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Year 1 SBA revision > 105 - Pleurisy > Flashcards

105 - Pleurisy Flashcards

1
Q

Embryological origins of lungs

A

Epithelium

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2
Q

Embryological origins of pleura

A

Mesoderm

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3
Q

What is the pleural cavity

A

Potential space between visceral and parietal pleura. Only present in abnormalities.

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4
Q

What is empyema

A

Pus in pleural cavity. Results in development of scar tissue - pleural thickening

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5
Q

What is a pneumothorax

A

Air in pleura - causes a collapsed lung

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6
Q

What is a chylothorax

A

Lymph in pleura.

Rare - secondary to thoracic duct obstruction due to lymphoma.

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7
Q

Tumour in pleural cavity - what could it be?

A

Primary - mesothelioma

Secondary - metastatic, commonly carcinomas

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8
Q

What is pulmonary oedema

A

Fluid in lungs. Not the same as pleural effusion

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9
Q

Radiological signs of pneumothorax

A

Deviation of trachea away from affected side.
Collapsed lung - black space (will be hyper-resonant)
Check apex. Easily missed in this region

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10
Q

What is a sub pleural bleb?

A

Peripheral cyst on surface of lung filled with air. If pops - pneumothorax

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11
Q

How to treat pneumothorax

A

Insert a chest drain. End in sterile water to prevent air getting back into pleural cavity

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12
Q

Treatment of recurrent pneumothorax

A

Sterile talc to irritate pleura and cause to stick together.

Removal of lobe affected by pleural blebs.

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13
Q

What is Starling’s equillibrium

A

Fluid movement between intravascular and extravascular compartments is controlled by Starling forces.

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14
Q

Net fluid flow though a capillary wall (out of the blood) is controlled by:

A
  • Hydrostatic pressure (arterial blood pressure) at the arteriole end of the capillary bed.
  • Capillary permeability.
  • Opposing osmotic pressure exerted by serum proteins and interstitial oncotic pressure (oncotic pressure = osmotic pressure exerted by proteins).
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15
Q

Reabsorption of interstitial fluid is controlled by:

A
  • Plasma oncotic pressure – pulling pressure.
  • Hydrostatic pressure in the interstitial space – tissue pressure.
  • Fall in hydrostatic pressure at venous end of capillary.
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16
Q

Imbalance in Starling forces

A

Interstitial spaces expand

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17
Q

Pulmonary oedema occurs when

A

Lymphatic drainage capacity is exceeded

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18
Q

What is exudate?

A

Pleural effusion made of a protein rich cloudy fluid full of inflammatory cells. Occurs due to inflammation

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19
Q

What is transudate

A

Excess tissue fluid that leaks into the space between layers. A clear, protein poor fluid that usually arises in diseases that alter Starling equilibrium e.g. heart failure.

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20
Q

Colour of transudate and exudate

A

Transudate - straw coloured, clear.

Exudate - cloudy

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21
Q

Pleural effusion

A

Fluid in pleural cavities

22
Q

Bilateral pleural effusions tend to be

A

Transudate

23
Q

Unilateral pleural effusions tend to be

A

Exudate. Occur due to inflammation.

24
Q

Investigations in pleural effusion

A

CXR
Microbial culture
Cytopathology

25
Q

Pulmonary embolism

A

Wedge sharped infarct with involvement of visceral pleura. Blocks arterial blood to lung. Causes pleuritic pain. May have broken off a DVT

26
Q

Pleuritic pain

A

Sharp, localised pain on deep inspiration

27
Q

Radiological signs of pleural effusion

A

White, cloudy appearance on X-Ray.
Blunting of costodiaphragmatic angle.
Meniscus sign - curved lung base as filled with liquid.
Lung can collapse.
Trachea displaced away from affected side.

28
Q

Use of ultrasound

A

Use to identify presence of pleural fluid and to guide diagnostic aspiration

29
Q

Routine pleural aspirate investigations

A

CXR
Diagnostic aspiration under US
Check colour of liquid
Send samples for analysis

30
Q

Further investigations for transudate pleural effusion

A

• U&Es – check kidney function.
• LFTs - check liver function
ECG – check heart function

31
Q

Further investigations for exudate pleural effusion

A
  • CT thorax

* Thoracoscopy if the pleural aspiration was non-diagnostic. Take another biopsy using an endoscope.

32
Q

When would Light’s criteria be used - how would it be interpreted.

A

se when [protein] in aspirate is between 25-30g/L and cannot determine if transudate or exudate.

If any of the 3 conditions for exudate is met, consider exudate. 20% will be transudate but only 2% of cases diagnosed as transudate will be exudate.

33
Q

Light’s criteria

A

Fluid is exudate if one of the following Light’s criteria is present:[1, 2, 3, 4]

Effusion protein/serum protein ratio greater than 0.5
Effusion lactate dehydrogenase (LDH)/serum LDH ratio greater than 0.6
Effusion LDH level greater than two-thirds the upper limit of the laboratory’s reference range of serum LDH

34
Q

Indications for chest drain insertion in pneumothorax

A
  • Persistent/recurrent pneumothorax after simple aspiration.
  • Tension pneumothorax – initial relief with small bore cannula/needle but then will always need a chest drain.
  • Ventilated patients with pneumothorax always need a chest drain as will become tension pneumothorax if not.
  • Large, spontaneous secondary pneumothorax in pts >50yrs.
  • Iatrogenic causes may require drainage.
  • If traumatic pneumothorax
  • Haemopneumothorax.
35
Q

Indications for chest drain insertion in pleural effusions.

A

Pleural effusions – drain malignant pleural effusions, all pleural effusions in ventilated patients, empyema and complicated parapneumonic pleural effusion (bacterial infection).

36
Q

Where to insert chest drain in pneumothorax/pleural effusion

A

Pneumothorax – aim to remove air, air rises so drain at apex.
Pleural effusion – aim to remove fluid, fluid sinks so drain at base.

37
Q

How to fix blocked chest tube

A

Replace - never milk as can suck lung tissue into chest drain

38
Q

When an you clamp a pneumothorax

A

ONLY under control of respiratory physician. Can convert to a tension pneumothorax

39
Q

What is a floating rib

A

Rib broken in 2 places - free floating fragment

40
Q

What is a flail chest

A

3 or more contiguous floating ribs. Marker for high impact chest trauma.

41
Q

Significance of traumatic break to upper 3 ribs

A

Risk of damage to brachial plexus or subclavian vessels

42
Q

Difference between pleural and pericardial rub

A

Sound very similar – pericardial rub with pericarditis if three audible components but if one or two audible components then could be either. Pleural rub can be heard during inspiration and expiration but a pericardial rub can be heard even when the patient holds their breath. Pleural rub is generally in lateral part of the chest wall while pericardial rubs are central.

43
Q

Pneumothorax not pleural effusion if

A

Due to trauma

Hyper-resonant percussion tone

44
Q

Pleural effusion not pneumothorax if

A

Due to underlying pathology
Stony-dull percussion tone
Can hear pleural friction rub
Non-productive cough

45
Q

Trachea in tension pneumothorax

A

Deviates AWAY from affected side

46
Q

Treat a tension pneumothorax

A

Chest drain

47
Q

Treat a simple pneumothorax

A

Aspirate 16-18G cannula

48
Q

Treated pleural effusion, now what?

A

Always look for underlying cause

49
Q

Tracheal deviation in pleural effusion

A

Away from affected side

50
Q

Tracheal deviation in collapsed lung

A

Towards affected side - least pressure

Year 1 SBA revision (37 decks)

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