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2. Respiratory Medicine (Lectures) > Non Lung Cancer Thoracic Surgery > Flashcards

Non Lung Cancer Thoracic Surgery Flashcards

1
Q

What is an abscess?

A

A collection of pus in the body surrounded by granulation tissue

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2
Q

Causes of lung abscess

A

Aspiration, including foreign body
Pneumonia
PTE
Lung cancer
Septic emboli

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3
Q

What may happen if the pus from the abscess comes through the pleural cavity?

A

Cause severe pain

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4
Q

What may happen is the pus from the abscess comes into the main airway?

A

Patient could cough up a lot of pus

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5
Q

What type of bacteria is associated with a bad smell?

A

Anaerobic bacteria

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6
Q

What is an empyema?

A

Pus in the pleural space

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7
Q

Causes of empyema

A

Post pneumonic
Post op
Oesophageal (ruptured oesophagus)
Upper abdo related
Osteomyelitis
Post traumatic

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8
Q

Pathology of empyema

A

Inflammatory process
Thickening of visceral and parietal pleura which prevents the lung expanding as its lost its elasticity (trapped lung)

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9
Q

How does a pleurectomy and decortication work?

A
  1. Peel away parietal pleura
  2. Peel away visceral pleura off lung surface. (quite difficult as pleura thick and inflamed)
  3. Evacuate pus
  4. Lung re expands
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10
Q

What is done to check the pleurectomy and decortication has worked?

A

CXR

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11
Q

What does the thymus gland produce?

A

T cells

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12
Q

Do thymomas have malignant potential?

A

Yes

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13
Q

Are all thymomas removed?

A

Yes

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14
Q

Least malignant thymoma

A

Thymolipoma

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15
Q

Most malignant thymoma

A

Thymic carcinoma

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16
Q

What is the thymus gland derived from?

A

Pharyngeal pouches

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17
Q

Examples of thymic tumours

A

Thymoma
Thymolipoma
Thymic carcinoma
Carcinoid tumours of the thymus
Lymphoma

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18
Q

What would tracheal surgery be used for?

A

DONT TEND TO OPERATE ON TRACHEA
Repair of iatrogenic injury
Tracheal tumours
- salivary gland tumours
- squamous carcinomas

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19
Q

Where do adenoid cystic carcinomas arise from?

A

Arise from mucous glands in the trachea (tends to be non smokers)

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20
Q

Who tends to get squamous carcinomas of the trachea?

A

Smokers

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21
Q

Are the benign tumours of the chest likely to be removed?

A

Yes, because they are likely to grow to large sizes and take over the space the lungs are meant to be in

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22
Q

Examples of benign lung tumours

A

Hamartoma
Fibroma
Lipoma
Neural tumours
Papillomas
Chondroma

23
Q

What is a pneumothorax?

A

Air in the pleural space

24
Q

What is a pneumothorax commonly caused by?

A

Leak in the pleura

25
Q

Common pathological cause of primary pneumothorax

A

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.

26
Q

What can blebs become if they grow larger or come together to form a larger cyst?

A

Bullae

27
Q

What is a tension pneumothorax?

A

Air escaping the lung cavity causing increased pressure. Shifts mediastinal structures to the other side and causes pressure on the lung

28
Q

How could a spontaneous haemothorax occur?

A

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

29
Q

What does a small fluid level in a spontaneous pneumothorax indicate?

A

Bleeding into their chest

30
Q

When could bulla become problematic?

A

If patient goes diving, flying etc

31
Q

What surgery can be done for pneumothorax?

A

Pleurodesis
Pleurectomy

32
Q

What is pleurodesis?

A

Talcum powder which promotes bonding between the two pleural layers; talc pleurodesis

33
Q

What is a pleurectomy?

A

Removal of part of the pleura

34
Q

When are bronchial cysts present from?

A

Birth

35
Q

How do bronchial cysts cause symptoms?

A

Pressing on trachea or oesophagus

36
Q

3 most common causes of lung transplantations

A

CF
Pulmonary fibrosis
Emphysema

37
Q

What age group do lung transplants tend to be restricted to?

A

< 65 y/o

38
Q

What does CF cause?

A

Bronchiectasis where the bronchi become abnormally enlarged due to repeated infections of the lung
Large bronchi cause more and more sputum and mucous production

39
Q

Exclusion criteria for lung transplantation

A

Age < 65 y/o
Not overweight
Not diabetic
No renal failure
No mental illness
Good social support

40
Q

Who would get a single lung transplant?

A

Emphysema
Pulmonary fibrosis

41
Q

Mortality of single lung transplant

A

5 - 10%

42
Q

Who would get a double lung transplant?

A

CF

43
Q

Morality of CF

A

10 - 20%

44
Q

What is atelectasis?

A

Common post op complication in which basal alveolar collapse can lead to resp difficulty. It is caused when airways become obstructed by bronchial secretions

45
Q

When should atelectasis be suspected?

A

Presence of SOB and hypoxaemia 72 hours post operatively

46
Q

Management of atelectasis

A

Chest physio with mobilisation and breathing exercises

47
Q

What would be seen on a CXR in heart failure?

A

Alveolar oedema (bats wings)
Kerley B wings (interstitial oedema)
Cardiomegaly
Dilated prominent upper lobe vessels
Pleural effusions

48
Q

What is the transfer factor? What is used to test this?

A

The rate at which a gas will diffuse from the alveoli into the blood
Carbon monoxide is used to test the rate of diffusion

49
Q

How are the results given of the transfer factor?

A

Either
- total gas transfer (TLCO) OR
- that for corrected lung volume (transfer coefficient, KCO)

50
Q

Causes of a raised TLCO

A

Asthma
Pulmonary haemorrhage (Wegeners, goodpastures)
Left to right cardiac shunts
Polycythaemia
Hyperkinetic states
Male gender, exercise

51
Q

Causes of a lower TLCO

A

Pulmonary fibrosis
Pneumonia
PE
Pulmonary oedema
Emphysema
Anaemia
Low cardiac output

52
Q

What can cause a raised KCO with a normal or reduced TLCO?

A

Pneumonectomy/lobectomy
Scoliosis/kyphosis
Neuromuscular weakness
Ankylosis of costovertebral joints e.g. ankylosing spondylitis

53
Q

What is ARDS characterised by?

A

Bilateral pulmonary infiltrates
Hypoxaemia

2. Respiratory Medicine (Lectures) (50 decks)

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