Path- approach to pt. with lung cancer Flashcards
accumulation of fluid in interstitial tissues.?
edema
are accumulations of fluid in body cavities?
effusions
Noninflammatory effusions and edema are protein-poor fluids called?
transudates
What type of effusion is common in many diseases, including heart failure, renal disease, and liver failure?
transudates
edema and effusions may occur secondary to:
๏ Increased Hydrostatic Pressure
๏ Reduced Plasma Osmotic Pressure
๏ Sodium and Water Retention
๏ Lymphatic Obstruction
Noninflammatory
Non-inflammatory Effusions and Edema increase/ decreased Hydrostatic Pressure?
Increases in hydrostatic pressure are mainly caused by disorders that impair venous return.
increased
What causes low albumin and subsequent reduced oncotic pressure leading to noninflammatory effusions?
✴ Reduced albumin synthesis occurs in severe liver diseases, eg, end-stage cirrhosis.
✴ Albumin loss occurs in the nephrotic syndrome, where albumin leaks into the urine through abnormally permeable glomerular capillaries.
✴ Plasma protein may be decreased in protein malnutrition.
Increased/ decreased salt retention occurs whenever renal function is compromised, eg, primary kidney disorders, and in cardiovascular disorders that decrease renal perfusion.
Increased salt retention, with retention of associated water, leads to both increased/ decreased hydrostatic pressure and increased/ decreased vascular colloid osmotic pressure (due to dilution).
increased; decreased
Inflammation-related effusions and edema are protein rich?
exudates.
What caused exudates of vessels leading ot effussions and edema?
They are due to increases in vascular permeability caused by inflammatory mediators.*
Serous, serofibrinous, fibrinous (and suppurative) fluids may all have an basis, differing only in the intensity and duration of the process.
inflammatory
inflammation is marked by the exudation of cell-poor fluid into spaces created by injury to surface epithelia, or into mesothelial-lined body cavities.
Serous
Typically, the fluid is/ is not infected by destructive organisms, and does not contain large numbers of leukocytes.
is not
A exudate develops when the vascular leaks are large, and/or there is a local procoagulant stimulus.
fibrinous
Concerning fibrinous inflammation exudate,
With a large increase in vascular permeability, higher-molecular-weight proteins such as fibrinogen pass out of the blood, and is formed and deposited in the extracellular space.
fibrin
A exudate is characteristic of inflammation in the lining of body cavities, such as the meninges, pericardium, and pleura.
fibrinous
๏ Histologically, appears as an eosinophilic meshwork of threads or as an amorphous coagulum.
fibrin
๏ Purulent inflammation is characterized by the production of , an exudate of neutrophils, the liquefied debris of necrotic cells, and edema fluid.
pus
The most frequent cause of purulent (also called suppurative ) inflammation is infection with bacteria that cause liquefactive tissue necrosis, such as ; these are referred to as pyogenic (pus-producing) bacteria.
staphylococci
- Accumulation of pleural fluid may occur in the following settings:
- Increased hydrostatic pressure, eg, CHF.
- Decreased osmotic pressure, eg, nephrotic syndrome
. • Decreased lymphatic drainage, eg, mediastinal carcinomatosis.
• Increased vascular, eg, pneumonia.
permeability
Noninflammatory collections of serous fluid within the pleural cavities are called
clear and straw colored.
The most common cause is cardiac failure, and so it is usually accompanied by pulmonary congestion/edema.
• Transudates may also collect in any systemic disease associated with generalized edema, and so are found in renal failure and cirrhosis of the liver
hydrothorax .
The escape of blood into the pleural cavity is known as
• It is almost always a fatal complication of a ruptured aortic aneurysm or vascular trauma, or it may occur postoperatively
hemothorax.
is an accumulation of milky fluid, usually of lymphatic origin, in the pleural cavity.
• Chyle is milky white because it contains finely emulsified fats.
Chylothorax is most often caused by duct trauma or obstruction, that secondarily causes rupture of major lymphatic ducts.
• It is typically caused by malignancies that the major lymphatic ducts.*
Chylothorax; thoracic; obstruct
The most common causes of pleuritis are disorders associated with of the underlying lung, eg, tuberculosis, pneumonia, lung infarcts, lung abscess, and bronchiectasis.
exudates
inflammation
Systemic disorders, including Rheumatoid arthritis, systemic lupus erythematosus, uremia, diffuse systemic infections, and involvement of the pleura can also cause serous or serofibrinous pleuritis
metastatic
note: slide shows malignant cells in pleural fluid
A= metastatic mammary carcinoma in pleural fluid
B= Many proliferation spheres (arrows) are present due to continued division of carcinoma cells in nutrient rich effusions.
A purulent pleural exudate () usually results from bacterial or mycotic seeding of the pleural space.
• Most commonly, seeding occurs by contiguous spread of organisms from infection.
empyema; intrapulmonary
Empyema may resolve, but more often the exudate organizes into dense, tough fibrous that frequently obliterate the pleural space or envelop the lungs; either can seriously restrict pulmonary expansion.
adhesions
Hemorrhagic pleuritis manifested by sanguineous inflammatory exudates is infrequent and is found in hemorrhagic diatheses, diseases, and neoplastic involvement of the pleural cavity.*
rickettsial
When hemorrhagic pleuritis is seen, a careful search should be made for the presence of exfoliated cells.
tumor
note: tumor cells with hemorrhagic exudate (breast cancer metastasis)
Light’s criteria
Breast cancer, Romanaski stain
small cell carcinoma, not a lot of cytoplasm, nuclear molding (puzzle pieces)
