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PNEUMOPATII

INTERSTIIALE
NEGRANULOMATOASE
PNEUMOPATI INTERSTIIALE
DE CAUZA CUNOSCUT DE CAUZA NECUNOSCUT
FORME
GRANULOM
Pneumoniile de
hipersensibilit
Berilioza


Sarcoidoza
Histiocitoza X
Vasculite granulomatoase
Granulomatoza bronhocentric
Granulomat limfomatoid
FORME
NE
GRANULOM.
.Asbestoza
Medicamente
Iradierea
Fum,gaze

Fibroza pulmonar idiopatic
Pneumonia idiopatic interstitial
Afect pulm in bolile de es conj
Proteinoza alveolar
Amiloidoza
Sindr hemoragipare pulmon

PNEUMONIA IDIOPATIC
INTERSTIIAL
Grup de boli difuze parenchimatoase
De cauza necunoscut
Fibroz
Inflamatie
Distrugerea arhitecturii pulmonare
PNEUMONIA IDIOPATIC
INTERSTITIAL
Dispnee i tuse/scd cap de efort-
progresive
Fara cauz- obstr/alte fibroze
Radiografie cu infiltrate/desen reticulat
CT
Gazometrie modific
fumat
PNEUMONIA IDIOPATIC INTERSTIIAL
tipuri de pneumonie interst idiopatic
1 FIBROZA PULMONAR IDIOPATIC-tipul clasic
2 PNEUMONIA INTERSTIIAL NESPECIFIC
3 PNEUMONIA CRIPTOGENIC-BOOP
4 PNEUMONIA DESCUAMATIV-broniolita asoc
bolii interst pulmon
5

PNEUMONIA INTERSTIIAL ACUT-sindr
Hamman-Rich

6 PNEUMONIA LIMFOID
PNEUMONIA IDIOPATIC
INTERSTITIAL
Aduli,B,F
Factori de risc
-fumatul
-infectii virale
-imunodepresia
Ex clinic/anamnez
-normal
-dispnee progresiv la efort/
-dispnee sever relativ brusc instal
-tuse seac
-raluri-crepitaii bazale
-febr
-hipocratism
-semne ale insuficienei resp pna la detres resp
-semne ale cordului pulmonar
PNEUMONIA IDIOPATIC
INTERSTITIAL
Investigaii
Radiografia pulmonara/CT cu rez inalt
-opaciti bazale bilaterale
-desen reticulat
-broniectazii de traciune
-asp de fagure
-asp de geam mat
-asp de consolidare pneumonic
-opaciti bilaterale migrat



FIBROZA
PULMONAR
IDIOPATIC
PN INTERST NESP
PN CRIPT-BOOP
BOOP
BOOP
Consolidri cronice
PNEUMONIA INTERSTIIAL ACUT
-sindr Hamman-Rich

FIBROZ PULMONAR IDIOPATIC
Geam mat+fibroz+br-ectazii
Geam mat+fibroza/ingroarea septala
PNEUMONIA IDIOPATIC
INTERSTITIAL
Spirometria
Gazele sangv
DLCO
Investigaii biochimice
Biopsia transbronic/transtoracic


PNEUMONIA IDIOPATIC
INTERSTITIAL
Anatomopatologie
-inflamaie min/moderat
-depozite de colagen
-ngroarea pereilor alveolari
-focare de proliferare fibroblastic
-es de granulaie n alveole i bronhiole
-macrofage intraalveolare
-descuamarea es epit bronic de ctre mcf
-fibroz masiv,acut,mb hialine
-infiltrat limfocitar interst

PNEUMONIA IDIOPATIC
INTERSTITIAL
Evoluie,prognostic
-rasp diferit la tratam n fc de asp anatomopat
- de la detres resp la evol lent spre CP si IR

Tratament
-Prednison 0,5-1mg/kc
+Ciclofosfamid 2mg/kc /
+Azatioprin 2mg/kc
-tratamentul/ profilaxia infeciilor
-transplant pulmonar unic
n studiu
-pirfenidone-inhib sinteza de colagen
-Ifn -1b
AFECTAREA PULMONARA
IN BOLILE DE COLAGEN
LUPUS ERITEMATOS SISTEMIC
ARTRITA REUMATOID
SCLEROZA SISTEMIC
POLIMIOZITA/DERMATOMIOZIT

LUPUS ERITEMATOS SISTEMIC
Afectiune sistemica autoimuna care afecteaz F
tinere cu evoluie progresiv
Pleurit-revrsat pleural
Pneumonite lupice
BOOP
Alveolit hemoragic
Afectarea mm resp
Afectarea cilor resp sup
Hipertensiune pulmonar
Boal trombembolic
Pneumonii bacteriene

LUPUS
Modificarile fct pulmon sunt frecv in lupus-80%
Chiar si in absenta simpt/rx
Scd DLCO
Scd volumelor pulmonare
Modific gazelor sangv-hipoxemie
Insoesc afectarea renal

LUPUS
Revarsat lich
-cel mai frecv
-75%,B,mic,unilateral
Afectarea interstitial
-fibroz/inflamatie/infiltrate + Ac antiADNdc
Pneumonita
-debut brusc febra+tuse+IR
-infiltrat mononuclear+fibroz+alveolit+vasculit
sindr plmnului mic in lupus
-Volum pulm scazut
-Diafragme ascens
-Atelect bazale
-Afect muscular/dfg
HTP+CP


SINDR PLMNULUI MIC IN LUPUS
ARTRITA REUMATOID
Afectare pleural
Pneumonita interstitial
Noduli pulmonari
Afectarea cilor resp
Boala vasc pulmonar
Afectarea pulmonar det de mdc


ARTRITA REUMATOID
Afectarea pleural
-cea mai frecv
-mai ales la B
-insoit de noduli reumatoizi
-toracenteza
Pneumonita interstitial
-tuse+dispnee+crepitatii+DLCO+hipoxie+FR
Mdc-metotrexat/sruri de aur/infliximab-tbc
Noduli pulmonari reumatoizi
-frecv,B
-asoc cu exacerb articular
-necroz fibrinoid+celule epit gigante in palisad
-se pot rupe in pleur
-sindr Caplan-noduli reumatoizi+artrite simetrice la p cu pneumoconioz
Caile aeriene
-afect cilor resp mici/BOOP/Broniolit obliterativ


PROTEINOZA ALVEOLAR
PROTEINOZA ALVEOLAR
Rar
Depunerea unui material eo in alveole i ci aeriene
Defect genetic/ctigat al catabolismului
surfactantului-mcf rspunz/ac anti surfactant
Tuse+expect+dispnee progresiv
Rx-infiltrate nodulare perihilare asemnt cu EPA
-asp miliar
-multinodular
-geam mat
Bronhoscopie-lich lptos+corpi eo cu gran pas-
pozitiv
Complic-infeciile
Tratam-lavaj+de susinere+corticoterap
AFECTAREA PULMONAR
DETERMINAT DE MEDICAMENTE
Tuse-IEC
Bronhospasm-BETABLOC
Dureri toracice-METOTREXAT
BOOP-SARURI DE AUR,PENICILAMIN
Pneumonii interstitiale-AMIODARONA,
NITROFURANTOIN,CHINIOTERAPIA ex
BLEOMICINA
Hemoragii alveolare-PENICILAMINA,
ANTICOAGULAREA
Granuloame-FLUOXETIN,TALC
HTP-AMFETAMINE,FENFLURAMINA,COCAIN




SARCOIDOZA
HISTIOCITOZA X