week 6 ILD

Question 1

define Interstitial lung disease

Answer 1

1. aka pulmonary fibrosis

2.180 diseases of inflammation lung disorders

3.acute or chronic inflammatory inflitration of alveolar walls, cells, fluid,and connective tissue

4.untreated turns to irreversible pulmonary fibrosis

Question 2

alterations of the lung in ILD

Answer 2

1. extensive inflammation
   -pulmonary fibrosis
   -gramulomas
   -honeycombing
   -cavity formation
   -excessive bronchial secretions

Question 3

occupation and environment causes of ILD

Answer 3

inhaling harmful substances over time
1. asbestosis
2.coal dust (black lung)
3.mold hay& sugar cane
4.fungal compost
5.hypersensitive pneumonitis

Question 4

which disease is ILD associated with

Answer 4

1. sarcoidosis
   -enlargement of the lymph glands in chest

Question 5

what are diseases with unique pathology

Answer 5

1. pulmonary alveolar proteinosis (alveoli fill w/protein and lipids)
   -looks like pulmonary edema
   -confirmed through BAL

2.goodpasture syndrome
-pulmonary hemorrhage. & hemoptysis
-increased DLCO

Question 6

physical examination of pt with ILD

Answer 6

1. vital signs
   -tachypnea
   -tachycardia
   -hypertension

2.cyanosis

3.peripheral edema & venous distention
-distended neck vein
-pitting edema
-enlarged & tender liver

4.non productive cough

5.digital clubbing

6. chest findings:
   -Increase tactile & vocal fremutis
   -dull percussion note
   -bronchial breath sounds
   -crackles-fine and coarse
   -pleural friction rub

Question 7

PFT for ILD

Answer 7

restrictive
⬇️ FVC
N or ⬇️: FEVT, FEF 25-75%, FEF 50%, FEF 200-1200, PEFR, MVV
N or ⬆️: FEV1/FVC ratio

2. lung capacities
   ⬇️:IRV,ERV,RV,VC,IC,FRC,
   TLC
   N:RV/TLC ratio
   N or ⬇️: Vt

Question 8

is DLCO increased or decreases in ILD?

Answer 8

all decreased except goodpasture syndrome is increased

Question 9

what are the ABG findings for pt with ILD

Answer 9

1.mild/moderate:
-acute respiratory alkalosis

2. chronic ILD-fibrosis
   -chronic respiratory acidosis

Question 10

for Severe ILD how would the hemodynamics look

Answer 10

most issue in the Rheart and lungs –>cor pulmonale

1.CVP ⬆️, RAP ⬆️, PAP ⬆️, RVSWI ⬆️, PVR ⬆️
2.PCWP: N , CO: N, SV:N, SVI: N, Ci :N, LVSWI:N,
SVR:N

Question 11

what would the hematology look like for a pt with ILD

Answer 11

polycthemia
-due to compensatory response to chronic hypoxemia triggers kidneys
-kidneys release erthropoietin:hormone that stimulates the production of red blood cells

Question 12

how does the chest radiograph look for ILD

Answer 12

1. bilateral reticulonodular pattern
   -fine lines and small nodules through lungs
   2.irregular shaped opacites
   3.gramulomas
   4.cavity formation
   5.honeycombing (hallmark of advance fibrotic)
   6.pleural effusion
   7.pleural thickening

Question 13

which imaging technique can see ILD

Answer 13

computed tomography (CT)
especially high resolution CT

Question 14

what does honeycombing signifiy

Answer 14

-(clusters of cyst like air spaces, located in peripheral and lower region in lungs) irreversible damage and reflects chronic progression

Question 15

what is the pharmacological way to treat ILD

Answer 15

-specific to various disorders
-corticosteroids-reduce inflammation
-immunosuppressive agents (reduce reaction of the immune system) body naturally fibroblast thick collagen bundles but because of chronic inflammation the long gets stiffer

Question 16

what treatment is used for goodpasture syndrome

Answer 16

plasmaphersis-remove harmful antibodies from the blood

Question 17

what treatment is used for pulmonary alveolar proteinosis

Answer 17

Bronchial lavage-bal

Question 18

what are the respiratory protocols for ILD

Answer 18

1. Oxygen therapy
   -highflow nasal very useful
   2.mechanical ventilation