Asbestosis - Santa Monica College

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  • 1.Asbestosis A Case study By Erica Ducker
  • 2.What is Asbestos? Consists of naturally occurring silicate minerals. In the 19th Century, it was increasingly mined and used because of its ability to absorb sound, its high tensile strength, resistance to fire, heat, electrical damage, and affordability.
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  • 6.Asbestosis Asbestosis is defined as a type of pneumoconiosis caused by the inhalation of asbestos fibers. In the 1920’s, scientists first recognized the link between asbestos and pulmonary fibrosis. In the 1960’s, firmly established link between asbestos and both bronchogenic carcinoma and malignant mesothelioma. Current strict regulation of asbestos has significantly decreased risk of developing asbestosis.
  • 7.Asbestosis Causes no symptoms in the early stages. Progressive cough, shortness of breath, weakness, fatigue develop over time. Clinical asbestosis is decreasing in frequency but asbestos-related lung cancer deaths are becoming more common.
  • 8.Healthy Lung Tissue
  • 9.Asbestos in Lung Tissue
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  • 12.The Patient 69 year old man. Retired construction contractor of 45 years. Primarily installed insulation materials in high-rise apartment and office buildings. Been retired for 4 years and began experiencing respiratory symptoms approximately 6 months ago.
  • 13.Medical History Appendectomy at age 13 Osteoarthritis in left knee (high school football injury) x 30 years Status post-cholecystectomy, 16 years ago Benign prostatic hyperplasia, transurethral resection 7 years ago Hypertension x 7 years Hyperlipidemia x 4 years Gastroesophageal reflux disease x 4 years
  • 14.Family History Paternal history of coronary heart disease. Father died age 63 from “heart problems.” Material history of cerebrovascular disease. Mother died at age 73 after a series of strokes. Brother died in boating accident at age 17. No other siblings.
  • 15.Social History Married with 3 grown children, aged 40, 45, and 49 Smokes 1 pack per day x 45 years Rarely exercises History of heavy alcohol use Volunteers at community food pantry No history of intravenous drug use Known to unreliable in keeping follow up appointments, doesn’t like doctors
  • 16.Review of Systems Denies rash, nausea, vomiting, diarrhea, and constipation Denies headache, chest pain, bleeding episodes, dizziness, and tinnitus Denies loss of appetite and weight loss Reports minor visual changes recently corrected with stronger prescription bifocal glasses. Complains of generalized joint pain, especially left knee pain Never been diagnosed with chronic obstructive pulmonary disease or any other pulmonary disorder Denies paresthesias and muscle weakness Negative for urinary frequency, dysuria, nocturia, hematuria, and erectile dysfunction
  • 17.Medications Acetaminophen 325 mg 2 tabs po Q 6H PRN Ramipril 5 mg po BID Atenolol 25 mg po QD Pravastatin 20 mg po QD Famotidine 20 mg po Q HS
  • 18.General Pleasant but nervous, elderly white gentleman Appears pale but is in no apparent distress Looks his stated age Strong Italian accent Appears to be slightly overweight
  • 19.Vital Signs Blood pressure (sitting, both arms) = average 131/75 mm Hg Pulse = 69 beats per minute Respiratory rate = 29 breaths per minute and slightly labored Temperature = 98.6 °F Pulse oximetry = 95% on room air Height 5’9” Weight = 179 lb
  • 20.Skin Pallor noted No lesions or rashes Warm and dry with satisfactory turgor Nail beds are pale
  • 21.Head, Eyes, Ears, Nose, and Throat Extra-ocular muscles intact Pupils equal at 3mm with normal response to light Funduscopy within normal limits (no hemorrhages or exudates) No strabismus, nystagmus, or conjunctivitis Sclera anicteric Tympanic membranes within normal limits bilaterally Nare patent No sinus tenderness Oral pharyngeal mucosa clear Mucous membranes moist but pale Good dentition
  • 22.Neck and Lymph Nodes Neck supple Negative for jugular venous distension and carotid bruits No lymphadenopathy or thyromegaly
  • 23.Chest and Lungs Breathing labored with tachypnea Prominent end-inspiratory crackles in the posterior and lower lateral regions bilaterally Subnormal chest expansion Mild wheezing present
  • 24.Heart Regular rate and rhythm Normal S1 and S2 Negative S3 and S4 No murmurs or rubs noted
  • 25.Abdomen Soft, non-tender to pressure, and non-distended Normal bowel sounds No masses of bruits No hepatomegaly or splenomegaly
  • 26.Genitalia and Rectum Normal male genitalia, testes descended, circumcised Prostate normal in size and without nodules No masses of discharge Negative for hernia Normal anal sphincter tone Guaiac-negative stool
  • 27.Musculoskeletal and Extremities No clubbing, cyanosis, or edema Muscle strength 5/5 throughout Peripheral pulses 2+ throughout Decreased range of motion, left knee No inguinal or axillary lymphadenopathy
  • 28.Neurological Alert and oriented x 3 Cranial nerves II-XII intact Sensory and proprioception intact Normal gait Deep tendon reflexes 2+ bilaterally
  • 29.Laboratory Blood Test Results Na………………………..142 meq/L K…………………………..4.9 meq/L Cl………………………....105 meq/L HCO3…………………… ...22 meq/L BUN………………………..12 mg/dL Cr………………………….0.9 mg/dL Glu, fasting………………..97 mg/dL Ca………………………….9.1 mg/dL Hb…………………………..15.9 g/dL Hct……………………………….41% WBC………………….9,200/mm^3 plt…………………..430,000/mm^3 pH……………………………...7.35 PaO2…………………….83 mm Hg PaCO2…………………..47 mm Hg
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  • 31.Pulmonary Function Tests (Spirometry) Vital capacity, 3200 cc Inspiratory reserve volume, 1700 cc Expiratory reserve volume, 1000 cc Tidal volume, 500 cc Total lung capacity, 4500 cc
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  • 33.Chest X-Ray Posterior anterior radiograph showed coarse linear opacities at the base of each lung, more prominent on the left. Cardiac borders and diaphragm obscured. Consistent with findings of asbestosis cases.
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  • 35.High-Resolution CT Scan Thickened septal lines and small, rounded, subpleural, intralobular opacities in the lower lung zone bilaterally- suggests fibrosis. Ground-glass appearance involving air spaces in the upper lung zone bilaterally suggests alveolitis. Small, calcified diaphragmatic pleural plaques and mild “honeycomb” changes with cystic spaces less than 1 cm were seen bilaterally and are consistent with asbestosis.
  • 36.Discussion of Treatment No cure for asbestosis. Treatments are all supportive. Management of disease by prevention of further injury or inhalation of asbestos. Cease smoking highly recommended. Prompt attention to possible respiratory infections. Supplemental oxygen given if patient is hypoxemic. Other supportive treatments to remove secretions from the lungs. Patient is monitored for development of lung and pleural cancers. Hospice care is given if disease progresses to terminal phase.
  • 37.Conclusion Exposure to asbestos can cause lung cancer, pleural cancer, and pulmonary fibrosis. Complications of pulmonary fibrosis include pulmonary hypertension, heart failure, and progressive respiratory insufficiency. Both the severity of the disease and prognosis are directly related to the history of exposure to asbestos fibers. Patients that develop lung cancer have a very poor prognosis.
  • 38.Questions?
  • 39.Thank you for your attention.