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Systems: Resp. WK > 35. Non-Lung Cancer Thoracic Surgery > Flashcards

35. Non-Lung Cancer Thoracic Surgery Flashcards

1
Q

What are the main medical conditions that require a non-lung cancer thoracic surgery? (10)

A
  1. lung abscess
  2. empyema thoracic
  3. pleurectomy _decortication
  4. thymic tumours
  5. tracheal surgery
  6. benign lung tumours
  7. pneumothorax
  8. bullous lung disease
  9. bronchogenic cysts
  10. lung transplant (e.g. in CF)
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2
Q

What is a lung abscess?

A
  • collection of pus in a body cavity surrounded by granulation and necrotic tissue
  • made up of tissue fluid, bacteria, neutrophils, pus (dead infected tissue)
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3
Q

What can cause a lung abscess? (5)

A
  1. aspiration, including foreign body
  2. pneumonia
  3. PTE; pulmonary thromboendarterectomy (removes thrombus from pulmonary arteries)
  4. Lung calcium
  5. septic emboli
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4
Q

What is the body’s natural response to a lung abscess?

A
  • immune system will form granulation tissue and will begin to scar (collagen tissue)
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5
Q

Why can patients with lung abscesses sometimes cough up pus?

A

abscess may rupture the pleural cavity, cause pain or find way to main airway

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6
Q

What main feature of the pus can indicate a lung abscess?

A

the bad smell of pus; due to anaerobic bacteria

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7
Q

What are treatment options for a lung abscess?

A
  1. antibiotics or antifungals prescribed
  2. postural drainage; mucus and pus removed
  3. bronchoscopy for drainage/removal of pus
  4. surgery (if abscess doesn’t respond to antibiotics and infected lobe needs to be removed or drained)
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8
Q

What is empyema thoracic?

A

pus in the pleural cavity

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9
Q

What is empyema mainly caused by? (2)

A

98% due to pneumonia (but lung abscess can also cause it)

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10
Q

What are the most common causes for empyema thoracic? (6)

A
  1. post-pneumonic
  2. post-operative
  3. oesophageal
  4. upper abdominal related
  5. osteomyelitis
  6. post-traumatic
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11
Q

What is lung decortication pleurectomy?

A
  • surgical procedure which removes the surface layer or fibrous cover/membrane of an organ (lungs can be covered by inelastic, thick peel which needs to be removed as it restricts lung expansion)
  • pleurectomy= removal of affected pleura lining is removed
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12
Q

Patient with what type of cancer often have pleurectomy and decortication?

A

pleural mesothelioma

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13
Q

What group of people may face complication with pleurectomy and decortication procedure?

A

Elderly; especially with COPD as peeling process will not heal which can be fatal

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14
Q

Is all of pleura removed in a pleurectomy and decortication?

A

No, only enough to make lungs expand again (not all of it can be taken off as parts of it are attached to diaphragm and heart)

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15
Q

What is the aim of pleurectomy and decortication surgery?

A

to allow lungs to expand again

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16
Q

What are thymic tumours caused by? (5)

A
  1. thymoma
  2. thymolipoma
  3. thymic carcinoma
  4. carcinoid tumours of the thymus
  5. lymphoma
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17
Q

Where in the mediastinum does the thymus lie?

A

Anterior superior mediastinum (in front of heart and behind the sternum)

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18
Q

What is the function of the thymus?

A
  • factory for maturing t cells (which are also produced in bone marrow)
  • trains and develops t cells
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19
Q

What happens to the thymus at puberty?

A

It begins to shrink and by the age of 40/50 disappears completely forming fat

20
Q

What is the most benign thymic tumour?

A

thymoma

21
Q

What is the most metastatic thymic tumour?

A

thymic carcinoma (has lymphoid and epithelial components)

22
Q

What are the main tracheal surgeries?

A
  1. repair of iatrogenic injury

2. tracheal tumours (salivary gland tumours and squamous carcinomas)

23
Q

What are the most common carcinomas in smokers and non-smokers in tracheal cancers?

A
  • in non-smokers it’s adeno-cystic carcinoma

- in smokers it’s squamous carcinoma

24
Q

What are common benign lung tumours? (7)

A
  1. hamartoma
  2. fibroma
  3. lipoma
  4. neural tumours
  5. papillomas
  6. chondroma
  7. carcinoid
25
Q

Why should benign tumours be removed as quickly as possible?

A

They can unexpectedly grow to large sizes and do more damage

26
Q

What is a primary pneumothorax?

A
  • cause is unknown

- occurs spontaneously especially in young people

27
Q

What is a secondary pneumothorax?

A
  • patient has underlying lung disease e.g. COPD or emphysema
28
Q

What are 2 forms of a pneumothorax?

A
  1. recurrent

2. persistent

29
Q

What is a persistent pneumothorax often caused by?

A

Often a ruptured bulla( sac over 2cm)

Bulla: dilated air space in the lung parenchyma (cellular tissue of organs)

30
Q

What is an open pneumothorax?

A
  • Involves unsealed opening in the chest wall which impairs breathing (lungs hang out of the chest due to the hole)
  • If hole diameter is bigger than trachea (2cm), then air will flow through hole and not trachea which can be fatal
31
Q

What is a tension pneumthorax?

A
  • when air is escaping from lung tissue into pleural cavity and cannot return
  • leads to accumulation of air
  • causes high pressure volume expansion and compression of underlying ling and shift of mediastinal structures to one side of the chest
32
Q

What causes bilateral tension pneumothorax?

A

If tension pneumothorax pushes organs to opposite hemithorax and can impair venous return to the heart as well as cause a pneumothorax

33
Q

What are indications for surgery in pneumothorax? (3)

A
  1. recurrence
  2. persistence
  3. sometimes after one episode
34
Q

What are 2 surgeries for a pneumothorax?

A
  1. pleurodesis; sticking/adhering two membranes together with talc to prevent build up of fluid in pleural cavity
  2. pleurectomy; removal of part of pleura to prevent build up of fluid in the affected area
35
Q

What other condition in lungs can pleurodesis be used for?

A

pleural effusion

36
Q

What cancer type in lungs involves pleurectomy?

A

mesothelioma (pleural mesothelial cancer)

37
Q

Are bronchogenic cysts present from birth?

A

Yes, they are congenital malformations of the bronchial tree

38
Q

How do bronchogenic cysts cause symptoms?

A

they press on the trachea and oesophagus and cause compression

39
Q

What are bronchogenic cysts collectively known as?

A

foregut duplication cysts (most common type of foregut duplication cysts)

40
Q

What are the most common causes of needing a lung transplantation? 93)

A
  1. cystic fibrosis
  2. pulmonary fibrosis (idiopathic)
  3. emphysema
41
Q

What occurs in pulmonary fibrosis?

A
  • air sacs become scarred

- lungs become stiff and not stretchable

42
Q

What are common acquired and infective causes of bronchiectasis? (4)

A
  1. pneumonia
  2. cystic fibrosis (v. common)
  3. immune system problems
  4. tuberculosis
43
Q

What age range is restricted for lung transplantation?

A

<65 years

44
Q

What are lung transplantations restrictions? (6)

A
  1. age <65
  2. not overweight
  3. not diabetic
  4. no renal failure
  5. no mental illness
  6. good social support
45
Q

What is the mortality rate of a single lung transplantation?

A

5-10%

46
Q

What is the mortality rate for a double lung transplantation?

A

10-20%

Systems: Resp. WK (40 decks)

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