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Pulm > Lec 22 Pleural Diseases > Flashcards

Lec 22 Pleural Diseases Flashcards

1
Q

What is blood supply to pleura?

A 
parietal = intercostal arteries
visceral = bronchial arteires
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2
Q

WHat is drainage of parietal pleura?

A

systemic veins

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3
Q

What is drainage of visceral pleura?

A

pulmonary veins

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4
Q

WHat is lymphatic drainage of parietal pleura?

A

internal mammary chain and internal intercostal chain

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5
Q

What is lymphatic drainage of visceral pleura?

A

hilar and middle mediastinal lymph nodes

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6
Q

Which part of pleura is normally responsible for pleural fluid formation and absorption?

A

parietal pleura!

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7
Q

What is starling equation for pleura?

A

fluid movement = L [(Pcap - Ppleura) - o(oncoticPcap - oncoticPpleura)]

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8
Q

What are pleural stomata?

A

big holes in parietal pleura = look liek microvilli in intestine

designed for moving fluid around + can take up large particles

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9
Q

What are the 2 causes of pleural effusion?

A

altered permeability of pleural membranes = EXUDATE

altered driving P = TRANSUDATE

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10
Q

What things typically cause exudative pleural effusion?

A

inflammation or tissue disruption

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11
Q

WHat things typically cause transudative pleural effusion?

A

fluid avid states –> CHF, cirrhosis, nephrotic syndrome

== not the lung’s fault

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12
Q

How do you detect effusions on physical exam?

A

decreased breath sounds and fremitus; dullness to percussion

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13
Q

How do you detect effusions on chest radiograph?

A

200-500 mL of fluid needed to blunt lateral costophrenic angle

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14
Q

When are two situations when you DONT tap pleural effusion?

A
  • less than 10 mm of free-flowing fluid on lateral decubitus film
  • CHF w/ improvement with treatment
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15
Q

What is technique for thoracocentesis?

A
  • insert one interspace below loss of fremitus/dullness to percussion
  • pt upright not leanding forward
  • insert over rib [b/c vessel/nerve below]
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16
Q

What is light’s criteria?

A

if any criteria met = exudate
if none met = transudate

  1. pleural fluid/serum protein ration > 0.5
  2. pleural fluid/serum LDH ratio > 0.6
  3. pleural fluid LDH > 2/3 upper limit of normal
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17
Q

What are some things that cause transudative effusions?

A
  • CHF
  • nephrotic syndrome
  • hypoalbuminemia
18
Q

What are some findings in transudative pleural effusion?

A
  • increased hydrostatic P
  • decreased plasma oncotic P
  • movement of transudative abdominal fluid [ascites]
19
Q

How does pleural effusion form in CHF?

A

high PCWP –> fluid leaks into interstitium of lung and subsequently pleural space

20
Q

What is hepatic hydrothorax?

A
  • pressure in abdomen is positive; pleura is negative

fluid may move north if there is a connection

R more than L

fluid is transudate

due to ascites

21
Q

How do you treat hepatic hydrothorax?

A

treat the ascites –> diuretics, reduced portal pressure

22
Q

What are some causes of exudative effusions?

A
  • infectious
  • malifnant
  • PE
  • asbestos
  • chylothorax
23
Q

What is a parapneumonic effusion?

A

effusion around the time of pneumonia

24
Q

What are 3 types of parapneumonic effuson?

A
  • simple
  • complicated
  • empyema
25
Q

What is complicated parapneumonic effusion?

A

loculated
pH < 7.2
LDH > 1000

26
Q

What is empyema?

A

parapneumonic effusion that contains organisms or has gross appearance of pus

27
Q

What is possible complication of empyema/complicated parapnuemonic effusions if left undrained?

A
  • fibrothorax

- septic shock

28
Q

What is TB pleuritis?

A
  • subpleural focus of TB ruptures into pleural space 6-12 wks after primary infection or reactivation

TB antigens in pleural space –> acute hypersensitivity rxn w/ exudative pleural effusion

29
Q

If not treated what happens in TB pleuritis?

A
  • generally resolves over wks

- 65% go on to develop active pulm TB

30
Q

What causes malignant pleural effusion?

A
  • tumor implanted on pleural surface from embolus or direct extension lung/breast
  • lymphatic obstruction by tumor prevents fluid reabsorption
31
Q

What are symptoms/signs of pleural effusion?

A
  • dyspnea
  • pleuritic chest pain
  • fever
  • dull to percussion
  • decreased breath sounds
  • pleural friction rub
32
Q

What do you see on xray in pt with pleural effusion?

A
  • blunted costophrenic angle
33
Q

What is a loculated pleural effusion?

A

effusion that is not really moving around = can see thick visceral pleura on inside

34
Q

What defines hemothorax?

A

pleural fluid with Hct > 50% of serum Hct

35
Q

What is a pneumothorax?

A

air in pleural space

36
Q

What are two types of pleural effusion? etiologies?

A

entry from parietal pleura = trauama or iatrogenic

entry from visceral pleura = rupture lung cyst; complication of mechanical ventilation; necrosis due to tumor, infection

37
Q

WHat is a spontaneous pneumothorax?

A

sudden onset pleuritic chest pain w/ dyspnea

38
Q

Who gets primary pneumothorax?

A

tall, male, thin smoker

w/ asymptomatic subpleural blebs

39
Q

What are some diseases associated w/ spontaneous pneumothorax?

A

emphysema, PCP, CF, abscess

40
Q

What is effect of tension pneumothorax?

A
  • collapsed lung
  • decrease venous return
  • displaced mediastinum to opposite side of chest
  • cardiovascular collapase

Pulm (24 decks)

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