MEDICAL-SURGICAL 1 LECTURE

MEDICAL-SURGICAL WEEK 3.2 WHAT CAUSES PULMONARY HYPERTENSION?

LOWER RESPIRATORY SYSTEM DISORDERS
(INFECTIONS) AND NURSING MANAGEMENT 3 Causes of Secondary PH
blood clots in the lungs (pulmonary emboli)
PULMONARY HYPERTENSION ✓ chronic obstructive pulmonary disease such as
emphysema
Introduction ✓ Connective tissue disorders, such as scleroderma
In the human body, there are two types of circulation that
✓Upper airway obstructed during sleep
enable distribution of blood throughout the body. The portion
that pumps oxygenated blood from the left side of the heart ✓ obesity with reduced ability to breathe
via the left ventricle to all parts of the body is known as the ✓lung diseases such as pulmonary fibrosis (causes scarring in
systemic circulation. the tissue between the lungs’ air sacs)

On the other hand, the portion that pumps deoxygenated

blood from the right side of the heart via the right ventricle Left-sided heart failure
into the lungs to obtain • heart’s left ventricle weakens and cannot pump out enough
oxygen is referred to as the PULMONARY CIRCULATION. blood
• increase in pressure backs up blood through pulmonary
Millions of people are affected by a condition known as high veins to arteries in lungs
blood pressure (hypertension) whereby the blood travels
through the body’s arteries at a pressure higher than normal. Congenital heart disease

Pulmonary hypertension is a less common type of high blood Pathophysiology of Pulmonary Hypertension
pressure that affects the arteries in the lungs. Pressures in the
lung arteries are normally lower than the pressures in the
systemic circulation. Pulmonary hypertension occurs when
the pressure in the pulmonary circulation becomes
abnormally elevated.

This disease can occur in men, women and children of all

ages. However, it is most common in females between 20 and
40 years old. The condition is rare in children but is
sometimes seen in infants born with heart defects. Pulmonary
hypertension may be a primary or secondary cause of hypoxia
in neonates.

Ordinarily, blood vessels in the lungs provide less resistance

to blood flow than blood vessels in the rest of the body . And
blood pressure is usually much lower in the lungs. While
pressure in general circulation is about 120/80 mm Hg, in the
pulmonary arteries, it is only around 25/15 mm Hg.

Mean (average) pulmonary artery pressure = number between

highest and lowest pressures

Normal at rest : 14 mm Hg
Pulmonary hypertension at rest : 25 mm Hg
during exercise : 30 mm H

TYPES OF PULMONARY HYPERTENSION

Primary Pulmonary Hypertension

▪ no underlying cause for the high blood pressure in lungs
▪ Begin with spasm of the muscle layer in pulmonary arteries
▪ patients are sensitive to substances that cause blood vessels
to constrict
▪ may have an inherited predisposition for the disease

Secondary Pulmonary Hypertension

• results directly from another medical problem
• Chronic Obstructive Pulmonary Disease, scleroderma,
pulmonary fibrosis, lung diseases such as asbestosis in this
diseases flow of blood impedes through the lungs.

TRANSCRIBED BY: ROSANES, JERSEY KHEYT O. SN 1

MEDSURG LEC WEEK 3.2
Pulmonary Angiogram
Used to measure circulation in the lungs and to visualize clots
in the lung on x-rays. The test involves insertion of a thin
catheter into the pulmonary artery through which an iodine
dye is injected.

Image of any blood clots present in the lung can be observed

and circulation of blood through lung’s blood vessels can be
tracked.

Pulmonary Function Tests

Non-invasive tests to measure how much air your lungs can
hold and the airflow in and out of your lungs. They can also
measure the amount of gases exchanged across the membrane
between the lung wall and capillary membrane. During the
tests, the patient will be asked to blow into a spirometer. An
abnormality here may be amongst the first indication of PH.

TREATMENT OF PH
▪fluid restriction
▪ diuretics to decrease fluid accumulation
▪ and rest.
▪ cardiac glycosides (eg, digitalis) in an attempt to improve
cardiac function
▪ calcium channel blockers for vasodilation,
▪Intravenous prostacyclin helps to decrease pulmonary
hypertension by reducing pulmonary vascular resistance and
pressures and increasing cardiac output

▪Anticoagulants such as warfarin have been given to patients

because of chronic pulmonary emboli.

▪Heart— lung transplantation has been successful in select

patients with primary hypertension who have not been
SIGNS AND SYMPTOMS responsive to other therapies
➢ shortness of breath fatigue or light headed upon exertion
➢ dizziness or fainting spells (syncope)
PULMONARY HEART DISEASE – COR
➢ swelling (edema) in ankles, legs and eventually in
PULMONALE
abdomen (ascites) – fluid leak out of veins and into tissues
➢ bluish colour to lips and skin (cyanosis) Cor pulmonale is a Latin word that means "pulmonary heart,"
➢ coughing (sometimes with blood) and wheezing its definition varies, and presently, there is no consensual. Cor
➢ distended neck veins pulmonale is a condition that most commonly arises out of
➢ enlarged liver complications from high blood pressure in the pulmonary
➢ heart palpitations arteries (pulmonary hypertension ). It’s also known as right
➢ Chest pain sided heart failure because it occurs within the right ventricle
of your heart. Cor pulmonale causes the right ventricle to
➢ feel weak – body tissues not receiving
enlarge and pump blood less effectively than it should. The
enough oxygen ventricle is then pushed to its limit and ultimately fails.
DIAGNOSIS OF PH
▪ history of present illnesses DEFINITION
▪ past medical history • It is the hypertrophy of the right ventricle resulting from
▪ Family history diseases affecting the function and/or structure of the lung,
▪ Any past or present medications that the patient may have except when these pulmonary alterations are the result of
taken diseases that primarily affect the left side of the heart or
▪physical examination will also take place. congenital heart disease
Electrocardiogram (ECG) • Cor pulmonale is the enlargement of the right ventricle
ECG is a record of the electrical activity produced by the secondary to diseases of the lung , thorax, or pulmonary
heart. Abnormal rhythms (arrhythmias) may indicate that the circulation. Pulmonary hypertension is usually apre-existing
heart or part of the heart is undergoing unusual stress. condition in the individual with cor pulmonale. The most
common cause is COPD. (lewis)

INCIDENCE

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• The prevalence of COPD in the United States is reported to Normally, air flows smoothly from the mouth and nose into
be about 15 million, Cor pulmonale is estimated to account the lungs at all times. Periods when breathing stops are called
for 6% to 7% percent of all types of adult heart disease in the apnea or apneic episodes
United States.
10. Idiopathic (no specific cause) tightening (constriction)
• Chronic cor pulmonale accounted for 16.6 percent of all of the blood vessels of the lungs If the main pulmonary artery
cardiac cases in a five-year survey in Delhi and the figure was is completely blocked, the right ventricle (the chamber of the
the highest in the world for a non-industrial population. 1 heart that pumps blood into the lungs) cannot get the blood
• Further, the incidence was variable in the 17 Indian states, into the lungs; this “right ventricular failure” then leads to
being high in Northern and Central India and low in the death from PE
South.
11.Sickle Cell Anemia : Sickle cell anemia is an inherited red
blood cell disorder in which there aren't enough healthy red
ETIOLOGY blood cells to carry oxygen throughout your body.
Pulmonary hypertension is the most common cause of cor
pulmonale.

Lung conditions that cause a low blood oxygen level in the

blood over a long time can also lead to cor pulmonale.
Some of these are:

1. Autoimmune diseases that damage the lungs, such as

scleroderma (Build-up of collagen thickens lung tissue and
causes fibrosis or scarring, making the transport of oxygen
into the bloodstream more difficult.)

2. Chronic obstructive pulmonary disease (COPD) : A group

of lungdiseases that block airflow and make it difficult to
breathe.

• Emphysema and chronic bronchitis are the most common

conditions that make up COPD

3.Acute respiratory distress syndrome (ARDS) is a type of

respiratory failure characterized by rapid onset of widespread
inflammation in the lungs.

4. Chronic blood clots in the lungs : A pulmonary embolism

is a blood clot that occurs in the lungs. which obstruct the free
flow of blood through the lungs It can damage part of the lung
and other organs and decrease oxygen levels in the blood.

5. Cystic fibrosis (CF) : Cystic fibrosis affects the cells that

produce mucus, sweat and digestive juices. It causes these
fluids to become thick and sticky. They then plug up tubes,
ducts and passageways.

6. Severe bronchiectasis : A condition in which the lungs'

airways become damaged, making it hard to clear mucus or CLINICAL MANIFESTATION
a persistent cough that usually brings up phlegm (sputum) •Shortness of breath or lightheadedness during activity is
often the first symptom of cor pulmonale.
7. Scarring of the lung tissue (interstitial lung disease): •Palpitation like your heart is pounding.Over time, symptoms
Interstitial lung disease is another term for pulmonary occur with lighter activity or even while you are at rest.
fibrosis, or “scarring” and “inflammation” of the interstitium
(the tissue that surrounds the lung’s air sacs, blood vessels Symptoms are:
and airways). This scarring makes the lung tissue stiff. •Fainting spells during activity
•Chest discomfort, usually in the front of the chest
8. Severe curving of the upper part of the spine •Chest pain
(kyphoscoliosis): Kyphoscoliosis is a thoracic cage deformity • Swelling of the feet or ankles
that causes extrapulmonary restriction of the lungs and gives • Symptoms of lung disorders, such as wheezing or coughing
rise to impairment of pulmonary functions. or phlegm production
• Bluish tinge on skin, nail bed, lips, or gums (cyanosis)
• loud S2 (accentuation of the pulmonary component of the
9. Obstructive sleep apnea It is a condition in which breathing second heart sound) narrow splitting of S2.
stops involuntarily for brief periods of time during sleep.

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•A holosystolic murmur of tricuspid regurgitation at the left ➢ Improving oxygenation and right ventricular (RV)
lower sternal border, right-sided S4 heart sound function by increasing RV contractility and decreasing
•Abdomen: Hepatomegaly, ascites. pulmonary vasoconstriction.
• Chronic Hypoxemia
• Anginal pain -due to right ventricular ischemia MANAGEMENT
• Hemoptysis - due to rupture of a dilated or atherosclerotic ➢ Oxygen therapy relieves hypoxemic pulmonary
pulmonary arteriole. vasoconstriction, which then improves cardiac output, lessens
sympathetic vasoconstriction, alleviates tissue hypoxemia,
DIAGNOSTIC EVALUATION and improves renal perfusion.
• History Collection – Collect history regarding the
➢Diuretics are used to decrease the elevated right ventricular
etiology and signs and symptoms
(RV) filling volume in patients with chronic cor pulmonale.
• Physical Examination - increase in chest diameter,
distended neck veins and cyanosis may be seen , On ➢Anticoagulation and thrombolytic agents for massive
auscultation of the lungs, wheezes and crackles may be heard pulmonary embolism
, On percussion - hyper-resonance of the lungs may be a sign ➢Calcium channel blockers: vasodilate the pulmonary
of underlying COPD. arteries
• Blood Antibody Test – Antinuclear antibody ➢Beta agonists (epoprostenl, iloprost): bronchodilate
(ANA) level for collagen vascular disease, anti-SCL-70
antibodies in scleroderma and Coagulations studies to ➢Pulmonary Vasodilators :
evaluate hypercoagulability states (eg, serum levels of 1. Prostaglandins decrease pulmonary artery pressure and
proteins S and C, antithrombin III, factor V Leyden, increase right ventricular ejection fraction and cardiac output.
anticardiolipin antibodies, homocysteine) to detect chronic 2. Aerosolized prostacyclin causes pulmonary artery
venous thromboembolism vasodilatation and improves cardiac output and arterial
• Arterial Blood Gas Analysis Arterial blood gas oxyhemoglobin saturation in patients with chronic pulmonary
measurements may provide important information about the hypertension.
level of oxygenation and type of acid-base disorder.
• Chest radiograph: Enlargement of the pulmonary
➢Inotropes with vasodilatory properties :
artery and Left ventricle is seen.
1. Dobutamine is an inotropic agent with vasodilatory effect
• Electrocardiogram: Shows features of right
which improves right ventricular function and cardiac output,
ventricular hypertrophy/enlargement
but its effect on systemic blood pressure is unpredictable.
• Doppler Echocardiography It usually demonstrates
signs of chronic right ventricular (RV) pressure overload and
to estimate pulmonary arterial pressure 2. Amrinone lowers pulmonary artery pressure and rises
• Chest CT angiography to rule out pulmonary cardiac output and systemic blood pressure.
thromboembolism ➢Bronchodilators- Theophylline,
• Ventilation/perfusion (V/Q) scanning can be ➢Endothelin receptor antagonist : Bosentan is an endothelin
particularly useful in evaluating patients with cor pulmonale, receptor antagonist that produces pulmonary vasodilation and
especially if pulmonary hypertension is due to chronic attenuates ventricular remodeling and improve survival on
thromboembolic pulmonary hypertension. chronic use.
• Lung Biopsy It may occasionally be indicated to
determine the etiology of underlying lung disease. This is SURGICAL MANAGEMENT
especially true if interstitial lung disease (ILD) is the • Phlebotomy : Phlebotomy is indicated in patients with
suspected etiology for pulmonaryhypertension resulting in chronic cor pulmonale and chronic hypoxia causing severe
cor pulmonale. polycythemia, is the process of making a puncture in a vein,
• Pulmonary Function Test (PFT) and 6-minute usually in the arm, with a cannula for the purpose of drawing
walk test for assessment of the severity of lung disease and blood.
exercise capacity respectivel
• Right heart catheterization - In patients with cor • Uvulopalatopharyngoplasty (UPPP) in selected patients
pulmonale, right heart catheterization reveals evidence of with sleep apnea and hypoventilation may relieve cor
right ventricular (RV) dysfunction without left ventricular pulmonale. It is a surgical procedure or sleep surgery used to
(LV) dysfunction. remove tissue and/or remodel tissue in the throat
• Hemodynamically, this typically presents as a
mean pulmonary artery pressure (PAP) above 25 mmHg, • Pulmonary embolectomy is indicated in patients with acute
which leads to elevated RV systolic pressures and central pulmonary embolism and hemodynamic instability when
venous pressures (CVP). However, these findings are also thrombolytic therapy is contraindicated.
seen in LVdysfunction. One method of differentiating
leftsided from right-sided disease includes measuring the • Lung transplantation or pulmonary transplantation, is a
pulmonary capillary wedge pressure (PCWP), which is an surgical procedure in which a patient's diseased lungs are
estimation of left atrial pressure. Thus, RV dysfunction is also partially or totally replaced by lungs which come from a
defined as having a PCWP below 15 mmHg. donor.

MEDICAL MANAGEMENT
•AIM OF THE MANAGEMENT :
COMPLICATION

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❑Syncope • Fatigue related to decreased cardiac activity and laboured

❑ Hypoxia respirations as evidenced by difficulty in performing
activities of daily living
❑ Pedal edema
• Anxiety related to sign and symptoms , diagnostic measures
❑ Passive hepatic congestion and treatment process as evidenced by patient`s verbalization
❑Death and facial expressions

LIFE STYLE MODIFICATION

• Avoid strenuous activities and heavy lifting.
• Avoid travelling to high altitudes.
• Get a yearly flu vaccine, as well as other vaccines, such as
the pneumonia vaccine.
• If you smoke, stop.
• Limit how much salt you eat. Your provider also may ask
you to limit how much fluid you drink during the day.
• Use oxygen if your provider prescribes it.

HEALTH EDUCATION
• Advice patient to take protein rich diet.
• Educate patient regarding his disease condition.
• Educate patient regarding modification in lifestyle like
cessation of smoking & alcohol consumption.
• Advice patient to reduce spicy & fatty foods.
• Instruct patient to avoid caffeine intake which can increase
pulse rate & produce angina.
• Educate patient to minimize level of activities to prevent
strain.
• Advice patient for regular follow-up & care.

PULMONARY EMBOLISM

refers to the obstruction of the pulmonary artery or one of its

branches by a thrombus (or thrombi) that originates
somewhere in the venous system or in the right side of the
heart

Causes
1.thrombous
2. embolism
3.trauma
4. surgery
5. hypercoaguability
6. heart failure
7. pregnancy ( increase coaguability of BL
NURSING DIAGNOSIS 8. older than 50 years
• Decreased cardiac output related to an ineffective 9. atrial fibrillation
ventricular pump as evidenced by dyspnea at rest and/or
peripheral edema PATHOPHYSIOLOGY
• Impaired gas exchange related to expiratory airflow -When a thrombus completely or partially obstructs a
obstruction as evidenced by decreased oxygen saturation pulmonary artery or its branches,
levels the alveolar dead space is increased. The area, although
• Impaired tissue perfusion related to decreased cardiac continuing to be ventilated, receives little or no blood flow.
contractility and expiratory airflow obstruction as evidenced Thus, gas exchange is impaired or absent in this area.
by increased capillary refilling time >3 seconds -In addition, various substances are released from the clot
• Imbalanced nutrition status less than body requirement and surrounding area, causing regional blood vessels and
related to breathlessness , Wheezing, Haemoptysis as bronchioles to constrict.
evidenced by weight loss This causes an increase in pulmonary vascular resistance.
• Disturbed sleep pattern related to shortness of breath and This reaction compounds (the ventilation–perfusion
sleep apnea as evidenced by presence of dark circles around imbalance.)
the eyes, Redness of eyes and Drowsiness
• Activity intolerance related to decreased cardiac activity and -The hemodynamic consequences are increased pulmonary
laboured respirations as evidenced by difficulty in performing vascular resistance from the regional vasoconstriction and
activities of daily living reduced size of the pulmonary vascular bed.

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This results in an increase in pulmonary arterial pressure
and, in turn, an increase in right ventricular work to maintain Medical Management
pulmonary blood flow. • General measures to improve respiratory and vascular
the work requirements of the right ventricle exceed its status
capacity, • Anticoagulation therapy
right ventricular failure occurs, leading to a decrease in • Thrombolytic therapy
cardiac output followed by a decrease in systemic blood • Surgical intervention
pressure and the development of shock.
GENERAL MANAGEMENT
RISK FACTORS -Oxygen therapy is administered to correct the hypoxemia,
Venous Stasis (slowing of blood flow in veins) relieve the pulmonary vascular vasoconstriction, and reduce
-Prolonged immobilization (especially postoperative) the pulmonary hypertension.
-Prolonged periods of sitting/traveling -Using elastic compression stockings or intermittent
-Varicose veins pneumatic leg compression devices reduces venous stasis.
-Spinal cord injury -These measures compress the superficial veins and
-Hypercoagulability (due to release of tissue increase the vesecosity of blood in the deep veins by
thromboplastin after injury/surgery) redirecting the blood through the deep veins
-Injury -Elevating the leg (above the level of the heart) also
-Tumor (pancreatic, GI,, breast, lung) increases venous flow.
-Increased platelet count (polysalathemia, splenectomy
-Venous Endothelial Disease Anticoagulation Therapy
-Thrombophlebitis -Vascular disease . Anticoagulant therapy (heparin, warfarin sodium)
-Foreign bodies (IV/central venous catheters) has traditionally been the primary method for managing
-Certain Disease States (combination of stasis, coagulation acute deep vein thrombosis and PE
alterations, and venous injury) Heparin is used to prevent recurrence of emboli but has no
-Heart disease (especially heart failure) effect on emboli that are already present.
-Trauma (especially fracture of hip, pelvis, vertebra, lower It is administered as an intravenous bolus of 5,000 to
extremities) 10,000 units, followed by a continuous infusion initiated at a
-Postoperative state/postpartum period dose of 18 U/kg per hour, not to exceed 1,600 U/hour
-Diabetes mellitus
-Chronic obstructive pulmonary disease c o p D Thrombolytic Therapy
-Other Predisposing Conditions -Thrombolytic therapy (urokinase, strepto-kinase,
-Advanced age -Obesity -Pregnancy alteplase, anistreplase, reteplase) also may be used in treating
-Oral contraceptive use -Constrictive clothing PE, particularly in patients who are severely compromised
-History of previous thrombophlebitis, pulmonary (eg, those who are hypotensive and have significant
embolism hypoxemia despite oxygen supplementation).
resolves the thrombi or emboli more quickly
CLINICAL MANIFESTATIONS restores more normal hemodynamic functioning of the
1.Dyspnea is the most frequent symptom; tachyapnea pulmonary circulation, Reducing pulmonary hypertension
(very rapid respiratory rate) is the most frequent sign . The Improving perfusion, oxygenation, and cardiac output
duration and intensity of the dyspnea depend on the extent of
embolization. Chest pain is common and is usually sudden SURGICAL MANAGEMENT
and pleuritic. It may be substernal and misdiagnosed with -Pulmonary embolectomy requires a thoracotomy with
angina pectoris or a myocardial infarction. cardiopulmonary by- pass technique.
-Transvenous catheter embolectomy is a technique in which
- Other symptoms include anxiety, fever, tachycardia, a vacuum-cupped catheter is introduced transvenously into
apprehension, cough, diaphoresis, hemoptysis, and syncope. the affected pulmonary artery. Suction is applied to the end
of the embolus and the embolus is aspirated into the cup.
Assessment and Diagnostic Findings
-The diagnostic workup includes a SARCOIDOSIS
- ventilation–perfusion scan,
-pulmonary angiography, Synonyms
-chest x-ray • Besnier Boeck Disease
-, ECG, • Schaumann's syndrome
-peripheral vascular studies, and arterial blood gas
analysis. Sarc-oid-osis
-Doppler ultrasonography and venography • sarc- flesh,
•- oid - like
Prevention •- osis - diseased or abnormal condition
prevent deep venous thrombosis.
1. active leg exercises DEFINITION
2. The intermittent pneumatic leg compression device • Sarcoidosis is a multisystem non-caseous granulomatous
( reduces venous stasis). disorder of unknown aetiology characterized by depression of
3. use of elastic compression stockings cutaneous delayed type hypersenstivity and heightened Th1
4. anticoagulant therapy immune response in affected organs.

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• Most commonly affecting young adults • Pleural invovlment in 5-10% cases.( effusions and pleural
• Presenting most frequently with bilateral hilar thickening)
lymphadenopathy, pulmonary infiltration and skin or eye • Aspergilloma
lesions. • Bronchiectasis
• Necrotising sarcoid angitis
Etiology • Superior venacaval syndrome
• Unknown • Mediastinal lymph node calcification
• exposure to pine pollen or beryllium • Mediastinal fibrosis
• infection with Mycobacterium, viruses and fungi, • Vanishing lung syndrome(giant bulla)
• protoplast or L form of the tubercle bacillus may be a cause
of sarcoidosis PNEUMOCONIOSIS

Lungs Definitions
• First site involved • The term pneumoconiosis derives its meaning from the
• Begins with alveolitis involving small bronchi and small Greek words: pneuma = air and konis = dust
blood vessels • The International Labour Organization defines
• Alveolitis either clears up spontaneously or leads to pneumoconiosis as “the accumulation of dust in the lungs
granuloma and fibrosis and the tissue reactions to its presence”.
• Around 50% patients asymptomatic. • Not included in the definition of pneumoconiosis are
• Dry cough and dyspnoea conditions such as asthma, chronic obstructive pulmonary
• Chest pain-rare disease (COPD), and hypersensitivity pneumonitis, in which
• Wheezing secondary to endobronchial disease, extrinsic there is no requirement for dust to accumulate in the lungs in
compression by lymphadenopathy or bronchial distrortion the long term.
secondary to fibrosis. • Dust within the size range of 0.5mm to 3 micron, is health
• Productive cough- traction bronchiectasis hazard producing, after a variable period of exposure, a lung
• Hemoptysis- bronchiectasis or aspergilloma disease known as PNEUMOCONIOSIS, which may
gradually cripple a man by reducing his working capacity due
Radiographic features to lung fibrosis and other complications
• Chest radiograph abnormal in 90% of sarcoidosis patients.
• Bilateral hilar lymphadenopathy in 50-85% cases. Pneumoconiosis can be defined as the non-neoplastic reaction
• Lymph nodes big and sharply defined with clear line of of lungs to inhaled minerals or organic dust and the resultant
transluscency between mediastinum and lymph nodes- alteration in their structure excluding asthma, bronchitis and
POTATO NODES. emphysema.– Textbook of Pulmonary Medicine , D Beher
• Unilateral lymphadenopathy- rare
• Pulmonary infiltrates in 25-60% cases

Scadding staging system

• Stage 0: Absence of radiographic abnormalities
• Stage I: Bilateral hilar and/or mediastinal adenopathy
without pulmonary parenchymal abnormalities
• Stage II: Hilar and/or mediastinal lymphadenopathy with
pulmonary parenchymal abnormalities (generally a diffuse
interstitial pattern)
• Stage III: Diffuse parenchymal disease with out nodal
enlargement
• Stage IV: Pulmonary fibrosis with evidence of volume loss,
cystic or honeycomb changes, bullae, emphysema.

Other intrathoracic manifestations

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Types–
- Silicosis– from silica dust
- Asbestosis– from asbestos dust
- Coal workers pneumoconiosis (anthracosis)– from
coal dust
- Byssinosis– from cotton dust
- Bagassosis– from sugarcane dust
- Farmer's lung- from hay dust or molds or other
agricultural products.
- Berylliosis– from beryllium

FIBROSIS

Pulmonary Fibrosis is a chronic lung disease that causes

inflammation, scarring, thickening and stiffening of the
lung’s tissues

Major Pneumoconiosis: Inhalation of some dusts results in

“major fibrosis” of the lungs, which results in interference of
lung architecture or lung function tests.

• Examples are:
– Silica → silicosis
– Asbestos → asbestosis
– Coal →anthracosis

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Minor Pneumoconiosis: Inhalation of some dusts results in
“minor fibrosis” of the lungs. There is minimal fibrosis of the
lungs without interference of lung architecture
or lung function tests.

• These dusts include:

– Micapneumoconiosis
– Koalin (china clay) pneumoconiosis

Benign Pneumoconiosis: There isn't any reaction in the lungs,

but dust deposition casts a shadow in x-ray of the lung. There
is no fibrosis and no disturbance of lung functions.

• Itcan result from the inhalation of:

– Iron dust→ siderosis
– Tin dust→Tannosis
– Calcium dust→ chalcosis
• They are characterized by the presence of small rounded
dense opacities on a chest film due to perivascular collections
of dusts.
• The deposits in the lung disappear when exposure is
discontinued.

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