Diferencia entre revisiones de «Interstitial lung disease»

Revisión del 23:52 25 ene 2019

Background

General group of diseases that involve the scarring of lung parenchyma
Grouped together because of similar clinical, physiologic, radiographic, or pathologic findings
Specific diseases separated into ones with known causes and idiopathic
Treatment and prognosis differs between specific diseases
Examples of specific diseases:
- Interstitial pneumonia
- Hypersensitivity pneumonitis
- Cryptogenic organizing pneumonia
- Acute interstitial pneumonitis
- Sarcoidosis
- Idiopathic pulmonary fibrosis

Clinical Features

Symptoms
- Progressive exertional dyspnea
- Persistent, nonproductive cough
+/- hemoptysis, pleuritic chest pain
May have history of smoking, occupational exposures (asbestosis, silicosis, grain dust, bird droppings), medications that can cause pulmonary damage, connective tissue disease, IBD
Physical exam
- Usually nonspecific
- Increased work of breathing, hypoxia
- +/- Abnormal lung sounds (classically fine, "velcro-like" crackles)

Differential Diagnosis

Pulmonary Fibrosis

Interstitial pneumonias (acute, lymphocytic)
Lung malignancy
Aspiration pneumonia or pneumonitis
Bacterial, viral, or fungal pneumonia
Cryptogenic organizing pneumonia
Interstitial lung disease associated with collagen vascular disease
Drug-induced pulmonary toxicity (amiodarone, bleomycin, amphotericin B, carbamazepine, etc.)
Eosinophilic granuloma (Histiocytosis X)
Radiation pneumonitis
Sarcoidosis
Pneumoconiosis (Workplace exposure)
- Asbestosis
- Berylliosis
- Chemical worker's lung
- Coal worker's pneumoconiosis
- Silicosis

Acute dyspnea

Emergent

Pulmonary
- Airway obstruction
- Anaphylaxis
- Angioedema
- Aspiration
- Asthma
- Cor pulmonale
- Inhalation exposure
- Noncardiogenic pulmonary edema
- Pneumonia
- Pneumocystis Pneumonia (PCP)
- Pulmonary embolism
- Pulmonary hypertension
- Tension pneumothorax
- Idiopathic pulmonary fibrosis acute exacerbation
- Cystic fibrosis exacerbation
Cardiac
Other Associated with Normal/↑ Respiratory Effort
- Abdominal distension
- Anemia
- CO Poisoning
- Salicylate toxicity
- Diabetic ketoacidosis (DKA)
- Diaphragm injury
- Electrolyte abnormalities
- Epiglottitis
- Flail chest
- Hypotension
- Metabolic acidosis
- Pneumonia
- Pneumothorax/hemothorax
- Renal Failure
- Sepsis
- Toxic ingestion
Other Associated with ↓ Respiratory Effort

Non-Emergent

Evaluation

Definitive diagnosis of ILD rarely made in the ED
ED workup should focus on assessing for reversible pathologies that may be causing or exacerbating symptoms (e.g. infection, PE, pulmonary hypertension, pulmonary edema, concomitant COPD exacerbation, etc.)
- VBG/ABG
- CBC, BMP
- CXR
- Consider CT chest (to rule out PE or better characterize lung parenchyma)
- +/- Infectious workup, echo as appropriate
Inpatient/outpatient workup may include serologic studies (ANA, rheumatoid factor), PFTs, BAL, lung biopsy

Management

Treat underlying/exacerbating factors (e.g. antimicrobials for infection, optimize volume/hemodynamics for pulmonary hypertension patients, bronchodilators for concomitant obstructive lung disease)
Support oxygenation and ventilation
Specific disease treatments vary, but many respond to steroids, sometimes at high doses
- See management section of idiopathic pulmonary fibrosis

Disposition

Low threshold to admit

References

Authors:

@@ Línea 1: / Línea 1: @@
 ==Background==
-* General group of diseases that involve the lung parenchyma
+* General group of diseases that involve the scarring of lung parenchyma
 * Grouped together because of similar clinical, physiologic, radiographic, or pathologic findings
 * Specific diseases separated into ones with known causes and idiopathic
 * Treatment and prognosis differs between specific diseases
-* Examples of specific diseases: interstitial pneumonia, hypersensitivity pneumonitis, cryptogenic organizing pneumonia, acute interstitial pneumonitis, sarcoidosis, idiopathic pulmonary fibrosis
+* Examples of specific diseases:
+**Interstitial pneumonia
+**Hypersensitivity pneumonitis
+**Cryptogenic organizing pneumonia
+**Acute interstitial pneumonitis
+**[[Sarcoidosis]]
+**[[Idiopathic pulmonary fibrosis]]
 ==Clinical Features==
-* Symptoms: progressive exertional dyspnea, persistent nonproductive cough, hemoptysis, pleuritic chest pain
+* Symptoms
-* History of occupational exposure: asbestosis, silicosis
+**Progressive exertional [[dyspnea]]
-* Abnormal chest imaging or pulmonary function tests
+**Persistent, nonproductive [[cough]]
-* Take detailed history making sure to focus on past medical history (connective tissue disease, inflammatory bowel disease, malignancy), smoking history, family history, medications, occupational and environmental exposures
+*+/- [[hemoptysis]], pleuritic [[chest pain]]
-* Physical exam is generally nonspecific
+* May have history of smoking, occupational exposures (asbestosis, silicosis, grain dust, bird droppings), medications that can cause pulmonary damage, connective tissue disease, IBD
+*Physical exam
+**Usually nonspecific
+**Increased work of breathing, [[hypoxia]]
+**+/- Abnormal lung sounds (classically fine, "velcro-like" crackles)
 ==Differential Diagnosis==
-* Pneumonia
-* Asbestosis
+{{Pulmonary fibrosis differential}}
-* Berylliosis
-* Pulmonary edema
-* Coal worker's pneumoconiosis
-* Cryptogenic organizing pneumonia
-* Drug induced pulmonary toxicity
-* Farmer's lung
-* Hypersensitivity pneumonitis
-* Interstitial pulmonary fibrosis
-* Collagen-vascular disease
-* Lung malignancy
-* Restrictive lung disease
-* Sarcoidosis
-* Silicosis
 {{SOB DDX}}
 ==Evaluation==
-''Work up and test results differ between types of interstitial lung diseases. Below are common studies obtained to determine disease. See page for specific disease for specific labs/imaging and findings. ''
+*Definitive diagnosis of ILD rarely made in the ED
-* CBC/CMP
+*ED workup should focus on assessing for reversible pathologies that may be causing or exacerbating symptoms (e.g. infection, [[PE]], [[pulmonary hypertension]], [[pulmonary edema]], concomitant [[COPD]] exacerbation, etc.)
-* Serologic studies: ANA, Rheumatoid factor
+**VBG/ABG
-* Imaging: Chest x-ray, chest CT
+**CBC, BMP
-* Pulmonary function tests
+**[[CXR]]
-* Cardiac ECHO
+**Consider CT chest (to rule out PE or better characterize lung parenchyma)
-* Bronchoalveolar lavage
+**+/- Infectious workup, echo as appropriate
-* Lung biopsy
+*Inpatient/outpatient workup may include serologic studies (ANA, rheumatoid factor), PFTs, BAL, lung biopsy
 ==Management==
-* Management differs between specific types of interstitial lung diseases. This is why it is important to determine specific cause of disease. See specific disease page for management.
+*Treat underlying/exacerbating factors (e.g. antimicrobials for infection, optimize volume/hemodynamics for pulmonary hypertension patients, bronchodilators for concomitant obstructive lung disease)
+*Support [[oxygen therapy|oxygenation]] and [[ventilation]]
+*Specific disease treatments vary, but many respond to [[steroids]], sometimes at high doses
+**See management section of [[idiopathic pulmonary fibrosis]]
 ==Disposition==
-* Depending on how stable the patient is, patient can be admitted for work up or discharged for outpatient work up.
+* Low threshold to admit
-* Important to determine acute vs chronic symptoms.
 ==See Also==
 * [[Sarcoidosis ]]
-* Idiopathic pulmonary fibrosis
+* [[Idiopathic pulmonary fibrosis]]
+* [[Pneumoconiosis]]
+* [[Hypoxia]]
+* [[Dyspnea]]
 ==References==