00:00
Let's going through a second type
is a Berylliosis.
00:03
Who is your patient here?
Well, in that modern era,
we have a patient
that might be working in
well, high tech industries.
00:11
So electronic
manufacturing industries
Berylliosis when NASA was
a big deal in the US,
and aerospace and all that
was a big deal,
Well, berylliosis was something that
maybe perhaps patient was developing
berylliosis.
00:27
This is our second example
of a pneumoconiosis
and all pneumoconiosis
come under the category of
restrictive lung disease.
00:36
That's where we are.
00:37
I'm going to do this
every single time.
00:39
So if aerospace, ceramic,
we have electronic
manufacturing industries,
that's huge nowadays.
00:45
Now, here,
please highlight in your mind
that this is the upper lobe
that's involved.
00:52
What about the roofer?
The roofer asbestos,
lower lobe,
Berylliosis, upper lobe.
01:00
Next, look at this.
01:02
It's a granulomatous
type of histology,
with occasional responsive
glucocorticiods
very similar to whom?
There you go,
sarcoidosis.
01:12
So, you tell me, sarcoidosis,
who's your the patient most likely?
A young African American
female.
01:20
There is going to be
bilora lymphadenopathy
that non-case
any type of granuloma,
non-case any granuloma
that you would find,
and sarcoid could be
in other organs.
01:28
What are they?
Maybe the skin, maybe the liver,
maybe the intestine, and so forth.
01:32
Right?
And sarcoid maybe there is
increased production of ACE
and might be increased production
of when I call 1-alpha-hydroxylase
those things are not present here.
01:43
And on the shin,
on the front of the leg,
and patient with sarcoid,
what are you going to find?
Ough!
The patient is going to be
a little bit of pain. Why?
And you take a look at it.
It looks red.
01:55
And its erythema nodosum.
01:58
Erythema nodosum.
01:59
You don't find that here either.
02:01
You see how easy it is
for you to differentiate
one from the other?
You just need to spend time with the
differentials, and you'll be good.
02:08
Who is the patient berylliosis?
Oh, occupational hazard.
02:11
There you go.
02:13
Hilar lymphadenopathy.
02:15
Well, that once again,
it's non-specific.
02:16
It's once again similar to sarcoid.
02:19
You stick to those facts here
that you see
that is going to differentiate
one from the other
Second type of pneumoconiosis.
02:28
Berylliosis is what that is.
02:30
Let's go into a third type.
02:32
Our third type is coal worker.
Be very careful.
02:35
Do not get your coal worker confused
with your asbestos.
02:38
Is that clear?
And the fourth type,
we'll take a look at silica.
02:40
so what I would recommend
that you do is every so often,
knockout maybe one or two
every time you come and see me, Hmm.
02:47
So you're knockout
"Oh, I get my asbestos
completely down."
Okay, great.
02:51
Who is my exposure?
Well, maybe environmental,
or non-environmental.
02:54
Okay, fine.
02:55
You got those occupations.
02:57
You got the ferruginous body
and the fibers done.
02:59
You're good to go.
03:00
Maybe take a look at berylliosis,
real quick.
03:01
Ah, stop, pause,
take a break,
maybe go back and
study something else.
03:06
Do some questions.
03:07
And then come back, and take a
look at coal worker, and move on.
03:10
There's going to be four major ones.
03:11
And coal worker, obviously
this patient is working in a mine.
03:15
In a mine that then get exposed to
anthracotic particles,
Right, carbon particles.
03:21
So black lung disease,
literally what it is?
What color is coal?
Have you seen coal?
It's black.
03:27
So that black carbon
is what you're breathing in.
03:30
So therefore, you call this
whats known as sooty air,
right?
So when you're burning coal,
it's rather sooty.
03:37
Can we say, quote unquote
take a look at the statement here,
"Black lung disease, what we call it
due to exposure to anthracotic."
Well, whatever particle
that you then get into your lung,
I guess it was going to come in
and have a feast,
the macrophages, correct.
03:52
And so therefore, for example, if
our hemosiderin-laden macrophages,
that's not what this is.
This is carbon.
03:59
So this is carbon-laden macrophages.
04:01
So use common sense
in terms of well,
if the phagocytic cells
are appearing,
what does it actually trying to
eliminate here?
It's the carbon.
04:10
Urban areas with city air,
upper lobe involvement.
04:14
Ah, once again,
let me ask you,
Asbestos, where was it?
The roofer?
The bottom portion of the lobe,
right?
The basal portion is upper.
04:25
Then asymptomatic.
04:26
Now, this is huge.
04:28
That statement,
don't just run through this.
04:31
Asymptomatic, really?
I have a patient
black lung disease
and I'm finding
anthracotic particles
and Dr. Raj, you're telling me
this asymptomatic?
That's exactly
what I'm telling you. Hmm.
04:42
So what point are you
worried about this patient
going to severe disease and
resulting perhaps potentially
in right sided heart failure?
Oh, it's called
progressive massive fibrosis.
04:55
Isn't that kind of take you back
to the good old days
when you are referring to
restrictive lung disease, right?
So you go back to your comfort zone?
Well, you know, fibrosis to you
means automatically non-compliance,
a very stiff lung, and therefore
we have restrictive lung disease.
05:12
This is where things become
really dangerous for the patient.
05:15
But if you find that you're lung
to be black,
and there is it fibrosis
and we are no evidence of it.
05:20
It's asymptomatic.
05:22
But you tell the patient,
"Please be careful.
05:24
You might want to start thinking
about changing your job?"
And this is what's going to happen.
05:29
Because how old are these patients
that you should go into mines?
If I was an 18 year old boy.
05:35
And there was a company
that came to me and said,
"Hey, little boy,
I'll give you $80,000 per year,
if you want to come in
and work in a mine."
Oh, that sounds mighty tempting.
05:48
Sure it does.
05:49
So therefore, don't you feel
a little invincible?
Perhaps.
05:53
So meaning to say, that you want to
understand who your patient is,
and how they might resist
and they might even say in
the office.
05:59
"Yes, Doc. Yes, Doc. I'm going to
change my job. I change my job."
Two years have gone by,
More black lung disease,
more fibrosis.
06:08
See what I'm saying?
And once again,
what if they're smoking?
If they're smoking then you get into
all kinds of other issues as well.
06:15
And that occurs more common
than you would think.
06:18
Continue.