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Flashcards in Restrictive Thoracic Disease Deck (42)
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1

What are causes of thoracic restriction outwith the lungs?

* Skeletal: vertebrae (e.g. kyphoscoliosis), ankylosing spondylitis, ribs (e.g. multiple rib fracture)
* Muscle weakness: intercostal or diaphragmatic (due to myopathy, neuropathy, myelopathy) e.g. Myasthenia Gravis, Guillian Barre, Motor Neurone Disease, Poliomyelitis
* Abdominal obesity/ascites - compression of diaphragm into thoracic cage, cannot contract and descend as effectively

2

What is myopathy?

Disease of the muscle

3

What is neuropathy?

Disease of the nerves

4

What is myelopathy?

Disease of the spinal cord

5

What are examples of diseases that cause muscle weakness?

* Myaesthenia Gravis
* Guillan Barre
* Motor neurone disease
* Poliomyelitis

6

What is ascites?

Build up of fluid in abdominal cavity

7

What does thoracic restriction result in?

* Chronic alveolar hypoventilation with decreased PaO2 (hypoxia) and increased PaCO2 (hypercapnia)
* Reduced lung volumes

8

What are the causes of thoracic restriction originating from within the lungs?

* Acute DPLD (interstitial lung disease)
* Episodic DPLD
* Chronic DPLD due to occupational or environmental agents/drugs
* Chronic DLPD with evidence of systemic disease
* Chronic DLPD with no evidence of systemic disease

9

What is DPLD?

Interstitial lung disease

10

What is lung interstition?

Area between alveoli

11

What is restrictive thoracic disease?

Occurs due to disease within the lungs

12

What are examples of diseases that cause thoracic restriction?

* Disease of alveolar structures (walls/lumen) e.g. DPLD
* Pathophysiology - impaired exchange of O2, but not CO2

13

What does Alveolar-Arteriolar barrier determine?

How effectively oxygen is transferred across alveolar epithelium into red blood cells where it binds to haemoglobin

14

Why is CO2 exchange unimpaired due to pathophysiology?

* Alveolar ventilation is normal
* CO2 is very soluble and blown off (normal PaCO2)

15

What are causes of DPLD?

* Fluid in the alveolar air spaces
* Consolidation of alveolar air spaces
* Inflammatory infiltrate of alveolar walls (i.e. alveolitis)
* Drug-induced alveolitis
* Toxic gas/fumes
* Pulmonary fibrosis
* Autoimmune (multi-system)
* Dust-disease (pneumoconiosis)
* Carcinomatosis
* Eosinophilic allergic response

16

What is ARDS?

Adult respiratory distress syndrome (shock lung) caused by leaky pulmonary capillaries

17

What are causes of consolidation of alveolar air spaces?

* Infective pneumonia (most common cause)
* Pulmonary infarction (pulmonary emboli)
* BOOP (bronchiolitis obliterans organising pneumonia)

18

What causes fluid to build up in alveolar air spaces?

* Cardiac Po oedema (in alveolar walls and lumen) due to raised Po venous pressure e.g. due to left ventricular failure
* Non cardiac Po oedema - normal Po venous pressure with leaky Po capillaries due to sepsis or trauma

19

What causes BOOP?

* Rheumatoid disease
* Drugs
* Cryptogenic (unknown cause)

20

What are the 2 causes of granulomatous alveolitis?

* Extrinsic allergic alveolitis
* Sarcoidosis

21

What is extrinsic allergic alveolitis?

Hypersensitivity type 3 reaction due to extrinsic antigen (not allergen as not mediated by IgE)

22

What are examples extrinsic allergic alveolitis?

* Farmer's lung
* Avian

23

What inflammation is caused by extrinsic allergic alveolitis and sarcoidosis?

No eosinophilic inflammation - gives lymphocytic inflammation, causing formation of granulomas

24

What is sarcoidosis?

A disease that results in granulomatic lymphocytic inflammation

25

What is the cause of sarcoidosis?

No known cause

26

What drugs can induce alveolitis?

* Amiodarone
* Bleomycin, Methotrexate
* Gold

27

What toxic gas can cause DPLD?

Chlorine

28

What are examples of autoimmune diseases that cause DPLD?

* Systemic lupus erythematosus (SLE)
* Polyarteritis
* Wegeners
* Churg-Strauss
* Bechet's

29

What is pneumoconiosis?

Dust-disease - usually associated with fibrosis

30

What are the 2 types of pneumoconiosis?

* Fibrogenic
* Non-fibrogenic