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12.11.19 Ward notes

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)
        • Except asbestos
    • Lower zones are better perfused
      • Drugs, autoimmunne
        • Except AnkSpond

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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