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Interstital Lung Disease


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What can interstital lung disease lead to
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Leads to temporary or permanent changes in the interstitial tissues (development of fibrosis tissue) Interfere gas exchange Change mechanics of breathing Stiff lungs - The development of fibrous tissue in the interstitium, makes lungs less compliant, to produce a 'restrictive' ventilatory defect

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What can interstital lung disease lead to
Leads to temporary or permanent changes in the interstitial tissues (development of fibrosis tissue) Interfere gas exchange Change mechanics of breathing Stiff lungs - The development of fibrous tissue in the interstitium, makes lungs less compliant, to produce a 'restrictive' ventilatory defect
What is a interstitum
The 'interstitial space' is a potential space between alveolar cells and the capillary basement membrane, which is only apparent in disease states, when it may contain fibrous tissue, cells or fluid Structures between the alveoli and capillaries
What are some investigations which can be used
Chest X-ray Lung Function Test In difficult cases, surgical lung biopsy might be necessary
What would you find on examination of patient with interstital lung disease
Cyanosis Tachycardia Tachypnea Finger Clubbing ( important in Pulmonary Fibrosis ) Fine end inspiratory crackles Signs of right heart failure such as peripheral oedema
What is the presentation of interstital lung disease
Progressive breathlessness with reduced exercise tolerance Dry cough Extra-pulmonary symptoms --> Fever, joint pain and lethargy etc.
What are the easy to remember inorganic inhaled dust
Asbestos Silicates Carbon ( Coal dust )
What is the pathophysiology of asbestos
Asbestos fibres breathed in and lodge in distal air spaces ( less than 7mm ) Scavenged by macrophages This can lead to pleural plaques, benign pleural effusion and diffuse pleuritic thickening It can also be cardiogenic causing mesothelioma and broncho-carcinoma
What is Fibrosing Alveolitis
Progressive inflammatory condition in which the cause in unknown --> idiopathic Pathogenesis is also unclear but histologically there is high number of macrophages hence could be an infection or pollutant WBC cause damage to the alveoli by releasing proteases which leads to tissue destruction and fibrosis Finger clubbing is present in this disease
What is an Extrinsic Allergic Alveolitis
Term used for a number of conditions in which the inhalation of an organic material triggeres a diffuse allergic reaction in the walls of alveoli and bronchioles E.g. Farmers Lung due to exposure to an antigen from Thermophillic Actinomyocyetes
How can you differentiate between Extrinsic Allergic Alveolitis and Fibrosing Alveolitis
There is no finger clubbing in Extrinsic Allergic Alveolitis
What is hypersensitivity Pneumonitis
Caused by inhalation of variety of organic or inorganic antigens trigger a complex immune response Alveolar walls thickened and infiltrated with immune cells Lymphocytes and occasionally eosinophils
What is the difference between acute and chronic form of hypersenstivity pneumonitis
Acute form : Produces dry cough and breathlessness on exertion CXR findings – micro-nodularity denser towards the hilar Chronic form : Long-term exposure to antigens over months or years malaise (feeling persistently unwell) dry cough and breathlessness CXR findings → normal but may progress to pulmonary fibrosis affecting upper zones
What are some investigations for HP
Lung biopsy --> if everything is not working Bronchoalveolar levage which has evidence of lymphocytosis ( greater than 20% is diagnostic )
What can be used to distinguish between Sarcoidosis and TB/lymphoma
Characteristics features is the presence of non-caseating granuloma on a biopsy Used to distinguish between TB and lymphoma
What might you see in investigations of sarcoidosis
Obstructive or restrictive patterns in lung functioning tests ACE serum level raised Hypercalcaemia
What are Idiopathic Interstitial Lung Disease
Inflammation of interstitial tissues of unknown cause
Pathophysiology of IPF
Cause is unknown Progressive inflammatory condition of the lung Histologically there is evidence of increased numbers of activated alveolar macrophages Activated macrophages attract neutrophils and eosinophils which produce local lung damage by generation of reactive oxidant species and proteases. This results in tissue destruction and fibrosis
What are the different causes of pleural effusion
Excess fluid in pleural space Hydrostatic pressure increases in capillaries – Heart failure Permeability of capillaries increases – Inflammation, malignancy Oncotic pressure decreases - hypoproteinaemia
What is the meaning of Empyema and Chylothorax
Empyema --> Pus Chylothorax --> Chyle
What are the causes of transudate and exudate pleural fluid
Transudate → cardiac failure, liver failure, renal failure Exudate → Cancer, infection or connective tissue disease
What are pleural plaques
Benign areas of thickening → post asbestos exposure Usually asymptomatic patients
What are some congenital chest wall diseases
Pectus carinatum is a protrusion deformity of the anterior chest wall ( pigeon chest ) Pectus excavatum (funnel chest ) is a deformity of the chest wall characterized by a sternal depression Scoliosis → abnormal lateral curvature of the spine Kyphosis → Abnormal excessive forward curvature of the spine