Lungs: Restrictive Extrinsic Conditions - Kyphoscoliosis, Pleural Effusions, Pneumothorax, Tension Pneumothorax, Neuromuscular Disorders (GBS, MG) Flashcards
How does kyphoscoliosis affect lung function
Deviation of the normal curvature of the spine in the sagittal, coronal plane => restrictive lung problems
Pleural effusions
-presentation, examination findings
No hemi diaphragm Meniscus Dense white shadowing Locular effusions Fluid sinks to the bottom, compresses lung above
Decreased expansion Mediastinal shift to contralateral side Stony dull percussion Bronchial breathing at level of effusion Decreased VF/TF
What is the difference between a chest drain, pleural tap and thorascopy
Chest drain - drainage of air, blood, fluid, pus out of pleural space => reexpansion of lung
-Seldinger kit
Pleural tap - drainage of pleural fluid for sampling
Thorascopy - laproscopic technique to view lung and pleura, take lung biopsies and insert talc
What info can you get from a pleural tap
Physical appearance
Protein and LDH often change together
-transudate < 25 LIGHTS CRITERIA 35 < exudate
AFB - TB culture
MCS - microbe culture
Cytology - cells
Glucose and pH often change together
- if low, likely
- infection/empyema
- malignancy
- RA, TB, SLE
What is the difference between transudate and exudate?
-what are the most common causes
Transudate
- due to increased hydrostatic pressure or low oncotic pressure
- low in protein and LDH
- systemic causes
Exudate
- due to inflammation and capillary permeability
- high in protien and LDH
- infection, inflammation, malignancy
What is the Lights Criteria
Exudate if at least 1 of the criteria met
- Pleural protein: Serum protein
- ratio > 0.5 - Pleural LDH: Serum LDH
- ratio > 0.6 - Pleural LDH greater than 2/3 upper limit of normal serum LDH
How would you manage a
- parapneumonic effusion
- empyema
- malignant effusion
- bilateral effusion
Parapneumonic effusion - secondary to pneumonia
- no infection in transudate
- manage pneumonia, no need to drain
Empyema - pus from infection in pleural space
-drain exudate, identify microbe, ABx
Malignant effusion - cancer cells in exudate increase production of fluid and decrease absorption
- lung, breast, lymphoma mets
- mesothelioma
- pleurodesis with talc to prevent formation of effusions
Bilateral effusion - transudate due to systemic issues
-treat underlying cause
Causes of
- primary pneumothorax
- secondary pneumothorax
No underlying pathology
Tall, thin patients
Presence of bullae on apices of lung
Often smokers
Trauma
Lung disease - asthma, CF, PCP, cancer, sarcoma, COPD
AI affecting lungs
Congenital - CF, Marfans, EDS
Pneumothorax
- presentation
- investigation, diagnosis
Pneumothorax
Sudden onset SOB, pleuritic pain
TP -
Insp => air moves into PS
Exp => valve on lung closes
Increased air in PS => compress heart
Reduced chest expansion, reduce breath sounds on affected side
CXR => loss of lung markings on affected side
Management of
- primary pneumothorax
- secondary pneumothorax
- tension pneumothorax
Primary
2cm+ / SOB?
-yes - aspiration & OPD => chest drain & admit
-no - OPD
Secondary 2cm+ / SOB? -yes - chest drain & admit No - 1-2cm? -yes - aspirate & admit => chest drain & admit -no - admit and observe
Tension
- needle decompression 5ICS MAL
- high flow O2, chest drain
What neuromuscular conditions may cause a restrictive lung disease
-management
GBS, MG
-IVIG, plasmapheresis