost
Honeycomb chest x-ray =?
Proliferative stage of ARDS
ARDS Diagnosis
BNP - low levels
Echocardiography
Pulmonary artery cath
ARDS Mgmt
Almost all pt's require mechanical ventilation Sedation, avoid neuromuscular blockade Analgesia Nutritional support DVT, GI prophylaxis PEEP
Asbestosis
Inhalation of asbestos fibers
Chrysotile responsible for most US cases
Slowly progressive
Malignant mesothelioma
Asbestosis Findings
20 - 30 yr latent period
Dyspnea on exertion
Fine bibasilar crackles, clubbing
Asbestosis radiography findings
Shaggy heart and ground glass appearance
Honeycombing in late stages
Bronchiolitis Obliterans (BO)
Chronic airway rejection in lung transplant patients due to:
Acute rejection
CMV pneumonitis
Noncompliance from immunosuppressives.
BO Presentation
Usually indolent URI type sx
Exertional dyspnea
Hyperinflation
Pseudomonas colonization
BO Diagnosis
45% of lung transplant recipients develop this by 5 years.
Usually made on patients who develop declining spirometry without acute illness
BO Tx
Change meds
Photopheresis
Retransplantation
25 - 50% mortality
Hypersensitivity Pneumonitis
AKA extrinsic allergic alveolitis, farmers lung
Immunologic rxn to inhaled agent (agricultural dusts, bioaresols, reactive chemical species)
HP Risk factors
Farmers and bird fanciers have an elevated risk
Plastic manufacturing, Painting
smoking REDUCES risk
Genetic factors
HP presentation
May follow heavy exposure to antigen
Abrupt onset of FLS, dyspnea, chest tightness
Tachypnea, fine rales
HP Tx
Removal from antigen
Should subside in 12 hrs
glucocorticoids for initial recovery
Interstitial Lung Dz
DIffuse parenchymal lung diseases, collectively referred to as ILD.
All have similar features
Extensive reconstruction of pulmonary architecture
Interstitial Pulmonary Fibrosis
50% idiopathic
Progressive exertional dyspnea and cough
hazy x-ray, then nodules, then linear opacities
Usually die of resp. failure within 3-6 yrs
Affects adults >40
IPF Tx
May not be helpful….
Glucocorticoids
Immunosupressives
Antioxidants
Sarcoidosis
A multisystem granulomatous disorder of unknown etiology
Characterized by noncaseating granulomas in involved organs.
Typically affects young adults
Sarcoidosis Presentation
Bilateral hilar adenopathy Pulmonary reticular opacities Skin, joint and eye lesions Lung involvement in 90% of patients Dyspnea, cough, CP
Pulmonary Sarcoidosis Tx
Spontaneous remission may occur
Glucocorticoids, daily
Drug-induced pulmonary dz
Eosinophilic Pneumonias
present 2-10 days after drug started
Radiation-induced lung injury
Radiation pneumonitis
Radiation fibrosis
Dose-limiting damage
Radiation-induced lung injury presentation
Early non-productive cough Dyspnea on exertion Low grade fever pleuritic CP Fine crackles Pulmonary HTN
Radiation-induced lung injury Tx
Corticosteroids
Inhibition of collagen synthesis
Pneumoconiosis
nonneoplastic reaction of the lung to inhaled mineral or organic dust
Silicosis, coal workers
