DE VERA, ALYSSA GAIL V.

October 24, 2018

II-A PATHOLOGY

SGD: ENVIRONMENTAL AND NUTRITIONAL DISEASES

CASE

A 57 year old male, married, from Botolan Zambales

Chief Complaint: Difficulty of Breathing
The patient complains of easy fatigability. He noticed that his symptoms have become worse in 4 years.
Past Medical History: Worked in Subic Shipyard for 25 years

EXPECTED PHYSICAL EXAMINATION FINDINGS

 Reduced chest expansion

 Shortness of breath
 Dullness over the lungs
 Presence of rales and crackles at the base of the lungs
 Intercostal muscle retractions
 Recent weight loss
 Nail clubbing
 cyanosis

SALIENT FEATURES

 57 y/o, male
 Chief complain: difficulty in breathing
 Easy fatigability
 Symptoms became worse in 4 years (progressive)
 Shipyard worker for 25 years

PRESENT WORKING IMPRESSION

Asbestosis

DIFFERENTIAL DIAGNOSIS

Chronic obstructive pulmonary disease (COPD)

Common Signs and Symptoms  - experienced by the patient

X - not experienced by the patient
Shortness of breath 
Fatigue 
chronic cough (usually productive) X
Wheezing X
Progressive signs and symptoms 

COPD is ruled out due to absence of wheezing and chronic productive cough.
DE VERA, ALYSSA GAIL V. October 24, 2018
II-A PATHOLOGY

Hypersensitivity pneumonitis

Common Signs and Symptoms  - experienced by the patient

X - not experienced by the patient
Shortness of breath 
Fever X
cough (usually productive) X
Fatigue 
Chills X
Headache X
Episodic signs and symptoms X

Hypersensitivity pneumonitis is ruled out because the signs and symptoms are episodic which is in
contrast to the patient’s history. Most of the common signs and symptoms are not experienced by the
patient.

Asbestosis

Common Signs and Symptoms  - experienced by the patient

X - not experienced by the patient
Shortness of breath 
Loss of appetite with weight loss X
Persistent dry cough X
Fatigue 
Nail clubbing and deformities X
Progressive signs and symptoms 
Major Risk Factor: exposure to asbestos 

Asbestosis is ruled in because of the presence of most of its common signs and symptoms in the patient.
In addition, the patient is exposed to the major risk factor which is asbestos.

FINAL DIAGNOSIS

Asbestosis
DE VERA, ALYSSA GAIL V. October 24, 2018
II-A PATHOLOGY

PATHOPHYSIOLOGY OF ASBESTOSIS

DIAGNOSTIC TOOLS

 Chest X-ray
 Chest CT scan
 Spirometry

PATHOLOGIC FINDINGS

Macroscopic findings

 Calcified pleural plaques

 Fibrosis in the lungs
 Honeycomb appearance of lungs

Microscopic findings

 Asbestos bodies
DE VERA, ALYSSA GAIL V. October 24, 2018
II-A PATHOLOGY

MANAGEMENT

There's no treatment to reverse the effects of asbestos on the lungs. Treatment focuses on
slowing the progression of the disease and relieving symptoms.

Supportive treatment

1. Respiratory Physiotherapy

2. Bronchodilators – relax airway muscles

3. Immunization – pneumococcal and influenza & to prevent secondary infection

4. Supplemental Oxygen

Lifestyle changes

 Avoid exposure to cigarette smoke

 Change workplace (if possible)
 Always wear protective mask