by Carlo Raj, MD

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    00:01 Our fourth and final type of pneumoconiosis.

    00:04 This is silica, or silicosis.

    00:07 So under silicosis, you're paying attention to letter S S S.

    00:11 What occupation is this? Oh, that miner.

    00:15 And that miner got exposed to grinding stone.

    00:20 Okay, you're grinding that stone what happens? You are breathing in breathing in, breathing in, breathing in that silica.

    00:25 And you end up bringing this in. And then what are you looking for? Exposure to mining and sand blasting.

    00:31 S, cement processing.

    00:35 And oftentimes, when you're in a mine, and you're working with, let's say coal, aren't you grinding through stone? And you might be then breathing in, what anthracotic again? Oh, yeah, that's cool.

    00:49 What's that asbestos? Oh, yeah, maybe I was working with, you know, stone when I was building a house.

    00:56 And so therefore, I got exposed to silica and asbestos at the same time.

    01:01 You see what I'm getting at.

    01:02 So, to be careful please. Be careful.

    01:06 Now, the macrophages are going to respond here.

    01:08 This is not going to be carbon-laden.

    01:10 If it's strictly silica that you're breathing in.

    01:13 And the silica here is obviously going to attract your phagocytic cells.

    01:18 Once again, here the macrophages are going to consume whom or attempt to.

    01:23 Good.

    01:24 In your mind, take a look and pay attention to crystalline.

    01:28 Alright, so you are now the macrophage of crystalline, silica and dioxide, and the silica, and here, it will singh fibrogenic factors, Did fibrogenic mean to you? Oh, yeah, restricted lung disease, The silica may disrupt the formation of it's very important that you pay attention here secondary lysosome.

    01:46 Why? Why is that important? Because clinically speaking, these patients that have been exposed to silica, they have an increased susceptibility to TB.

    01:57 You see that.

    01:58 So the one thing that you want to take out of this for sure, clinically, because if, how would you know this? Well understand, it's the fact that we see patients that have TB and they've had a history of silica over, and over, and over again.

    02:12 So therefore, there's been tons of research, and trying to figure out, well what does this silica do? The best theory that you want to know at this point is you're literally from immunology, knocking out the secondary lysosome.

    02:23 So I can't finish my job of what? Destroying the antigen.

    02:27 Clear? Lysosome, phagosome. Thats your phagolysosome aka secondary lysosme.

    02:33 Silicotic nodules.

    02:34 Here, once again, were upper.

    02:37 So of all the pneumoconiosis, which was the only one that was affecting the base of lobe? Asbestos.

    02:43 All the others? Upper, upper, upper.

    02:45 Or they coal workers pneumoconiosis anthracotic.

    02:49 Next one was berylliosis.

    02:51 And here we have silica.

    02:53 Here, be careful here.

    02:56 The calcification that you find quote unquote, is referred to as being "egg-shell." The ivory white was dealing with asbestos, and yet pleural plaques, which is pathognomonic for asbestos.

    03:08 But both silica and asbestos had calcification.

    03:12 So you'd be careful.

    03:13 Both are going to be described as being white, this buzzword of egg-shell, or ivory white, Probably not going to be found, but they'll call it calcification.

    03:23 Or use no two of these as involving them.

    03:28 Let's take a look at the x-ray of silicosis once again, tell me as to who your patient is.

    03:34 They got exposed to some type of a stone cutting shall we say it, "think mining," think S, sandblasting.

    03:40 Give yourself one big clue.

    03:42 And if you take a look at the x-ray you find there to be increased opacity, reticular pattern, the fact that fibrosis is kicking in in the interstitium, fibrogenic.

    03:52 Remember, these are silicotic nodules they are not granulomas.

    03:56 Is that understood? These are called silicotic nodules.

    03:59 The silica is then going to track the macrophages, and then you're going to release your fibrogenic factors.

    04:05 Also keep in mind this patient here, Oftentimes with silica, they are susceptible to what please? If you did find a granuloma in an x-ray, in a patient that is silicosis, you know it's TB.

    04:20 Is that clear? You want to be careful with questions that you get here.

    04:24 Are they going for the primary disorder? Or are they going for what is then a consequence of silicosis in which you have impairment of your secondary lysosome functioning, resulting in increased susceptibility to TB.

    About the Lecture

    The lecture Silicosis by Carlo Raj, MD is from the course Occupational Lung Diseases.

    Included Quiz Questions

    1. Involvement of the upper lobes of the lungs
    2. Involvement of the lower lobes of the lungs
    3. Hypercalcemia
    4. Pleural nodules
    5. Bilateral interstitial infiltrates
    1. Asymptomatic, and diagnosed incidentally.
    2. Hypersensitivity pneumonitis
    3. Elevated blood pressure due to increased serum ACE levels.
    4. Progressive massive fibrosis
    5. Pleural effusion
    1. Asbestosis
    2. Berylliosis
    3. Coal workers' pneumoconiosis
    4. Silicosis
    5. Anthracosis
    1. Cement processing
    2. Coal miner
    3. Roofer
    4. Shipbuilder
    5. Plumber
    1. Disruption of the secondary lysosome.
    2. Disruption of the primary lysosome.
    3. Disruption of the secondary lymphocyte.
    4. Disruption of the secondary leucocyte.
    5. Disruption of the neutrophil.
    1. Coal workers' pneumoconiosis
    2. Silicosis
    3. Lymphoma
    4. Sarcoidosis
    5. Berylliosis
    1. Sandblasting - Silicosis
    2. Sandblasting – Berylliosis
    3. Coal worker – Silicosis
    4. Roofer – Berylliosis
    5. Cement processor – Asbestosis
    1. Macrophages
    2. Monocytes
    3. B lymphocytes
    4. T lymphocytes
    5. Neutrophils

    Author of lecture Silicosis

     Carlo Raj, MD

    Carlo Raj, MD

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    By adrianmola2014@gmail B. on 08. July 2020 for Silicosis

    Excellent explanation. In a few words easy understand this important topic. Thank you very much