Effusion Flashcards
define pleural effusion
collection of fluid in the plerual cavity
what are the mechanism promoting plerual fluid accumulation?
microvascular circulation
- increased hydrostatic pressure (HF)
- deceased oncotic pressure (severe hypoalbuminemia)
lymphatics
- impaired draginage
diaphragm
- movement of fluid from the peritoneal space (heaptic hydrothorax)
what are the conditions that cause plerual effusion
- an increase in hydrostatic pressure
- decerease in oncotic pressure
causes of transudate collection
- HF
- Nephrotic syndrome
- Hepatic hydrothorax
- SVC syndrome
- peritoneal dialysis
- atelectasis
- Urinothorax
causes of exudates
parapneumonic effusion
- simple
- complicated
- empyema
infections
- TB
- fungal
- parasites
malinancy
finallamtory disorders
- CT disease
- rheumatoid arthritis
Abdominal disease
- pancreatitis
- pancreatic pseudocyst
what are the clinical manifestations
asymptomatic
dyspnea
pleuritic chest pain - unilat and sharp
cancontribute to respiraotry failue if large enough
what are the physical findings?
dullesness on percussion
diminished breath sounds
absent tactcile fremtus
explain the detail of plerual friction rub
auscultated during inspiration and expiration
low pitch and harsh sound
what are the continuous abnromal lugn spounds ?
high-pitched polyphonic wheeze
low-ptiched monophonic wheeze
stridor
what are the discontinoued abnormal lung sound
coarse crackles
fine crackles
plerual friction rub
diagnosis
X ray
- fluid must exceed 250 ml to be visible
- may collect in minor or major fissures
chest CT
- can detec small fluid colection
- determines loculated effusion
- identification of plerual and parenchyma abnormalities causing the effusion
- distingusih a locualed effusion from lung abscess
ultrasound
- can detect 5-10 ml fluid
- used to giude the needle in thoracentesis
what are the three steps of diagnosis?
clinical evaluation
imaging studies
plerual fluid analysis
what are the indications for thoracentesis
- plerual effsuon whch needs diagnsotic work-up
- symptomatic treatmetn of a large plerual effsuon
relative contrainducations of thoracentesis
- Bullous disease - emphysema
- Positive end-expiratory pressure (PEEP) mechanical ventilation
- Only one functioning lung
Small volume of fluid (less than 1 cm thickness on a lateral decubitus)
what are the risk of thoracentesis ?
bleeding
fluid buildup in lungs
infection
pneumothorax
pulmonary edema
respiraotry distress
what is the compostion of the plerual fluid effusion ?
serocitrin
hemorrhagic
purulent
lymphatic
what is the bipchemical compostion of effusion?
- Rivalta reaction
- Exudative/transudative
- Proteins
- Glucose
- Lipids
- LDH
what is the cytology of pleural effusion
- Neoplastic cells
- Mesenchymal cells
- Lymphocytes
- Eosinophiles
- RBC
in what conditions can transudate effusions be seen?
HF - bilatrela. in unilarter = hemithorax
cirrhosis
nephrotic syndrome
myxedema
pulmonary embolism
SVC obstruction
peritoneal dialysis
in what conditions can exudate effusions be seen?
occurs due to an aleration
infllamtory states
infection
neoplasm
Pleural fluid characteristics of exudates
prtoein . 0.5 plerual fluid/serum value
LDH > 0.6 pleural fluid/serum value
LDH > 2/3 upper limit of normal serum value
how is the exuadte in empyema, malignancy, esophageal rupture, CT diease and tuberculous pleuritis?
pH < 7,2
