RESTRICTIVE THORACIC DISEASE Thoracic Restriction due to causes out with the lungs • Skeletal :Vertebrae-eg Thoracic kyphoscoliosis , Ribs –eg Traumatic multiple rib #s • Muscle Weakness - Intercostal or Diaphragmatic (due to Myopathy/Neuropathy/Myelopathy) –eg Myaesthenia Gravis ,Guillan Barre, Motor neurone disease ,Poliomyelitis • Abdominal Obesity/Ascites –compression of thoracic contents • Results in Chronic alveolar under ventilation with low PaO2 ( ( SaO2) and raised PaCO2 and reduced lung volumes
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RESTRICTIVE THORACIC DISEASE Thoracic Restriction due to causes out with the lungs Skeletal :Vertebrae-eg Thoracic kyphoscoliosis, Ribs – eg Traumatic.
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RESTRICTIVE THORACIC DISEASE
Thoracic Restriction due to causes out with the lungs
• Disease of alveolar structuresDisease of alveolar structures- alveolar walls/lumen ( lung interstitium )- alveolar walls/lumen ( lung interstitium )
• PathophysiologyPathophysiology impaired alveolar gas exchangeimpaired alveolar gas exchange- alveolar barrier to O- alveolar barrier to O22 exchange exchange
(ie Alveolar-Arteriolar barrier )(ie Alveolar-Arteriolar barrier )- CO- CO22 exchange unimpaired as alveolar ventilation exchange unimpaired as alveolar ventilation
normal (CO2 v soluble and blown off )normal (CO2 v soluble and blown off ): : PaOPaO22 ( ( SaO2) normal PaCOnormal PaCO22
Aetiology of ILD
• Fluid in the alveolar air spaces
• Cardiac Po oedema (in alv walls and lumen) due to raised Po venous pressure –ie LVF
• Non Cardiac Po oedema –Normal Po venous pressure with leaky Po capillaries -due to sepsis or trauma (Shock lung or ARDS)-due to Altitude sickness
AETIOLGY OF ILDAETIOLGY OF ILD
Consolidation of alveolar air spaces:Consolidation of alveolar air spaces:•• Infective pneumonia Infective pneumonia - viral, bacterial, fungal, protozoal - viral, bacterial, fungal, protozoal•• Infarction Infarction - pulmonary emboli/vasculitis - pulmonary emboli/vasculitis •• Other causes (ie BOOP)Other causes (ie BOOP) - rheumatoid disease - rheumatoid disease- drugs- drugs- cryptogenic- cryptogenic
• Breathless on exertionBreathless on exertion• No cough or wheezeNo cough or wheeze• Lung crackles (inspiratory)Lung crackles (inspiratory)• Finger clubbingFinger clubbing• Central cyanosis (if hypoxaemic)Central cyanosis (if hypoxaemic)
Pulmonary fibrosis(honeycomb lung)Pulmonary fibrosis(honeycomb lung)End stage response to any inflammatory processEnd stage response to any inflammatory process
DIAGNOSIS OF ILD #1DIAGNOSIS OF ILD #1• History-eg occupation,drugs,pets,arthritisHistory-eg occupation,drugs,pets,arthritis
• Reduced lung volumesReduced lung volumes: : FEVFEV11 FVCFVC11 normal ratio > 75% normal ratio > 75%
: Peak flow normal: Peak flow normal
• Reduced gas diffusion (TLCO)Reduced gas diffusion (TLCO)