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BSMS 103 > T4 - Restrictive lung disease > Flashcards

T4 - Restrictive lung disease Flashcards

1
Q

what is restriction defined by?

A

decrease in lung volume which prevents the lung expanding

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2
Q

by what three mechanisms can normal interstitial structures be altered?

A

fluid accumulation, inflammation and fibrosis

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3
Q

what is the defining feature of RLD?

A

reduced residual volume

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4
Q

give three examples of interstitial lung disease and what do these affect?

A

pneumoconioses, hypersensitive pneumonitis and idiopathic pulmonary fibrosis
- affects alveolar filing processes

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5
Q

what does interstitial lung disease result in?

A

pulmonary oedema, haemorrhage, infection and cancer

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6
Q

what happens to the intrarlobular septa in ILD and what does this cause?

A

septa become thick and this causes a diffusion limitation

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7
Q

where are intralobular septa found?

A

surrounding the alveoli

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8
Q

where are interlobular septa found and what is within them?

A

found outlining the secondary lobules and lymphatics and veins are found within then

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9
Q

when can interlobular septa be visualised on CT?

A

only when thickened

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10
Q

exposure to what two things found in the environment causes hypersensitivity pneumonitis?

A

mould and bird proteins

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11
Q

give three types of pneumoconioses

A

coal miners lung, silicosis, asbestosis

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12
Q

how is interstitial lung disease categorised?

A

by cause

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13
Q

what are four causes of ILD?

A

inorganic exposure (asbestos, dust, silica), organic exposure (bird, hay, mould, mycobacteria), smoking or connective tissue disease (RA)

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14
Q

what do problems associated with coal miners lung start and how long do they last?

A

begin as soon as you inhale the dust and last forever

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15
Q

what does coal miners lung result in?

A

massive fibrosis and inflammation due to dust particles being engulfed by MPs and laying down of tough non elastic collagen

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16
Q

what is created with MPs destroy dust particles from coal and what can this progress to?

A

fibrotic ring around it which can progress to massive fibrosis

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17
Q

does exposure to asbestos mean you will get disease?

A

no

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18
Q

what are two markers of significant asbestos exposure on imaging?

A

pleural plaques and honeycomb cysts (fine lines on CT)

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19
Q

how does mesothelioma form?

A

asbestos is taken up by dendritic ells and deposited in the pleural space (which is lined with mesothelial cells) that can undergo malignant transformation

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20
Q

what are three characteristics of silica and dust exposure in the lung?

A

1) nodular disease
2) tissue pulled into the lungs so they can’t expand
3) massive fibrosis

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21
Q

what type of septa are inflammed in hypersensitive pneumonitis?

A

intralobular septa (become thick)

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22
Q

what forms when mould or bird dust are inhaled?

A

body sees it as infection and forms a granuloma in small terminal bronchioles

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23
Q

what can a granuloma transform to and how is it seen on imaging?

A

can transform to a scar and will be seen as shadows or lobules on imaging

24
Q

what age range is idiopathic pulmonary fibrosis seen in?

A

elderly

25
Q

where is idiopathic pulmonary fibrosis seen and how is it characterised?

A
  • seen in lower and peripheral aspects of lung

- characterised by honeycomb cysts which are seen as holes on CT

26
Q

what cell types are present in abundance in idiopathic pulmonary fibrosis and what does this cause?

A

lots of fibroblasts therefore lots of collagen deposited causing lungs to be rigid

27
Q

what does alveolar collapse cause?

A

atelectasis

28
Q

what are the two types of atelectasis and what are they associated with?

A

1) resorptive - associated with endobronchial obstruction causing decrease in alveolar size and eventual collapse
2) compressive - due to pleural processes or a lung mass

29
Q

what is pleural effusion?

A

abnormal fluid collection between two layers of pleura

30
Q

can pleural effusion usually be detected on radiology?

A

no

31
Q

how is pleural effusion characterised in relation to influx and efflux of fluid?

A

influx > efflux due to a capillary leak and liquid from the visceral pleura leaks into the intersititum

32
Q

what causes pleural effusion?

A

congestive HF, liver disease w portal hypertension, low albumin due to nephrotic syndrome, infection eg TB, parasites, malignancy, chylothorax (high lymph in the pleura)

33
Q

what four things may a patient with pleural effusion present with?

A

dyspnoea, dull percussion at lung base, hazy CXR, may have collapse (atelectasis)

34
Q

what are the two types of pleural effusion

A

transudative and exudative

35
Q

what characterises transudative pleural effusion?

A

problems in normal fluid balance due to fluid leakage

36
Q

which type of pleural effusion is usually due to a primary non pleural process and probably doesn’t need to be drained?

A

transudative

37
Q

what characterises exudative pleural effusion?

A

problems with the pleura itself

38
Q

what type of pleural effusion is due to primary pleural disease and needs to be drained?

A

exudative

39
Q

how can an exudative pleural effusion be drained?

A

by needle aspiration or thoracotomy (chest tube)

40
Q

what are the seven mechanisms of exudative effusions?

A

1) uncomplicated parapneumonic
2) complicated parapneumonic
3) empyema
4) cancer
5) chylothorax
6) blood in pleural space
7) pleurisy

41
Q

what characterises an uncomplicated parapneumonic exudative effusion?

A
  • lots of inflammatory cells but NO bacteria

- altered capillary permeability

42
Q

what characterises a complicated parapneumonic exudative effusion?

A
  • lots of inflammatory cells WITH bacteria
  • no pus
  • needs draining
43
Q

what can a complicated parapneumonic exudative effusion result in if not drained?

A

pleural rind formation that needs to be surgically drained

44
Q

what characterises empyema?

A
  • frank pus

- needs draining with a chest tube

45
Q

how can cancer cause an exudative pleural effusion?

A

if tumour cells move into the pleural space via the lymphatics

46
Q

what is a chylothorax?

A

retrograde spillage of lymphatic material into the pleura

47
Q

what is a common cause of chylothorax?

A

thoracic duct injury (cut by mistake in surgery)

48
Q

what can cause blood in the pleural space?

A

penetrating trauma

49
Q

how is haemothorax defined in relation to haematocrit?

A

haematocrit is at least 50% of that of normal blood in the pleural space

50
Q

what is pleurisy and what causes it?

A
  • sterile process of inflammatory cells and fluid that accumulate in the pleural space
  • autoimmune causes
51
Q

what are the two main things to diagnose exudative pleural effusion?

A
  • lights criteria

- compare pleural levels to serum levels eg protein, LDH

52
Q

what things are analysed in fluid studies of pleura?

A
  • protein and LDH
  • pH/glucose
  • cytopathology for malignancy
  • cell counts with a WBC differential
  • microbial stain and culture
  • cholesterol and Tis for thoracic duct spillage
53
Q

what is a pneumothorax?

A

air collection in the pleural space due to alveolar rupture

54
Q

what are the two types of pneumothorax?

A

spontaneous or traumatic

55
Q

what are four causes of traumatic pneumothorax?

A
  • procedural
  • penetrating trauma
  • rib fracture
  • baro trauma
56
Q

what can cause chest wall disease?

A

generative spinal disease such as MND and polio

BSMS 103 (23 decks)

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