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Semester 3 - Respiratory > Session 8 - Interstitial lung disease > Flashcards

Session 8 - Interstitial lung disease Flashcards

1
Q

What is interstitial space?

A

• A potential space between alveolar cells and the capillary basement membrane which is only apparent in disease states, where it may contain fibrous tissue, cells or fluid

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2
Q

What is interstitial lung disease?

A

• Group of diseases with a variety of cuases that have similar pathophysiological effects and clinical features

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3
Q

What is the pathophysiology of interstitial lung disease?

A
  • Fibrous tissue develops in the intersticium, making lungs less compliajt, producing a restrictive venilatory defect
    • Diffusion path between alveolar air and blood impairs gas exchange. O2 uptake affected selectively
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4
Q

What are the clinical features of interstitial lung disease?

A

Shortness of breath, reduced exercise tolerance, dry cough

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5
Q

Give four signs of Interstitial Lung Disease

A
  • Tachynpnoea
    • Tachcardia
    • Reduced chest movement

Coarse crackles

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6
Q

Give five causes of interstitial lung disease?

A
  • Occupational
    • Treatment related
    • Connective tissue disease
    • Immunological
    • Idiopathic
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7
Q

Give three occupational causes of interstitial lung disease

A
  • Asbestosis
    • Siicosis

Coal workers Pneumoconiosi

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8
Q

Give three treatment related causes of Interstitial Lung Disease

A
  • Radiation
    • Methotrexate
    • Nitrofurantoin
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9
Q

Give three connective tissue disease

A
  • Rh. Arthritis
    • Polymyositis
    • Schelroderma
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10
Q

Give two immunological causes of Interstitial Lung Disease

A
  • Sarcoidosis

* Hypersensitivity pneumonitis

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11
Q

What is fibrosing alveolitis?

A
  • Progressive inflammatory condition of unknown cause
    • Increased activated alveolar macrophages
    • Attract neutrophils and eosinophils
    • Local lung damge due to ROS and proteases

Tissue destruction and fibrosis

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12
Q

What do patients present with when they have fibrosing alveolitis?

A
  • Progressive shortness of breath on exercise, often combined with a productive cough
    • Finger clubbing
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13
Q

What does the chest x ray of someone with fibrosing alveolitis show?

A

• Small lungs with micro-nodular shadowing predominating in the lower lobes, with ragged heart borders

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14
Q

How is fibrosing alveolitis treated, and what are the limitations of this treatment?

A
  • Treated with high dose oral steroids in the early stages

* Less effectve once fibrosis has developed

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15
Q

How is treatment of fibrosing alveolitis monitored?

A

• By repeated lung function tests

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16
Q

What is extrinsic allergic alveolitis?

A

• Inhalation of organic material which triggers an allergic reaction in alveoli and bronchioles

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17
Q

What are two states of the condition?

A

• Can be acute or chronic

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18
Q

Outline acute extrinsic allergic alveolits

A
  • Farmers lung
    • Thermophilic actinomycetes found in mouldy hay
    • Inhalation causes influenza like illness 4-9 hours later with a dry cough and dyspnoea on exertion.
    • Fine mid and late inspiratory crackles
    • Wheeze
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19
Q

Outline chronic extrinsic allergic alveolitis

A
  • Long term antigen exposure = Faeces of pidgeons/budgies
    • Insidious malaise
    • Dry cough and breathlessness over months and years
    • Inspiratory crackles
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20
Q

What sign does not occur in any types of allergic alveolitis?

A

• Finger clubbing

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21
Q

What does the x-ray show in acute extrinsic allergic alveolitis?

A

• Diffuse micro-nodular infiltrate denser towards the hila

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22
Q

What does the x-ray show in chronis extrinsic allergic alveolitis?

A

• Normal, may progres to fibrosis

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23
Q

What will a lung function test show in extrinsic allergic alveolitis?

A

• Lung function test will show reduced compliance and reduced gas transfer

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24
Q

What is asbestosis?

A

• Inhalation of asbestos fibres causes a disease to develop long after exposure

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25
Q

Give three different types of disease as a result of asbestos inhalation

A
  • Benign pleural plaques
    • Asbestosis
    • Mesothelioma
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26
Q

What do asbestos fibres do in the lungs?

A
  • Penetrate to the alveoli, causing alveolitis
    • Causes an influx of macrophages which produce distinctive asbestos bodies
    • Alveolitis progresses to fibrosis
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27
Q

What are the symptoms of asbestos related disease?

A
  • Patient breathless on exertion and a dry cough

* Inspiratory crackles at the lung base, which rise as the disease advance

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28
Q

What do lung function tests of someone with asbestos related lung disease show?

A

• Small lungs, reduced compliance and impaired gas transfer

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29
Q

What is sarcoidosis characterised by?

A

• Non-caseating granulomas in multiple organs and body sites

Most commonly found in the lungs

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30
Q

What occurs in the airways in sarcoidosis?

A

• Fluid is collected by lavage of the airways and alveoli contain lots of cells, including macrophages and lymphocytes

31
Q

In what ethnicities is sarcoidosis the most common?

A

• Afro-Carribean and Asians than in Caucasians

Genetic predisposition

32
Q

When is the highest incidence of sarcoidosis?

A

• 30’s and 40’s with more female cases

33
Q

What are the two main symptoms of sarcoidosis?

A
  • Cough

* Dyspnoea

34
Q

How is sarcoidosis graded?

A

On a scale of severity of 1-4

35
Q

What does X-ray show in sarcoidosis?

A

• Miliary and nodular shadowing and diffuse fibrosis

36
Q

How can sarocidosis be treated?

A

• Steroids

37
Q

What does the lung function test in sarcoidosis show?

A
  • Small lungs
    • Reduced compliance
    • Impaired gas transfer

May be evidence of air flow obstruction

38
Q

Give four diseases associated with the work place

A
  • Asthma
    • Diffuse fibrosis
    • Nodular fibrosis
    • Alveolitis
39
Q

In what occupation and after what exposure does one get Asthma

A
  • Lab worker

* Rat urine

40
Q

In what occupation and after what exposure does one get diffuse fibrosis

A

• Boiler/Pipe Laggers
• Railway/Construction
○ Asbestos

41
Q

In what occupations (3) and after what exposure does one get nodular fibrosis (pneumoconiosis)

A

• Coal miner, miner, demolition

Coal dust, silica, asbestos

42
Q

In what occupation and after what exposure does one get alveolitis

A
  • Farmer - fungal spores from hay

* Pidgeon fancier - Avian antigens

43
Q

Name five types of intersitial lung disease

A
  • Fibrosing alveolitis
    • Extrtinsic allergic alveolitis (acute)
    • Extrinsic allergic alveolitis (chronic)
    • Sarcoidosis
    • Asbestosis
44
Q

Give the plain film x-ray found in fibrosing alveolitis

A
  • Small lungs
    • Micro-nodular shadowing (lower lobes)
    • Ragged heart border
45
Q

Give the x-ray appearance of extrinsic allergic alveolitis

A

• Micro-nodular inflitrate, denser towards the hila

46
Q

Give the x-ray appearance of extrinsic allergic alveolitis

A

• Almost normal, progressing to fibrosis in late disease

47
Q

Give the x-ray appearance of sarcoidosis

A

Give the x-ray appearance of sarcoidosis
• Miliary and nodular shadowing
• Diffuse fibrosis

48
Q

Give the x-ray appearance of asbestosis

A
  • Plaques
    • Fibrosis
    • Mesothelioma
49
Q

What is the pleura?

A
  • A serous membrane consisting of a single layer of mesothelial cells with a thin layer of underlying connective tissue
    • Made up of parietal and visceral pleura
50
Q

What does the parietal pleura line?

A

• The inside of each hemithorax

51
Q

What does the visceral pleura line?

A

• The outside of the lung

52
Q

Where are the visceral and parietal pleura continous?

A

At the hilum of the lung

53
Q

What is the pleural cavity?

A

• A potential space between two layers of pleura

54
Q

What does the surface tension of the pleural fluid provide?

A
  • The cohesion that keeps the lung surface in contact with the thoracic wall
    • As a result, when the thorax expands, the lungs expand with it and fill with air
55
Q

What is the normal turnover of pleural fluid per day

A

• 15ml turnover per day

56
Q

What are the two methods by which pleural fluid is modified?

A
  • Added by capillary filtration at the parietal pleura

* Absorbed via lymphatic drainage

57
Q

What four factors affect the rate at which fluid is added to the pleural fluid?

A
  • Increase in lung interstitial fluid
    • Increase in hydrostatic pressure (heart failure)
    • Increase in permeability (Inflammation, sepsis or malignancy)

Increased by decreased Oncotic pressure (liver failure)

58
Q

What two facts factors affect the rate at which fluid is removed from the pleural cavity?

A
  • Decreased by lymphatic blockage

* Decreased by systemic venous pressure

59
Q

What is a transudate?

A

• Low protein content - <30g/l

60
Q

What is an exudate?

A

• High protein content - >30g/l

61
Q

Give three causes of increased transudate in the pleural space

A 
• Increased hydrostatic pressure
		○ Cardiac failure
	• Decreased capillary oncotic pressure
		○ Hypoalbuminaemia
		○ Nephrotic syndrome
	• Increased capillary permeability

Sepsis

62
Q

Give four causes of an exudate pleural effusion

A 
• Neoplasms
		○ Cancer involving pleural surface
		○ Secondary mets from breast, lung, ovarian, GI and lymphome
		○ Primary tumour of the pleura
	• Infection
		○ Pneumonia, TB
	• Immune disease
		○ Connective tissue disease
	• Abdominal 
		○ Pancreatitis (diaphragmatic inflammation)
		○ Ascites 
		○ Subphrenic abscess
63
Q

What is pleurisy?

A
  • Inflammation of the pleura

* Causes sharp pain on inspiration, which is worse than coughing, sneezing and laughing

64
Q

What is a characteristic sign of pleurisy?

A
  • Patients take small breaths and hold affected side of chest
    • Pleural rub, a creaking noise heard through a stethoscope with respiratory movements
65
Q

Why do patients with pleurisy get shoulder pain?

A

• Involvement of diaphramatic pleura causes pain in shoulder on the same side

66
Q

Give five causes of pleurisy

A
  • Infection
    • Autoimmune
    • Lung cancer
    • Pneumothorax
    • Pulmonary embolism
67
Q

What are the two types of infection which cause pleurisy?

A

• TB

Pneumonia

68
Q

What are the two types of autoimmune disease which cause pleurisy?

A
  • Systemic Lupus Erytematosus

* Rheumatoid arthritis

69
Q

What is pleural fibrosis?

A
  • Unabsorbed pleural effusion may lead to fibrosis of the pleura
    • A small degree of thickening has no effect, but widespread fibrosis restricts expansion with a measurable reduction in lung volumes and compliance
70
Q

What is the most common type of pleural tumour?

A
  • Malignant mesothelioma
    • Early symptoms are loss of pleural effusion, but with a duller pain
    • Signs are the of a large pleural effusion
71
Q

Name two chest wall abnormalities which cause significant functional impairment of the thoracic cage

A

• Scoliosis and kyphosis may produce significant functional impairment of the thoracic cage

72
Q

Give an acquired chest wall abnormality which can cause breathing abnormalit

A

• Broken rib

73
Q

Give a muscular defect and two nervous defects which can cause trouble breathing

A
  • Muscular dystrophy
    • Motor neurone disease
    • Polio
74
Q

What does muscle weakness cause in terms of breathing?

A

• Respiratory failure with lower resistance to respiratory tract infections because of poor clearance of secretions

Semester 3 - Respiratory (18 decks)

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