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Kendigs Respiratory Diseases > Pleura > Flashcards

Pleura Flashcards

1
Q

What is the pleural space?

A

A layer of lubricated fluid that prevents friction between the two pleural layers and creates a negative pressure gradient for alveolar expansion and gas transfer.

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2
Q

What develops during the 4th week of gestation?

A

A primordial intraembryonic body cavity shaped like a horseshoe, termed the intraembryonic coelom.

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3
Q

What are the two layers of the mesothelium?

A
  • Outermost parietal layer
  • Inner visceral layer
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4
Q

What is the function of the visceral pleura?

A

Attached to the lung parenchyma, it plays a key role in fluid movement and has no somatic sensory innervation.

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5
Q

What supplies the visceral pleura?

A

Bronchial arteries.

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6
Q

What is the primary role of the parietal pleura?

A

Attached to the chest wall and diaphragm, it provides drainage for pleural fluid through lymphatic spaces.

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7
Q

How does maximum filtration occur in the pleural space?

A

In dependent regions of the parietal pleura, particularly diaphragmatic and mediastinal surfaces, due to greater density of stomata.

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8
Q

What is the role of stomata in the pleural space?

A

They increase in size with inspiration, creating a negative pressure gradient that aids in fluid drainage.

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9
Q

What is pleural effusion?

A

Accumulation of fluid in the pleural space due to increased filtration or abnormal drainage.

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10
Q

What characterizes transudate in pleural effusions?

A

Low leukocyte count, lower protein levels, and normal capillary permeability.

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11
Q

What characterizes exudate in pleural effusions?

A

Higher protein levels, increased leukocyte count, and abnormal capillary permeability.

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12
Q

What is pneumothorax?

A

Air accumulation within the pleural space due to breaches in the pleura.

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13
Q

What are the types of pneumothorax?

A
  • Primary pneumothorax
  • Secondary pneumothorax
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14
Q

What are common causes of pneumothorax?

A
  • Spontaneously
  • Chest trauma
  • Iatrogenic
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15
Q

What is the pathophysiology of tension pneumothorax?

A

Air leaks unable to drain, causing progressive accumulation with each inspiratory effort.

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16
Q

What diagnostic method is used for pneumothorax?

A

Chest X-ray (CXR) to assess lung collapse and air hyperlucency.

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17
Q

What is the first-line treatment for tension pneumothorax?

A

Needle thoracentesis should be performed immediately.

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18
Q

What is the recommended treatment for small primary pneumothorax?

A

Conservative management with high-flow oxygen.

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19
Q

What are the key characteristics of empyema?

A

Fever, lethargy, productive cough, respiratory distress, and toxicity from pneumonia.

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20
Q

What is the most common cause of empyema?

A

Bacterial pneumonia.

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21
Q

What are the clinical manifestations of empyema?

A
  • Fever
  • Tachypnea
  • Decreased breath sounds
  • Chest pain
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22
Q

What should be suspected in children not responding to antibiotics within 48 hours?

A

Empyema.

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23
Q

What are the characteristics of nonparapneumonic pleural effusions?

A
  • Congenital heart disease
  • Renal and liver disease
  • Connective tissue disorders
  • Malignancy
24
Q

What is the role of the pleural lymphatic drainage system?

A

Maintains the volume of the pleural space and responds to increased filtration.

25
What factors increase the risk of spontaneous pneumothorax?
* Tall, thin boys * Respiratory distress syndrome * Congenital renal malformations
26
What is the significance of pleural fluid turnover?
Normal turnover is 0.2 ml/kg/hr.
27
What happens to pleural porosity in genetic connective tissue disorders?
Areas of disrupted mesothelial cells in the visceral pleura can occur.
28
What are the differences between transudate and exudate in pleural effusions?
* Transudate: low protein, low leukocyte count * Exudate: high protein, high leukocyte count
29
What is a potential complication of pneumothorax during diving?
Risk of recurrent pneumothorax due to Boyle's law.
30
What is the recommended action for patients with closed pneumothorax regarding flying?
They should not fly due to low cabin pressure.
31
What is the pathogenesis of empyema?
Mediated by increased vascular permeability secondary to cytokines from mesothelial cells.
32
What is empyema?
Accumulation of pus in the pleural space. ## Footnote Empyema should be considered in children who do not respond to appropriate antibiotics within 48 hours.
33
What are the indications for considering empyema in children?
Ongoing fevers, toxicity, and respiratory distress after 48 hours of antibiotics. ## Footnote CXR should assess for progression.
34
What does a CXR show in cases of empyema?
Loss of the costophrenic angle and meniscus sign. ## Footnote Erect or lateral decubitus views are used.
35
What does a supine CXR show in empyema?
Subtle increase in generalized opacification, reflecting underlying fluid. ## Footnote It may show opacification throughout the pleural space.
36
What is the investigation of choice for empyema?
Ultrasound. ## Footnote CXR may help identify loculations if ultrasound is unavailable.
37
What suggests loculated fluid in an ultrasound?
Failure of fluid to shift with a change in position. ## Footnote Erect CXR compared with a decubitus film can indicate this.
38
What are the advantages of ultrasound in empyema?
* More accurate assessment of pleural fluid volume * Characteristic of the fluid (loculations or septations) * Identification of optimal sites for chest drain insertion * No sedation required * No radiation exposure ## Footnote Ultrasound is more sensitive than CT for certain assessments.
39
What does air in the pleural space suggest?
A complicated effusion may involve a bronchopleural fistula or perforated viscus. ## Footnote This indicates a need for further evaluation.
40
How is empyema graded?
* Grade 1: Anechoic * Grade 2: Echoic fluid without septation * Grade 3: Thick septations * Grade 4: >1/3 of effusion comprising solid components ## Footnote Grades 1 and 2 do not have septations, while grades 3 and 4 are more complex.
41
What is the management aim for empyema?
Treat the microbial cause, sterilize pleural fluid, allow lung reexpansion. ## Footnote This may involve gradual reabsorption or active drainage.
42
What is the recommended antibiotic coverage for empyema?
Coverage for S. pneumoniae, S. pyogenes, and S. aureus, with macrolide for M. pneumonia. ## Footnote IV antibiotics continue until the child is afebrile for 24 hours.
43
What are the indications for surgical intervention in empyema?
Failure of conservative management, disease progression, or ongoing clinical issues. ## Footnote VATS is preferred over minithoracotomy.
44
What are common complications of empyema?
* Bronchopleural fistula * Pneumothorax * Lung abscess * Empyema necessitans ## Footnote Surgical intervention may be required for organized effusions.
45
What is chylothorax?
Accumulation of lymphatic fluid (chyle) in the pleural space. ## Footnote It often results from thoracic duct disruption.
46
What is the main function of the lymphatic system?
* Transport lipids and lipid-soluble vitamins * Circulate lymphocytes * Return fluid and protein from interstitial space to systemic circulation ## Footnote This is essential for maintaining fluid balance.
47
What is chyle fluid?
Lymphatic fluid containing chylomicrons, giving it a milky appearance. ## Footnote Chylomicrons are formed from long-chain triglycerides and enable fat absorption.
48
What are the common causes of chylothorax?
* Congenital abnormalities * Trauma * Postoperative complications * Cancer ## Footnote It is the most common cause of pleural effusion in neonates.
49
What are the clinical manifestations of chylothorax?
Dyspnea and cough, similar to other pleural effusions but without signs of infection unless secondarily infected. ## Footnote Significant accumulation can lead to cardiorespiratory complications.
50
What investigations are used for chylothorax?
* CXR * Ultrasound * Thoracentesis * Biochemical analysis of pleural fluid ## Footnote Presence of chylomicrons confirms diagnosis.
51
What is the management strategy for chylothorax?
Conservative medical management initially, followed by surgical intervention if necessary. ## Footnote Aims to decrease flow through the thoracic duct.
52
What dietary management is recommended for chylothorax?
Medium-chain fatty acids diet or total parenteral nutrition (TPN). ## Footnote Medium-chain triglycerides bypass intestinal lymphatics.
53
What is the role of somatostatin in chylothorax management?
It decreases lymph production, allowing time for healing of the thoracic duct breach. ## Footnote Octreotide is a synthetic analogue of somatostatin.
54
What is hemothorax?
Accumulation of blood in the pleural space, common after serious thoracic trauma. ## Footnote It is rare in children but associated with a high mortality rate.
55
What is the purpose of a FAST ultrasound scan in trauma cases?
To assess for hemothorax, may be more sensitive than CXR. ## Footnote Focused assessment with sonography for trauma.

Kendigs Respiratory Diseases (38 decks)

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