Week 219 - Haemoptysis Flashcards
Week 219 - Haemoptysis: What is the difference, in terms of pH, between haemoptysis and haematemesis?
- Haemoptysis - Alkali
* Haematemesis - Acid
Week 219 - Haemoptysis: What are the three broad vascular sources of haemoptysis? Give a brief description of each.
- Bronchial arteries; small proportion of CO, higher pressure, MORE IMPORTANT in haemoptysis.
- Capillaries.
- Pulmonary arteries; low pressure but almost entire cardiac output.
Week 219 - Haemoptysis: What is the most common cause of haemoptysis?
Acute or chronic bronchitis.
Week 219 - Haemoptysis: What are the major airway causes of haemoptysis?
- Acute/Chronic Bronchitis.
- Bronchiectisis.
- Bronchogenic carcinoma.
- Metastatic cancer.
- Bronchial adenomas.
- Sarcoidosis.
- Kaposi’s sarcoma.
Week 219 - Haemoptysis: What are the parenchymal causes of haemoptysis?
- Infection; TB, pneumonia, lung abscesses, aspergilloma)
* Auto-immune; Vasculitis with granulomatosis, Goodpasture’s syndrome, CVDs.
Week 219 - Haemoptysis: What are the vascular causes of haemoptysis?
- Pulmonary infarction.
- Elevated pulmonary venous pressure (heart failure,mitral stenosis)
- Arteriovenous malformations.
- Pulmonary veno-occlusive disease.
Week 219 - Haemoptysis: You are in a GP clinic and someone presents with haemoptysis, what is your course of action?
Refer to chest clinic, CXR.
Week 219 - Haemoptysis: What are the common causes of haemoptysis that presents with small streaks/clots?
- Smokers (Bronchitis)
- Pneumonia/TB
- Bronchiectasis
- Lung Cancer
- Heart failure
- PE
- Anticoagulation
Week 219 - Haemoptysis: What are the common causes of haemoptysis that present with large volume (>100ml)?
- Bronchiectasis
- Lung cancer
- TB
- Aspergilloma
- Vascular abnormalities
Week 219 - Haemoptysis: What is the management of massive haemoptysis?
- Ensure airway patency (intubate if needed).
- 02 therapy
- Ensure adequate IV access
- FBC, coagulation, grp and save, U+E, CXR
- Reverse any coagulopathy
- Maintain systolic BP >100
- Tranexamic acid
- Nebulised adrenaline
Week 219 - Haemoptysis: Give a definition of bronchiectasis.
- Abnormal and permanent/chronic dilation of one or more of the bronchi.
- It is a radiological diagnosis.
Week 219 - Haemoptysis: What are the inherited causes of bronhiectasis?
- cystic fibrosis
* Immotile cilia syndromes (e.g. Kartagener’s syndrome)
Week 219 - Haemoptysis: What are the acquired causes of bronhiectasis?
- Childhood pneumonia
- Chronic bronchial obstruction
- Chronic aspiration
- Allergic Bronchopulmonary Aspergillosis
- Immunoglobin deficiency and HIV
- Associations with RA and ulcerative colitis
Week 219 - Haemoptysis: What is ABPA?
Allergic bronchopulmonary aspergillosis
Week 219 - Haemoptysis: What are the physical signs of bronchiectasis?
- Breathlessness
- Polyphonic wheeze
- Finger clubbing
- Coarse, mid inspiratory crackles
- Respiratory failure
Week 219 - Haemoptysis: What is the treatment for bronchiectasis?
- PHYSIO
- Antibiotics for exacerbations
- Bronchodilators
- Treatment of respiratory failure
Week 219 - Haemoptysis: What are some of the complications of bronchiectasis?
- Infective exacerbation
- Haemoptysis
- Respiratory failure
- Associated Rheumatoid disease
- Brain abscess, Amyloidosis (Rare)
Week 219 - Haemoptysis: What is the mortality of pulmonary embolis?
- 30% if untreated
* 2-8% treated
Week 219 - Haemoptysis: What is Virchows triad?
Three factors that lead to a predisposition for thrombosis.
• Venous stasis
• Injury to vessel wall
• Increased blood coagulopathy
Week 219 - Haemoptysis: It is quite common for there to be no signs of DVT, but if symptoms were present what would they be?
- Local pain and tenderness.
- Fever
- Swelling
- Homan’s Sign - Pain in calf, on dorsiflexion of foot.
Week 219 - Haemoptysis: What is Homan’s sign?
- Pain in calf, on dorsiflexion of foot.
* A sign of DVT.
Week 219 - Haemoptysis: What is the scoring system for calculating risk of DVT?
Wells’ Score
- Score ≥2 - DVT likely
- Score <2 - DVT unlikely
Week 219 - Haemoptysis: What is the main imaging used for DVTs?
Doppler Ultrasound
Week 219 - Haemoptysis: What does a d-dimer test signify?
D-dimer is a breakdown product of cross-linked fibrin, it is elevated in thromboembolism.
Week 219 - Haemoptysis: What is the management of DVT?
- S/C heparin until diagnosis confirmed.
- USS
- Continue heparin / start anti-coagulants
- Stop heparin when INR 2.5
- Warfarin for 3/12 if clear cause
- Warfarin for 6/12 if no clear cause.
Week 219 - Haemoptysis: What is the difference in pathophysiology between a large and small clot? (In terms of where it lodges)
- Large clot - Bifurcation of pulmonary arteries > haemodynamic compromise.
- Small clot - Distal airways > infarction > pleuritic pain.
Week 219 - Haemoptysis: How does a paradoxical emboli occur?
- Atrial septal defect
* Causes systemic manifestation, e.g. stroke, renal failure acute limb infarction.
Week 219 - Haemoptysis: What are the three classifications of PE?
- Massive PE
- Acute minor PE
- Acute thomboembolic PE
Week 219 - Haemoptysis: What are the causes of a massive PE? What is the presentation?
• Acute; Recent surgery/immobility.
- Catastrophic drop in cardiac output, hypotension, cyanosis, tachypnoea, hypoxaemia.
• Sub-acute; progressive occlusion.
- SOB, tachypnoea, hypoxaemia, hypotension.
Week 219 - Haemoptysis: How does an acute minor PE present?
• Often with infarction; SOB, pleuritic pain, haemoptysis, fever.
Week 219 - Haemoptysis: How does a chronic thomboembolic PE present?
• Progressive SOB, pulmonary hypertension, Right sided heart failure.
Week 219 - Haemoptysis: What are the cardinal signs of PE?
• Dyspnoea, Tachypnoea, pleuritic pain.
Week 219 - Haemoptysis: How does the Well’s scoring system for PE work?
- > 6 high probability of PE.
- 2-6 moderate probability of PE.
- <2 low probability of PE.
Week 219 - Haemoptysis: What is the gold standard investigation for PE?
• CT pulmonary angiogram
Week 219 - Haemoptysis: What is the scoring system for predicting patient 30-day outcome with PE?
PESI score
Week 219 - Haemoptysis: What is the immediate management for someone suffering from PE?
- Hi-flow oxygen, IV fluids, analgesia.
- Clexane (whilst Ix)
- Unfractionated Heparin (If PE diagnosed and if rapid action is required).
- Thrombolysis - rTPA, if severe haemodynamic compromise.
Week 219 - Haemoptysis: What is the longer-term management for PE?
- Warfarin - until INR 2-3.
* IVC filter placement (rarely) - for recurrent VTE despite anticoagulation.
Week 219 - Haemoptysis: What are the prophylaxis steps that should be taken to prevent thromboembomolotic disease?
- low dose heparin to all immobile patients.
- Anti-embolus stockings / early mobilisation.
- Women should stop HRT/OCP prior to operations.
- FHx of VTE - investigate for thrombofilia.
Week 219 - Haemoptysis: What are the risk factors/causes of septic emboli? What is the complication of septic emboli?
- I.V. drug users, pelvic thrombphlebitis, infected venous catheter or pacemaker wire.
- Results in multiple lung abscesses.
Week 219 - Haemoptysis: What is the differential diagnosis of a cavitating mass?
- Carcinoma (usually squamous cell).
- Lung abscess.
- Rheumatoid nodule.
- Embolus (septic - usually IV drug user)
- Vasculitis with granulomatosis (wegeners).
- Bronchogenic cyst
- Hydatid cyst
Week 219 - Haemoptysis: What is the pathology behind Vasculitis with granulomatosis?
• Known as ‘Wegener’s triad’
- necrotising granulomatous inflammation of the respiratory tract.
- Focal necrotising glomerulonephritis.
- Systemic vasculitis.
Week 219 - Haemoptysis: What are the symptoms of vasulitis with granulomatosis?
- Chronic ENT symptoms
- Systemic symptoms
- haemoptysis / lung cavities
- Renal failure
- High ESR
Week 219 - Haemoptysis: Aside from ‘miscellaneous’ causes, what are the classifications of pulmonary hypertension?
- Pulmonary arterial hypertension.
- Pulmonary venous hypertension.
- Pulmonary hypertension associated with hypoxemia.
- Pulmonary hypertension due to chronic thomboembolic disease.
Week 219 - Haemoptysis: Which two types of pulmonary hypertension can be referred to the pulmonary arterial hypertension (PAH) service?
- PAH
* Pulmonary hypertension due to chronic thromboembolic disease.
