USMLE Respiratory 9: Restrictive Lung Diseases (Pneumoconiosis, Sarcoidosis and more!) | Jabar Post Indonesia – This time JabarPost.Net will discuss about Mesothelioma.
The following is USMLE Respiratory 9: Restrictive Lung Diseases (Pneumoconiosis, Sarcoidosis and more!). And for those of you who want to find a similar explanation, you can search in the Mesothelioma category
USMLE Respiratory 9: Restrictive Lung Diseases (Pneumoconiosis, Sarcoidosis and more!) | Jabar Post Indonesia
Mesothelioma is a type of cancer that develops from the thin layer of tissue that covers many of the internal organs (known as the mesothelium). The most common area affected is the lining of the lungs and chest wall. Less commonly the lining of the abdomen and rarely the sac surrounding the heart, or the sac surrounding the testis may be affected. Signs and symptoms of mesothelioma may include shortness of breath due to fluid around the lung, a swollen abdomen, chest wall pain, cough, feeling tired, and weight loss. These symptoms typically come on slowly.
More than 80% of mesothelioma cases are caused by exposure to asbestos. The greater the exposure the greater the risk. As of 2013, about 125 million people worldwide have been exposed to asbestos at work. High rates of disease occur in people who mine asbestos, produce products from asbestos, work with asbestos products, live with asbestos workers, or work in buildings containing asbestos. Asbestos exposure and the onset of cancer are generally separated by about 40 years. Washing the clothing of someone who worked with asbestos also increases the risk. Other risk factors include genetics and infection with the simian virus 40. The diagnosis may be suspected based on chest X-ray and CT scan findings, and is confirmed by either examining fluid produced by the cancer or by a tissue biopsy of the cancer.
Prevention centers around reducing exposure to asbestos. Treatment often includes surgery, radiation therapy, and chemotherapy. A procedure known as pleurodesis, which involves using substances such as talc to scar together the pleura, may be used to prevent more fluid from building up around the lungs. Chemotherapy often includes the medications cisplatin and pemetrexed. The percentage of people that survive five years following diagnosis is on average 8% in the United States.
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Done with obstructive lung diseases, let’s talk about restrictive! Certain pathologies limit the lungs ability to expand, restricting it. This decreases compliance and increases elasticity. When the lungs can’t expand, it affects our spirometry and lung volumes. It leads to reduced air volumes, vital capacity and forced vital capacity. This leads to a overall decrease in lung volumes and an increased or elevated FEV1/FVC ratio. This is the hallmark finding of restrictive lung diseases. Now there are many causes – some don’t even affect the lungs directly! For example, restriction of the chest wall (as seen in scoliosis or obesity), or poor breathing mechanics (as seen in polio, myasthenia gravis, and guillain barre), can all lead to the lung not expanding normally. However, we’re interested in lung pathology – mainly fibrosis causing lung stiffening. Causes of fibrosis include:
Acute lung distress/neonatal distress
Acute interstitial pneumonia
Drugs and radiation, like in bleomycin, amiodarone, or methotrexate
Occupational exposures: hypersensitivity pneumonitis or pneumoconiosis: hypersensitivity pneumonitis is a lot like asthma. However it causes fibrosis and granulomas. It has a low CD4:CD8 ratio and is seen in silo filler’s lungs, byssinosis, and farmer’s lungs. Pneuomoconiosis is due to inhalation of dusts that attracts cells and causes fibrosis. We will discuss the different micron size of dust particles and how they affect the lungs. The main ones here are coal, asbestos, silica and beryllium. Importantly, know that asbestos affects the lower lungs and is associated with pleural plaques and effusions, ferruginous bodies and mesothelioma. Silicosis is associated with an increase risk in cancer and TB (tuberculosis).
Idiopathic pulmonary fibrosis: possibly due to an increase in TGF-B. Causes honeycombing of the lungs.
Autoimmune (SLE, rheumatoid arthritis, scleroderma, Good Pastures)
Sarcoidosis: causes non-caseating granulomas and is seen more in black females. Lab findings include increased CD4:8 ratio, elevated calcium and ACE. Microscopic findings include Schaumann bodies and asteroid bodies. Done!
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