Causes of fibrosis
- Upper zone
- B - Beryllium
- R - Radiation
- E - Extrinsic allergic alveolitis
- A - Ankylosing spondylitis / Aspergillus
- S - Silicosis
- T - TB
- S - Sarcoidosis
- Lower zone
- C - Cyptogenic fibrosing alveolitis AKA Idiopathic Pulmonary Fibrosis
- A - Asbestosis
- R - Rheumatoid arthritis
- D - Drugs (AMEN: Amiodarone, Methotrexate, Ergot-derivatives, Nitrofurantoin)
- S - Systemic sclerosis
- Logic
- Upper zones are better aerated
- Inhaled stuff (EAA, Silicosis)
- Lower zones are better perfused
Fibrosis - symptoms
- Dry cough
- Dyspnoea (progressive)
- Digital clubbing
- Diffuse inspiratory crackles
Causes of clubbing - C - Cyanotic heart diseasse/Cystic Fibrosis
- L - Lymphoma
- U - Ulcerative colitis
- B - Bronchiectasis
- B - Bronchogenic malignancy
- I - Idiopathic pulmonary fibrosis
- N - Neoplasms
- G - Granulomatous diseases
Respiratory causes of clubbing - A - Abcess (lung)
- B - Bronchiectasis (including CF)
- C - Cancer (lung)
- D - Decreased oxygen (hypoxia)
- E - Empyaema
- F - Fibrosing alveolitis
Endocrine paraneoplastic phenomena - Cushing syndrome
- SIADH
- Hypercalcaemia
- Hypoglycaemia
- Carcinoid syndrome
- Polycythemia
- Hyperaldosteronism
Foster-Kennedy Syndrome - Constellation of findings associated with tumours of the frontal lobe
- Due to optic nerve compression, olfactory nerve compression, and increased ICP secondary to a mass
- Usually an olfactory groove meningioma
- Symptoms:
- Optic atrophy in the ipsilateral eye
- Papilledema in the contralateral eye
- Central scotoma in the ipsilateral eye
- Anosmia ipsilaterally
Emphysema subtypes - Panacinar
- Entire respiratory lobule, from respiratory bronchiole to alveoli, has expanded
- Occurs more commonly in the lower lobes (especially basal segments) and in the anterior margins of the lungs
- Centriacinar
- Respiratory bronchiole (proximal and central part of the acinus) has expanded
- Distal acinus or alveoli are unchanged
- Occurs more commonly in the upper lobes
- Paraseptal
- Involves the alveolar ducts and sacs at the lung periphery
- Emphysematous areas are subpleural in location and often surrounded by interlobular septa
- Bullous
- Defined as being at least 1 cm in diameter, and with a wall less than 1mm thick
- Bullae are thought to arise by air trapping in emphysematous spaces, causing local expansion
FET - Forced expiratory time
- Good final test to do if you suspect an obstructive lung condition
- Careful though if there's a coexisting restrictive problem
Oxygen therapy guidelines in COPD - Indications for assessment:
- Very severe airflow obstruction - forced expiratory volume in one second (FEV1) less than 30% predicted.
- Cyanosis
- Polycythaemia
- Peripheral oedema
- Raised jugular venous pressure
- Oxygen saturation 92% or below when breathing air
- Consider assessment for people with severe airflow obstruction (FEV1 30-49% predicted)
- Assessment:
- Measure ABGs on two occasions at least 3 weeks apart
- Criteria:
- PaO2 less than 7.3 kPa when stable
- Greater than 7.3 and less than 8 kPa when stable and with one of:
- Secondary polycythaemia
- Peripheral oedema
- Nocturnal hypoxaemia
- Pulmonary hypertension
- Use:
- People receiving LTOT should breathe supplemental oxygen for at least 15 hours a day
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