Pleura

Question 0

Where does the parietal pleura become continuous with the visceral pleura?

Answer 0

At the hila

Question 1

What lines the inside of each hemithorax?

Answer 1

Parietal pleura

Question 2

What is the pleural cavity and what is in it?

Answer 2

A potential pace between the two layers of pleura

A film of fluid produced by the parietal surface (absorbed by parietal and lymphatic vessels)

Question 3

What does the pleural fluid do?

Answer 3

Allows layers of pleura to slide over eachother which allows movement of the lungs against the chest wall while breathing
Provides surface tension so lungs can stay in contact with the thoracic wall

Question 4

How much pleural fluid is produced and absorbed in a day?

Answer 4

15ml

Question 5

How is pleural fluid produced?

Answer 5

By capillary filtration in parietal pleura, driven by Starling forces

Question 6

What forces increase production of pleural fluid?

Answer 6

Increased by

• increased lung interstitial fluid
• high hydrostatic pressure
• high permeability caused by inflammation, sepsis or malignancy
• low oncotic pressure in blood eg liver failure

Question 7

What factors affect lymphatic drainage?

Answer 7

Decreased by lymphatic blockage

Increased by systemic venous pressure

Question 8

What is a pleural effusion?

Answer 8

Any collection of extra fluid in the pleural space

Question 9

What is a haemothorax?

Answer 9

Collection of blood in the pleural space

Question 10

What is a chylothorax?

Answer 10

Collection of chyle in the pleural space (lymph with fats in it)

Question 11

What is empyema?

Answer 11

Collection of pus in the pleural space

Question 12

What is a simple effusion?

Answer 12

Collection of serous fluid in the pleural space

Question 13

Does transudate have high or low protein content?

Answer 13

Low - less than 30g per litre

Question 14

Does an exudate have a high or low protein content?

Answer 14

High - more than 30g/L

Question 15

When are transudates formed?

Answer 15

Increased hydrostatic pressure eg cardiac failure

Deceased capillary oncotic pressure eg hypoalbuminaemia, nephrotic syndrome

Increased capillary permeability eg sepsis

Question 16

When are exudates formed in the pleura?

Answer 16

Neoplasm - cancer involving pleural surface/secondary from breast, lung…/primary tumour of pleura

Infection eg pneumonia or TB

Immune disease eg CT disease eg rheumatoid arthritis, SLE

Abdominal disease eg pancreatitis, as cities, subphrenic abscesses causing diaphragmatic inflammation

Question 17

What is pleurisy?

Answer 17

Inflammation of the pleura

Question 18

Signs and symptoms of pleurisy?

Answer 18

Sharp pain on inspiration/coughing/sneezing/laughing…
Patient takes small breaths and holds affected side of chest
Involvement of diaphragmatic pleura causes pain in the shoulder
Pleural rub - a creaking noise heard through stethoscope

Question 19

Causes of pleurisy?

Answer 19

Infection eg TB, pneumonia
Autoimmune eg SLE, RA
Lung cancer
Pneumothorax
Pulmonary embolism

Question 20

How does pleural fibrosis occur?

Answer 20

If there an unabsorbed pleural effusion

Question 21

Why happens if there are widespread effects of fibrosis of the pleura? (Small amount of thickening has no effects)

Answer 21

Restricted expansion
Reduction in lung volume
Reduction in compliance

Question 22

What congenital chest wall abnormalities can affect breathing?

Answer 22

Deformation ribs, sternum, T spine, scoliosis and kyphosis - cause function impairment of thoracic cage

Question 23

What muscular and neurological diseases can affect breathing?

Answer 23

Muscular dystrophy and many other muscular diseases
Polio

Get muscle weakness with lower resistance to respiratory tract infections due to poor clearance of secretions