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