Restrictive Thoracic disease Flashcards
What is ILD? (DPLD)
(Interstitial lung disease) A general terms that includes many different conditions which affect a part of the lungs.
Name some restrictions to the thoracx due to causes out with the lungs? And what does it lead to?
Skeletal - curvature, ribs etc, cause restriction on the lungs to expand
Muscular - diaphragm paralysed, nerves not working etc
Abdominal obesity/Ascietes - compression of the thoracic contents.
Results in chronic alveolar under ventilation with low PaO2 and raised PaCO2 and reduced lung volumes
Name some restrictions to the thoracx due to causes within the lungs?
Acute DPLD - diffuse parenchymal lung disease
Chronic DPLD - due to occupational or environmental drugs/agents
Chronic DPLD - with evidence of systemic disease
Chronic DPLD - with no evidence of systemic disease
Describe DPLD? And its pathophysiology?
Diffuse parenchymal lung disease
Disease of the alveolar structures - alveolar wall/lumen (parenchyma)
It causes impaired alveolar gas exchange
Co2 exchanged unimpaired as alveolar ventilation normal
PaO2 decreases
PaCO2 stays the same
What is the aetiology of DPLD?
- fluid in the alveolar air spaces
Cardiac pulmonary oedema in the alveolar walls and lumen due to a raised pulmonary venous pressure = LVF
Non cardiac pulmonary oedema - normally pulmonary venous pressure, with leaky pulmonary capillaries, due to sepsis/trauma
What is the aetiology of DPLD?
- Consolidation of alveolar air spaces
Infective pneumonia - viral, bacterial, fungal
Infarction - PE, vasculitis
Other causes (BOOP) - rhematoid disease, drugs, idiopathic
What is the aetiology of DPLD?
- Inflam Infiltrate of alveolar walls (ie Alveolitis): Granulomatous-alveolitis
Extrinsic - allergic alveolitis - famers lung, pigeons lung
Sarcoidosis - Multi system disorder, erythema nodosum
Drug induced alveoli’s - amiodarone, methotrexate
Toxic gas/fumes - chlorine
Fibrosisng alveoli’s - Rheumatoid
Autoimmune (multi-system) - SLE, Wegners, Churg-strauss
What is the aetiology of DPLD?
- dust disease (Pneumoconiosis)
Fibrogenic - asbestosis, silicosis
Non-fibrogenic - Iron etc
What is the aetiology of DPLD?
- carcinomatosis
Lympathic/blood spread
What is the aetiology of DPLD?
- eosinophilic
(type 3 allergic response)
Drugs, fungal, parasites
What is the clinical syndrome of DPLD?
Breathless on exertion Cough but no wheeze Finger clubbing Inspiratory Lung crackles Central cyanosis (if hypoxaemic) Pulmonary fibrosis occurs as end stage response to chronic inflammation
What is the diagnosis of DPLD?
History Reduced lung volumes Reduced gas diffusion PaO2 decreased SaO2 decreased Bilateral diffuse alveolar infiltrates on CXR Ground glass appearance .... etc
Treatment of DPLD?
Remove trigger
Treat inflammation - i.e. ground glass appearance on HRTC immunosuppressants
Drugs….
Lung transplant for end stage
What is Alveolitis?
inflammation of the air sacs of the lungs.
What is pneuomonitis?
inflammation of the walls of the alveoli (air sacs) in the lungs.
