00:01
Extrinsic lung disease
is dealing with,
well, what was the patient
exposed to?
Was it occupation
of different types?
Was it or maybe
helmets and company?
And when we take a look
at everything that this patient
has been exposed to,
extrinsically
then at some point in time
it maybe there was
a disease process
that kicked in for the lung,
resulting on in a
restrictive lung type of issue.
00:28
To begin.
00:30
So under diffuse lung diseases,
where are we?
We're down by the
occupational / inhalation.
00:37
And we'll walk through
many of these categories:
Hypersensitivity,
asbestosis,
silicosis,
coal,
toxic gases.
00:46
In addition,
we'll also take a look at
some of those infections
that become
important to us,
especially the helminthic
Let's first take a look at
occupational lung diseases
and what it means.
00:57
Now, this is a lecture series you
want to pay attention to because
I find...
01:03
with my experience,
that students tend to get
this confused
and end up choosing
the wrong diagnosis because,
well, they're not broadening
their thinking.
01:13
So, first,
my patient got exposed to
some type of occupation,
or in the occupation got exposed to
some type of element.
01:22
Upon exposure to that element,
maybe perhaps the changes that were
taking place in the lung,
pathologically,
are rather benign in nature.
01:31
But then at some point,
guess what happened?
Massively went into fibrosis.
01:37
And as soon as you go into
massive fibrosis,
isn't that kind of like
end stage any disease?
Fibrosis of the liver,
end stage liver disease
Fibrosis of the lung,
honeycomb
right?
So once they get into fibrosis,
maybe maybe
the right side of the heart
starts to failing,
hypertrophy
and perhaps even cor pulmonale.
01:57
All right, so give yourself
a storyline
as to what you can expect
when your patient is then
being exposed
to a various
various antigens
during his or her
time in an occupation.
02:12
May present as
obstructive lung disease,
occupational asthma,
keep that in mind.
02:17
So if there's something as an
environmental allergen
that the patient is
then exposed
do then keep in mind
that this could be
an obstructive type of nature,
asthma, right?
Next, our focus
in this lecture series, however,
will be the theme that we have been
clinging on to the whole time,
which in fact is your
restrictive lung disease,
is that clear?
Now with
restricted lung disease,
you can expect there to be
compromise of that lung.
02:43
And so therefore, the lung become
stiffer non-compliant.
02:45
And so therefore, we'll present
as restrictive.
02:49
Several occupation exposures
that we'll walk through,
include the dust
that you may then
get from silica
or maybe perhaps you are
breathing in
particles of asbestos and such.
03:03
And then we will
take a look at
a very important,
and separate category
known as
hypersensitivity pneumonitis.
03:10
And that gets a little tricky
and extremely,
extremely important
in industrialized nations,
such as the US
from coast to coast,
where the patient
might then be exposed
to various types
of allergens.
03:22
But I'm going to be
very selective and very careful
as to the word allergen here,
because it's really about
the proteins and such
that you are then been
exposed to,
in which as we shall see
in hypersensitivity pneumonitis,
as to how your patients
going to present.
03:39
Some exposure can cause
cancer.
03:42
For example,
if you are dealing with
asbestos,
and at some point in time,
decades down the road,
upon exposure,
let's say that your patient
is working with brake lining,
a mechanic
or maybe your patient is
working with Naval Shipyard,
and so on and so forth.
03:57
And so therefore,
this individual in decades later
may then develop
what's known as bronchogenic.
04:04
bronchogenic
type of cancer.
04:08
Now, at first, with the
occupational lung diseases,
the topic is pneumoconiosis
and with pneumoconiosis,
we'll be focusing upon
four different elements,
depending as to what the occupation
the patient has been,
and exposure to these
common type of particles.
04:28
Keep in mind that if very possible
that two particles might be exposed
at the same time.
04:34
You'll see what I'm referring to.
04:35
So occupation exposure, resulting in
a restricted lung pattern
is what we're sticking with
in this lecture series.
04:42
At some point in time,
could to be asthma like issues,
sure,
but that would be much more...
04:48
A different type of presentation
with asthma.
04:53
All involved will have an
increased risk for cor pulmonale.
04:58
We just talked about that.
05:00
Meaning to say,
that there's
increased deposition of collagen
and fibrosis
ends up kicking in,
then it's the
right side of the heart,
which is now extremely vulnerable
to damage, isn't it?
Welcome to core pulmonale.
05:12
Next, another topic that I had
briefly touched upon,
when we talked about
connective tissue diseases
they may result in changes in the
interstitium that are nonspecific
by nonspecific we mean
patchy infiltration
or patchy infiltration of
inflammatory cells
without the fiberglass,
nonspecific.
05:32
Whereas, if it was
usual interstitial,
then there's quite a bit of fibrosis
and this was in the setting of
rheumatoid arthritis.
05:40
And so therefore, in a patient
rheumatoid arthritis,
with rheumatoid nodules,
and along with that,
your patient has now developed an
occupational type of lung disease.
05:50
You then call this
ladies and gentlemen,
Caplan syndrome.
05:53
C-A-P-L-A-N.
05:55
Not a typo.