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Interstitial Lung Disease

Description

MBBS Medicine CR (Respi) Mind Map on Interstitial Lung Disease, created by Amirul Aiman on 02/04/2018.
Amirul Aiman
Mind Map by Amirul Aiman, updated more than 1 year ago
Amirul Aiman
Created by Amirul Aiman over 6 years ago
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Resource summary

Interstitial Lung Disease
  1. Definition
    1. ILD
      1. Disorders that result in disruption of the distal lung parenchyma
      2. Interstitium
        1. alveolar walls and septae contains the lung connective tissue elements
        2. Fibrosis
          1. extensive alteration of alveolar/airway architecture
            1. aka Lung Scaring
              1. Alveoli is replaced by fibrotic tissue
                1. cause loss of the tissue’s ability to transfer oxygen
            2. Classification
              1. Aetiology
                1. Idiopathic
                  1. IPF
                    1. sarcoidosis
                      1. langerhans cells histiococytosis
                      2. Collagen Vascular
                        1. Scleroderma
                          1. RA
                          2. Drug
                            1. MTX
                              1. Radiation
                              2. Occupational
                                1. Inorganic
                                  1. Asbestosis
                                    1. Silicosis
                                    2. Organic
                                      1. Hypersensitivity Pnemonitis
                                        1. aka Extensive Allergic Alveolitis
                                          1. Antigen
                                            1. Thermophillic Actinomycetes
                                              1. Aspergillus
                                                1. Avian
                                                2. Type III Hypersensitivity
                                                  1. Progress to chronic
                                                    1. Type IV hypersensitivity
                                                      1. IgE
                                                        1. Allergen avoidance
                                                      2. Onset after 6-8 hrs
                                                        1. SnS
                                                          1. Dry Cough
                                                            1. SOB
                                                              1. Fever
                                                                1. Basal Creps
                                                                2. Predictor
                                                                  1. Exposure
                                                                    1. increased after SnS exposure
                                                                    2. recurrent episode
                                                                      1. Crackles
                                                                        1. weight Loss
                                                                  2. Post Infection
                                                                    1. TB
                                                                      1. Upper Lobes
                                                                        1. No ongoing Inflammation
                                                                    2. Radiology
                                                                      1. Upper Lobe
                                                                        1. CHHARTS
                                                                          1. Coalworkers
                                                                            1. Pneumoconiosis
                                                                              1. Caplan's Syndrome
                                                                                1. intrapulmonary nodules on CXR
                                                                                  1. in addition to RA
                                                                              2. Hypersensitivity
                                                                                1. Histiocytosis
                                                                                  1. Ankylosing Spondylitis
                                                                                    1. Radiation
                                                                                      1. Pneumonitis
                                                                                        1. Dose : ~2500 rads
                                                                                          1. 6 mo after RTx
                                                                                            1. responsive to steroids
                                                                                          2. Tuberculosis
                                                                                            1. Silicosis
                                                                                          3. Lower Lobe
                                                                                            1. RAIDS
                                                                                              1. Rheumatoid Arthritis
                                                                                                1. Pulmonary Nodules
                                                                                                  1. Pleuritis
                                                                                                    1. Pleural Effusion
                                                                                                    2. Asbestosis
                                                                                                      1. IPF
                                                                                                        1. Drugs
                                                                                                          1. MTX
                                                                                                            1. NItrofurantoin
                                                                                                              1. Amiodarone
                                                                                                                1. Prolonged O2
                                                                                                                2. Scleroderma
                                                                                                            2. Histology
                                                                                                              1. more cellular the picture, the more treatment responsive
                                                                                                                1. UIP (Usual)
                                                                                                                  1. NSIP (non specific)
                                                                                                                    1. DIS (Desquamative)
                                                                                                                      1. RD-ILD (Respiratory Bronchitis)
                                                                                                                        1. LIP (Lymphocytic)
                                                                                                                          1. AIP (Acute)
                                                                                                                            1. BOOP (Bronchiolitis Obliterans Organizing Pneumo)
                                                                                                                          2. Investigation
                                                                                                                            1. Radiology
                                                                                                                              1. CXR
                                                                                                                                1. Bilat shadowing/infiltrates
                                                                                                                                  1. Patchy/Nodular
                                                                                                                                    1. Starts Peripheral
                                                                                                                                    2. HRes CT Thorax
                                                                                                                                      1. Gold standard
                                                                                                                                        1. Pattern
                                                                                                                                          1. IPF
                                                                                                                                            1. Subpleural
                                                                                                                                              1. Lower Lobe
                                                                                                                                              2. Peripheral
                                                                                                                                                1. Asbestosis
                                                                                                                                                  1. COP
                                                                                                                                                  2. Central
                                                                                                                                                    1. Brocnhovascular thickening
                                                                                                                                                2. Reticular opacities
                                                                                                                                                  1. Honeycomb cyst
                                                                                                                                                    1. Traction bronchiectasis
                                                                                                                                                  2. PFT
                                                                                                                                                    1. Spirometry
                                                                                                                                                      1. Low FEV1
                                                                                                                                                        1. Low FVC
                                                                                                                                                          1. FEV1/FVC >80%
                                                                                                                                                          2. Diffusion Lung Capacity
                                                                                                                                                            1. Reduced
                                                                                                                                                              1. Ddx
                                                                                                                                                                1. Anemia
                                                                                                                                                                  1. Emphysema
                                                                                                                                                                2. Lung Volume
                                                                                                                                                                  1. TLC reduced
                                                                                                                                                                3. Bloods
                                                                                                                                                                  1. FBC
                                                                                                                                                                    1. UNE
                                                                                                                                                                      1. LFT
                                                                                                                                                                        1. Inc Ca2+
                                                                                                                                                                          1. Rheumatoid Factor
                                                                                                                                                                            1. dsDNA
                                                                                                                                                                              1. anti-scl70
                                                                                                                                                                                1. anti-GBM
                                                                                                                                                                                2. Functional Assess
                                                                                                                                                                                  1. ABG
                                                                                                                                                                                    1. type 1 resp fail
                                                                                                                                                                                    2. 6 min walk
                                                                                                                                                                                      1. +-Echo
                                                                                                                                                                                        1. exertional desaturaion
                                                                                                                                                                                      2. Bronchoscopy
                                                                                                                                                                                        1. EBUS-TPNA
                                                                                                                                                                                          1. ENDOBRONCHIAL ULTRASOUND-GUIDED TRANSBRONCHIAL NEEDLE ASPIRATE
                                                                                                                                                                                            1. for sarcoidosis
                                                                                                                                                                                          2. Bx
                                                                                                                                                                                            1. VATS
                                                                                                                                                                                              1. only atypical progressive
                                                                                                                                                                                          3. Signs
                                                                                                                                                                                            1. Pulmonary
                                                                                                                                                                                              1. PFT
                                                                                                                                                                                                1. Chest
                                                                                                                                                                                                  1. Rapid Shallow Breathing
                                                                                                                                                                                                    1. Central Cyanosis
                                                                                                                                                                                                      1. Tracheal Deviation
                                                                                                                                                                                                        1. Reduced chest expansion
                                                                                                                                                                                                          1. Ascultation
                                                                                                                                                                                                            1. FIne end crepitation
                                                                                                                                                                                                              1. crackle (velcro)
                                                                                                                                                                                                              2. Tactile Fremitus
                                                                                                                                                                                                                1. Increased
                                                                                                                                                                                                                  1. Normal
                                                                                                                                                                                                                  2. Percussion
                                                                                                                                                                                                                2. Extra Pulmonary
                                                                                                                                                                                                                  1. Hands
                                                                                                                                                                                                                    1. Clubbing
                                                                                                                                                                                                                      1. Slerodactaly
                                                                                                                                                                                                                        1. Raynaud's Phenomena
                                                                                                                                                                                                                          1. Onycholysis
                                                                                                                                                                                                                          2. Head and Neck
                                                                                                                                                                                                                            1. Butterfly Rash
                                                                                                                                                                                                                              1. Lupus Perino
                                                                                                                                                                                                                                1. Keratoconjuctivits
                                                                                                                                                                                                                                  1. Uveitis (red eye)
                                                                                                                                                                                                                                  2. Others
                                                                                                                                                                                                                                    1. Erythema Nodosum
                                                                                                                                                                                                                                      1. `Myopathy
                                                                                                                                                                                                                                        1. Radiation therapy marks
                                                                                                                                                                                                                                    2. History Taking
                                                                                                                                                                                                                                      1. PC
                                                                                                                                                                                                                                        1. Progressive Exertional Dyspnoea
                                                                                                                                                                                                                                          1. 6 to 12 months
                                                                                                                                                                                                                                          2. Cough
                                                                                                                                                                                                                                            1. not productive
                                                                                                                                                                                                                                            2. NO wheeze
                                                                                                                                                                                                                                              1. Impressive radiological with no SOB
                                                                                                                                                                                                                                                1. Musculoskeletal Pian
                                                                                                                                                                                                                                                  1. Photosensitivity
                                                                                                                                                                                                                                                    1. Pleuritis
                                                                                                                                                                                                                                                      1. Scleroderma Symptoms
                                                                                                                                                                                                                                                        1. tightening of skin @ hands
                                                                                                                                                                                                                                                          1. Raynaud's phenomenon
                                                                                                                                                                                                                                                            1. Precede long before lung symptoms
                                                                                                                                                                                                                                                          2. Px
                                                                                                                                                                                                                                                            1. Age
                                                                                                                                                                                                                                                              1. IPF >60
                                                                                                                                                                                                                                                                1. Sarcoidosis 20-40
                                                                                                                                                                                                                                                                2. Smoking
                                                                                                                                                                                                                                                                  1. IPF
                                                                                                                                                                                                                                                                    1. RB-ILD
                                                                                                                                                                                                                                                                      1. Reversible with cessation
                                                                                                                                                                                                                                                                    2. Gender
                                                                                                                                                                                                                                                                      1. Women > Men
                                                                                                                                                                                                                                                                      2. Duration
                                                                                                                                                                                                                                                                        1. Acute/Subacute misDx as pnuemo
                                                                                                                                                                                                                                                                        2. Meds
                                                                                                                                                                                                                                                                          1. OTC meds
                                                                                                                                                                                                                                                                            1. Protein Supplements
                                                                                                                                                                                                                                                                            2. Occupation
                                                                                                                                                                                                                                                                              1. Duration
                                                                                                                                                                                                                                                                                1. extent
                                                                                                                                                                                                                                                                                  1. Latency
                                                                                                                                                                                                                                                                                  2. Organic (HP)
                                                                                                                                                                                                                                                                                    1. Hay farming
                                                                                                                                                                                                                                                                                      1. Mushroom
                                                                                                                                                                                                                                                                                        1. Pigeon Fancier
                                                                                                                                                                                                                                                                                        2. Inorganic
                                                                                                                                                                                                                                                                                          1. Coal/Sandblasting?
                                                                                                                                                                                                                                                                                            1. Silica
                                                                                                                                                                                                                                                                                              1. Asbestos
                                                                                                                                                                                                                                                                                      2. IPF
                                                                                                                                                                                                                                                                                        1. Signs
                                                                                                                                                                                                                                                                                          1. Clubbing
                                                                                                                                                                                                                                                                                            1. Crepitation
                                                                                                                                                                                                                                                                                              1. Pathogenesis
                                                                                                                                                                                                                                                                                                1. Basement membrane changes
                                                                                                                                                                                                                                                                                                  1. Oxidative stress
                                                                                                                                                                                                                                                                                                    1. Procoagulant activity
                                                                                                                                                                                                                                                                                                      1. Vascular Remodelling
                                                                                                                                                                                                                                                                                                    2. Symptoms
                                                                                                                                                                                                                                                                                                      1. >60 y/o
                                                                                                                                                                                                                                                                                                        1. male > woman
                                                                                                                                                                                                                                                                                                          1. exertional SOB
                                                                                                                                                                                                                                                                                                          2. Treatment
                                                                                                                                                                                                                                                                                                            1. Poor prognosis
                                                                                                                                                                                                                                                                                                              1. NO effective Tx
                                                                                                                                                                                                                                                                                                                1. Steroid
                                                                                                                                                                                                                                                                                                                  1. on suspicion of NSIP
                                                                                                                                                                                                                                                                                                                    1. NO EFFECT
                                                                                                                                                                                                                                                                                                                    2. Lung transplant <65y/o
                                                                                                                                                                                                                                                                                                                      1. Palliative care
                                                                                                                                                                                                                                                                                                                    3. Sarcoidosis
                                                                                                                                                                                                                                                                                                                      1. Signs
                                                                                                                                                                                                                                                                                                                        1. BHL+ Erythema Nodosum
                                                                                                                                                                                                                                                                                                                          1. Good Prognosis
                                                                                                                                                                                                                                                                                                                            1. Lofgren's syndrome
                                                                                                                                                                                                                                                                                                                            2. Bi-hilar adenopathy
                                                                                                                                                                                                                                                                                                                              1. Hypercalcemia
                                                                                                                                                                                                                                                                                                                                1. Uveitis
                                                                                                                                                                                                                                                                                                                                  1. Keratoconjuctivitis
                                                                                                                                                                                                                                                                                                                                    1. Lupus Pernio
                                                                                                                                                                                                                                                                                                                                      1. Hepatic Granuloma
                                                                                                                                                                                                                                                                                                                                        1. Multi Organ
                                                                                                                                                                                                                                                                                                                                        2. Symptoms
                                                                                                                                                                                                                                                                                                                                          1. Fever
                                                                                                                                                                                                                                                                                                                                            1. Fatigue
                                                                                                                                                                                                                                                                                                                                              1. Weight Loss
                                                                                                                                                                                                                                                                                                                                              2. Treatment
                                                                                                                                                                                                                                                                                                                                                1. Steroid Responsive
                                                                                                                                                                                                                                                                                                                                                  1. WHO?
                                                                                                                                                                                                                                                                                                                                                    1. Hypercalcemia
                                                                                                                                                                                                                                                                                                                                                      1. Critical Organs
                                                                                                                                                                                                                                                                                                                                                        1. Cardiac
                                                                                                                                                                                                                                                                                                                                                          1. Neuroligical
                                                                                                                                                                                                                                                                                                                                                            1. Occular
                                                                                                                                                                                                                                                                                                                                                          2. 20-40mg/day Prednisone
                                                                                                                                                                                                                                                                                                                                                            1. Taper to low or QOD
                                                                                                                                                                                                                                                                                                                                                              1. 9 to 12 mo
                                                                                                                                                                                                                                                                                                                                                                1. if CNS / Cardiac
                                                                                                                                                                                                                                                                                                                                                                  1. Higher dose
                                                                                                                                                                                                                                                                                                                                                                  2. Relapse?
                                                                                                                                                                                                                                                                                                                                                                    1. MTX
                                                                                                                                                                                                                                                                                                                                                                      1. Adalinumab
                                                                                                                                                                                                                                                                                                                                                                        1. Plaquenil
                                                                                                                                                                                                                                                                                                                                                                    2. Investigation
                                                                                                                                                                                                                                                                                                                                                                      1. Hx/Exam
                                                                                                                                                                                                                                                                                                                                                                        1. CXR
                                                                                                                                                                                                                                                                                                                                                                          1. PFT
                                                                                                                                                                                                                                                                                                                                                                            1. Urinary Ca2+
                                                                                                                                                                                                                                                                                                                                                                              1. Tuberculin test
                                                                                                                                                                                                                                                                                                                                                                                1. HIstology
                                                                                                                                                                                                                                                                                                                                                                                  1. Non caseating granuloma
                                                                                                                                                                                                                                                                                                                                                                                2. Systemic Granulomatous Disease
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