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15 Cards in this Set
- Front
- Back
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What is asbestos? |
Silicate mineral fiber previously used in insulation - peaked in 1980s, - there is a long latency period between exposure and disease developemtn (15-35 years) - At risk in construction, shipbuilding and mining industry |
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What is the pathophysiology of asbestosis lung disease? |
Deposits at level of airway bifrucations and alevoli - lung may clear shorter fibers, but others go into interstitum and lymphatics to the pleura -> alvelolitis in short term exposure --> macrophage and fibroblast production in irreversible chronic fibrosis |
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What are the types of asbestosis disease? |
Pleural plaques - smooth white raised irregular lesios on the parietal pleura - Pleural fibrosis: visceroparietal pleural reaction, can be localized or diffuse, can lead to symptomatic restrictive disease - Rounded ATX: mass like lesion that includes bronchi and vessels - asymptoamtic but can lead to respiratory impariment if large enoguh - Pleural effusion: eosinophils, exudative, bloody - Much higher risk of lung cancer; |
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What is silicosis? |
Related to exposure to silica dust, the most common form of which is quartz, - exposes workes that process silica containing rock or sand - upper load predominant small rounded noles --> can progressive and confluent to massive fibrosis - INhaled bronchodiolators, abx, O2, no reversal agent - Quit smoking, quit job lung transpolant - increased risk of TB and CTD |
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When will a pleural effusion show up on radiography? |
PA films - when 200cc are there Lateral films - 50cc |
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When is pleural fluid bloody? |
Malignancy PE with infarction Trauma Asbestos Post cardiac injury |
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What is the albumin gradiet of pleural fluids? |
If lights criteria is equivocal, can use albumin gradient: if serum albumin to pleural fluid albumin is > 1.2, likely transudative |
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What is the pathophys of low glucose in pleural fluid? |
Increased utilization w/in the pleural space (bacteria, malignant cells) or decreased transplort into the pleural space (rheumatoid pleursiy) and a concentration < 60 Can also be lupus, tb and esophageal rupture - These are also associated with pH < 7.3 - If pH < 7.2 -- place drain, |
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How is pleural fluid amylase relevant? TG? |
>1 indicates pancreatic disease, esophageal rupture or malignant effusions TG level > 110 - chylothroax, < 50 exlcudes the diagnosis - Intermediate level: 50 -110 shoudl be investigated w/ lipoprotein analysis looking for chlomicrons |
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How is tb diagnosed? |
TB pleuritis - lymphocyte predominant - AFB smear and cx very specific, but have a low sensitivity 5-20% ADA - enzyme present in lymphocytes that is elevated in most tb pleural effusions (sensitivity 95%) |
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How is malignancy diagnosed from pleural fluid? |
Sensitivity 60%, sending more than 2 samples yield is very low - higher yeiled w/ adenocarcinoma than mesothelioma and lymphoma - If this fails, THOROSCOPY - has diagnostic sensitivity of > 90% |
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What is empiric coverage of an empyema?
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Anaerobic coverage - 36-72% of empyemas have cultured anaerobic species |
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How are empyemas treated?
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Pleural drain - smaller 10-14 are fine Intrapleural fibrinolytics - when used alone have limited benefit, when combined w/ mucolytic agent (deoxyribonuclease) results in greater decrease in size of effusion and lower ate of surgical referral If refractory --> surgical referral |
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What are the RFs for primary spontaneous PTX?
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- Also w/ cystic lung diseases |
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How are spontaneous PTX treated?
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- Advise againist air travel - Avoid diving |
