Non Lung Cancer Thoracic Surgery Flashcards
What is an abscess?
A collection of pus in the body surrounded by granulation tissue
Causes of lung abscess
Aspiration, including foreign body
Pneumonia
PTE
Lung cancer
Septic emboli
What may happen if the pus from the abscess comes through the pleural cavity?
Cause severe pain
What may happen is the pus from the abscess comes into the main airway?
Patient could cough up a lot of pus
What type of bacteria is associated with a bad smell?
Anaerobic bacteria
What is an empyema?
Pus in the pleural space
Causes of empyema
Post pneumonic
Post op
Oesophageal (ruptured oesophagus)
Upper abdo related
Osteomyelitis
Post traumatic
Pathology of empyema
Inflammatory process
Thickening of visceral and parietal pleura which prevents the lung expanding as its lost its elasticity (trapped lung)
How does a pleurectomy and decortication work?
- Peel away parietal pleura
- Peel away visceral pleura off lung surface. (quite difficult as pleura thick and inflamed)
- Evacuate pus
- Lung re expands
What is done to check the pleurectomy and decortication has worked?
CXR
What does the thymus gland produce?
T cells
Do thymomas have malignant potential?
Yes
Are all thymomas removed?
Yes
Least malignant thymoma
Thymolipoma
Most malignant thymoma
Thymic carcinoma
What is the thymus gland derived from?
Pharyngeal pouches
Examples of thymic tumours
Thymoma
Thymolipoma
Thymic carcinoma
Carcinoid tumours of the thymus
Lymphoma
What would tracheal surgery be used for?
DONT TEND TO OPERATE ON TRACHEA
Repair of iatrogenic injury
Tracheal tumours
- salivary gland tumours
- squamous carcinomas
Where do adenoid cystic carcinomas arise from?
Arise from mucous glands in the trachea (tends to be non smokers)
Who tends to get squamous carcinomas of the trachea?
Smokers
Are the benign tumours of the chest likely to be removed?
Yes, because they are likely to grow to large sizes and take over the space the lungs are meant to be in
Examples of benign lung tumours
Hamartoma
Fibroma
Lipoma
Neural tumours
Papillomas
Chondroma
What is a pneumothorax?
Air in the pleural space
What is a pneumothorax commonly caused by?
Leak in the pleura
Common pathological cause of primary pneumothorax
Often blebs in the lung where the alveoli never connected with the bronchial tree and so there is a bit of air and where the blister bursts there is a pneumothorax. This can heal itself but if it happens again (recurrent) then surgery can be done.
What can blebs become if they grow larger or come together to form a larger cyst?
Bullae
What is a tension pneumothorax?
Air escaping the lung cavity causing increased pressure. Shifts mediastinal structures to the other side and causes pressure on the lung
How could a spontaneous haemothorax occur?
The lung may heal after a pneumothorax with adhesions within the pleural layers. Next pneumothorax may cause damage to these adhesions and so would maybe cause bleeding
What does a small fluid level in a spontaneous pneumothorax indicate?
Bleeding into their chest
When could bulla become problematic?
If patient goes diving, flying etc
What surgery can be done for pneumothorax?
Pleurodesis
Pleurectomy
What is pleurodesis?
Talcum powder which promotes bonding between the two pleural layers; talc pleurodesis
What is a pleurectomy?
Removal of part of the pleura
When are bronchial cysts present from?
Birth
How do bronchial cysts cause symptoms?
Pressing on trachea or oesophagus
3 most common causes of lung transplantations
CF
Pulmonary fibrosis
Emphysema
What age group do lung transplants tend to be restricted to?
< 65 y/o
What does CF cause?
Bronchiectasis where the bronchi become abnormally enlarged due to repeated infections of the lung
Large bronchi cause more and more sputum and mucous production
Exclusion criteria for lung transplantation
Age < 65 y/o
Not overweight
Not diabetic
No renal failure
No mental illness
Good social support
Who would get a single lung transplant?
Emphysema
Pulmonary fibrosis
Mortality of single lung transplant
5 - 10%
Who would get a double lung transplant?
CF
Morality of CF
10 - 20%
What is atelectasis?
Common post op complication in which basal alveolar collapse can lead to resp difficulty. It is caused when airways become obstructed by bronchial secretions
When should atelectasis be suspected?
Presence of SOB and hypoxaemia 72 hours post operatively
Management of atelectasis
Chest physio with mobilisation and breathing exercises
What would be seen on a CXR in heart failure?
Alveolar oedema (bats wings)
Kerley B wings (interstitial oedema)
Cardiomegaly
Dilated prominent upper lobe vessels
Pleural effusions
What is the transfer factor? What is used to test this?
The rate at which a gas will diffuse from the alveoli into the blood
Carbon monoxide is used to test the rate of diffusion
How are the results given of the transfer factor?
Either
- total gas transfer (TLCO) OR
- that for corrected lung volume (transfer coefficient, KCO)
Causes of a raised TLCO
Asthma
Pulmonary haemorrhage (Wegeners, goodpastures)
Left to right cardiac shunts
Polycythaemia
Hyperkinetic states
Male gender, exercise
Causes of a lower TLCO
Pulmonary fibrosis
Pneumonia
PE
Pulmonary oedema
Emphysema
Anaemia
Low cardiac output
What can cause a raised KCO with a normal or reduced TLCO?
Pneumonectomy/lobectomy
Scoliosis/kyphosis
Neuromuscular weakness
Ankylosis of costovertebral joints e.g. ankylosing spondylitis
What is ARDS characterised by?
Bilateral pulmonary infiltrates
Hypoxaemia
