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Respiratory Block > Diseases of the pleura > Flashcards

Diseases of the pleura Flashcards

1
Q

What is the pleura?

A

A single layer of mesothelial cells and sub pleural connective tissue

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2
Q

Why is there a negative pressure in the pleura?

A

Due to the elastic recoil of the lungs

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3
Q

About how much pleural fluid lubricates the pleura?

A

2-3ml

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4
Q

What is the dynamic turnover of pleural fluid?

A

30-75%/hour

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5
Q

What is the net flow between pleura?

A

systemic to pulmonary

parietal to visceral

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6
Q

What is the driving pressure in the pleura?

A

plasma oncotic pressure

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7
Q

Name some features the pleura covers

A

spleen
liver
above first rib
kidneys

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8
Q

What is pleural effusion?

A

Collection of fluid in the pleural space

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9
Q

What do the symptoms of pneumothorax depend on?

A

the cause and the volume of fluid

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10
Q

List some of the symptoms of pneumothorax

A 
increasing breathlessness
pleuritic chest pain
gradually worsening if malignant
dull ache
dry cough
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11
Q

In a pneumothorax what other things do you need to enquire about?

A

Peripheral oedema
liver disease
orthopnoea
PND

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12
Q

What is orthopnoea?

A

dyspnoea whilst lying down

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13
Q

Name the 4 signs of pneumothorax

A

reduced expansion
stony dullness on percussion
bronchial breathing
vocal resonance

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14
Q

Name some other non respiratory signs of pneumothorax

A

clubbing
tar staining
lymph nodes
deviated trachea

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15
Q

What is a transudate?

A

absorption of pleural fluid due to high pressure and is usually bilateral

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16
Q

What is an exudate?

A

fluid leaking around cells of capillaries caused by inflammation and is usually unilateral

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17
Q

State the values for pleural fluid protein for transudate and exudates

A

transudate is <30g/l

exudate is >30g/l

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18
Q

List some causes of transudates

A 
liver cirrhosis
left ventricular failure 
hypothyroidism
hypoalbuminaemia
ovarian problems
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19
Q

List some causes of exudates

A

malignancy
pulmonary embolism
rheumatoid arthritis

20
Q

How much fluid is required for it to be picked up in a CXR?

A

20ml

21
Q

What can a CT look for in pneumothorax?

A

pleural thickening

determine if it is malignant

22
Q

List some complications of aspiration

A

pneumothorax
empyema
oedema
air embolism

23
Q

If the pH of the fluid is less than 7.2 what does this mean?

A

there is an infection

24
Q

What can the look and smell of fluid tell you?

A

pus = empyema and if it smells bad is anaerobic
milky = lymphoma
blood stained = cancer
food particles = oesophageal rupture

25
Q

What things are looked for in the lab in the fluid?

A

glucose and protein

stain to see the cells => cancer

26
Q

What needle is used in blind biopsies?

A

Abrams needle

27
Q

How many biopsies samples should you take?

A

4

28
Q

What should 3 of the biopsy samples be treated with and why?

A

formaldehyde to kill off TB

29
Q

Where should you biopsy in respect to a rib?

A

immediately above with cutting edge upwards to avoid hitting the vascular bundle

30
Q

What investigation is done to directly look at the pleura?

A

(video assisted) thoracoscopy

31
Q

Briefly explain pleurodhesis

A

patient lies on bed at 45 degree angle with arm above their head and insert thoracostomy tube in 4th intercostal space

32
Q

Why is the thoracostomy tube attached to an underwater seal?

A

To create a one way system - like a valve

33
Q

What volume should you not drain the pleurodhesis no more than/

A

500ml/hour

34
Q

What is a pneumothorax?

A

presence of air within the pleural cavity due to the breach of pleura leading to a collapsed lung

35
Q

Name the 2 broad categories of pneumothorax

A

spontaneous and traumatic

36
Q

give an example of when a primary spontaneous pneumothorax would occur

A

in young 20-30 year olds due to a ruptured bleb

37
Q

Give an example when a secondary spontaneous pneumothorax would occur

A

underlying disease including COPD, CF or asthma

38
Q

What is a tension pneumothorax?

A

When the trachea is deviated to the side away from the pneumothorax

39
Q

What is the size threshold for small and large rim of air in a pneumothorax?

A

2cm

40
Q

What is asbestos/

A

A highly fibrous naturally occurring mineral

41
Q

What colour of asbestos is the worst?

A

blue

42
Q

With asbestos how long after exposure does the disease occur?

A

20-40 years

43
Q

What is mesothelioma?

A

Pleural malignancy

44
Q

What percentage of mesothelioma is related to asbestos?

A

80%+

45
Q

Is mesothelioma usually unilateral or bilateral?

A

unilateral

Respiratory Block (29 decks)

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