Chapter 24 Phatho

Question 1

Pleural effusion

1. Fluid accumulates in the pleural space
2. Fluid is called: what

Answer 1

Pleural effusion

Question 2

2. Fluid separates what?

Answer 2

Visceral and parietal pleural

Question 3

3. What are the early symptoms of a Pleural Effusion?

Answer 3

Pleuritic chest pain
Chest pressure
Normal fluid in the pleural space (5 - 15mL)
Moderate Pleural Effusion (500 - 1500 mL) of fluid
Large Pleural Effusion (>1500 mL) of fluid
Dyspnea
Cough
Secondary to atelectasis

Question 4

4. What are the two types of pleural effusions?

Answer 4

Transudative:-

When fluid from the pulmonary capillaries moves into
the pleural space.
Fluid is thin and watery, contains few blood cells, and
little protein.
Few RBC’s
Little protein
No Bacteria

Exudative:-

• Caused by inflammation, infection, or malignancy
• High in protein
• High in cellular debris
• May be high in Bacteria

Question 5

5. What are the common causes of the transudate effusion.?

Answer 5

• Congestive hear failure
  
  • Right or left sided failure.
  • Increased hydrostatic pressure
  • Fluids from pulmonary capillaries
• Hepatic hydrothorax
  • Hepatic cirrhosis
  • Free fluid in abdomen
  • General result in right sided pleural effusion
• Nephritic syndrome

  - General bilateral
  - Result from decrease oncotic pressure

• Pulmonary emboli
  -Obstructive of pulmonary vasculature causes
  Rirhgt sided heart failure.

       - Pulmonary infarct causes increased permeability 
         on visceral pleura

Question 6

6. What are the causes of an exudative pleural effusion?

Answer 6

Malignant Pleural Effusions
2/3 occur in women
Highly associated with breast cancer
Malignant mesotheliomas
Bacterial Pneumonias
Up to 40% of patients develop pleural effusions
If permitted to worsen...pus can accumulate in the
pleural space.
Tuberculosis
Develop from extensions of a caseous tubercule into
the pleural cavity.
(Unilateral and small)
Fungal Disease
Histoplasmosis, coccidiodomycosis, blastomycosis
Pleural effusion resulting from disease of the gastrointestinal tract.
Pancreatitis
Subphrenic abscess
Intrahepatic abscess
Esophageal perforation
Abdominal operations
Diaphragmatic hernia
Pleural effusion resulting from collagen vascular diseases
Rheumatoid pleuritis
Systemic lupus
Sjogren's syndrome
Familial Mediterranean fever
Wegener's granulomatosis

Question 7

7. What are the other pathologic fluids that separate the parietal from the visceral pleura?

Answer 7

• Empyema (pus)
• Chylothorax (chyle)
• Hemothroax (blood)

Question 8

8. What are the clinical manifestations associated with a Pleural Effusion?

Answer 8

Atelectasis.

Question 9

9. What are the vital signs associated with a Pleural Effusion?

Answer 9

• Increased RR
• Increased HR
• Increased BP
• Chest pain
• Decreased chest expansion
• Cyanosis
• Cough (dry, non-productive)

Question 10

10. What are the chest assessment findings associated with a Pleural Effusion?

Answer 10

• Tracheal shift (away from the affected side)
• Decreased tactile and vocal fremitus
• Dull percussion note
• Diminished breath sounds
• Displaced heart sounds
• Pleural friction rub (occasionally)

Question 11

11. What are the (PFT) Pulmonary Function Test findings associated with a Pleural Effusion?

Answer 11

-Restrictive volumes and capacities.

Question 12

12. What are the (ABG) Arterial Blood Gas findings associated with a Pleural Effusion?

Answer 12

• Hyperventilation (Small Pleural Effusion)

- Hypoventilation (Large Pleural Effusion)

Question 13

13. What are the oxygenation indices associated with a Pleural Effusion?

Answer 13

Shunting

Decreased oxygen delivery

Question 14

14. What are the radiologic findings associated with a Pleural Effusion?

Answer 14

• Chest Radiograph
• Blunting of the costophrenic angles
• Fluid level on the affected side (straight lines)
• Depressed diaphragm
• Mediastinal shift (possibly) to unaffected side
• Atelectasis
• Mensicus sign

Question 15

15. General Management.

What are the best way to treat the underlying cause first?

Answer 15

Best way is to treat the underlying causes first:-

• Improve cardiac function
• Antibiotic therapy

Thoracentesis

• Drainage of the pleural effusion

Chest tube

• 28 to 36fr chest tube
• Inserted between 4-5 intercostal space, midaxillary

O2 therapy

• May be refractive to 02 if effussion is large enough
• Capillary shunting is the cause

Hyper-expansion therapy

-treat Atelectasis

Mechanical ventilation

• Only with acute respiratory failure

Pleuradesis

• Chemically adherence of the visceral and parietal pleura