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.