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Respiratory system SA > Pleura Diseases - pleural effusion > Flashcards

Pleura Diseases - pleural effusion Flashcards

1
Q

What are the three known diseases of the pleura

A

Pleural effusion
Pneumothorax
Mesothelioma

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2
Q

The pleura is a single layer of what type of cells?
What is the pleura lubricated with?
What is the pressure in the pleura?

A

mesothelial cells
2-3ml pleura fluid
-0.66kPa

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3
Q

What is the pressure pulling pleura fluid out of the pleura cavity

A

Plasma osmotic/oncotic pressure

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4
Q

What pressure is pulling pleura fluid into the pleura cavity

A

Systemic and arterial negative intra pleural pressure

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5
Q

What is the definition of pleura effusion

A

collection of fluid in pleural space that is

greater than 2-3ml of pleural fluid

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6
Q

What is the symptoms of pleura effusion

A 
Increasing breathlessness
pleuritic chest pain 
dull ache 
dry cough 
weight loss 
malaise 
fevers 
night sweats
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7
Q

When can a pleural effusion by asymptomatic

A

when its small and accumulates slowly

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8
Q

What activates coughing in pleura effusion

A

The feeling of heaving your lungs squished causes breathlessness activating receptors triggering you to cough

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9
Q

What is the signs of pleura effusion on chest examination

A

reduced chest expansion
stony dulness on percussion - due to water density
decreased breath sounds
decreased vocal resonance

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10
Q

What are further signs of pleural effusion on general examination

A 
Clubbing, 
tar staining of fingers
Cervical lymphadenopathy
Trachea away from large effusion 
Peripheral oedema
increased jugular venous pressure
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11
Q

What causes transudate pleural effusion

A

An imbalance of hydostatic forces influencing the formation and absorption of pleural fluid
Dont affect permeability
Usually bilateral

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12
Q

What causes exudate pleural effusion

A

is fluid that leaks around the cells of the capillaries caused by inflammation, increasing the permeability of of the local capillaries

e.g. malignancy

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13
Q

How much protein is roughly present in Exudate effusion and transudate effusion

A

exudates >35g/l

transudates <25g/l

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14
Q

Whats the most common cause of transudate pleural effusion

A

heart failure - left ventricle failure
Liver cirrhosis
hypoalbuminemia
Peritoneal dialysis- gut cleaning

Less common:
hypothyroidism 
Kidney disorder 
narrowing of heart valves
Pulmonary embolism
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15
Q

What is the most common cause of exudate pleural effusion

A

Malignancy (Lung/breast)
Pulmonary embolism
parapneumonic effusion

Less common
Rheumatoid arthritis
autoimmune disease  
Pancreatitis
Post myocardial infarction
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16
Q

What is parapneumonic effusion

A

a type of pleural effusion that arises as a result of a pneumonia, lung abscess, or bronchiectasis

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17
Q

What is very rare cause of transudate effusion

A

Constrictive pericarditis - inflammation of pericardium
Ovarian hyperstimulation syndrome
Meigs’ Syndrome - benign ovarian fibroma

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18
Q

What is the very rare causes of exudate effusion

A

Yellow nail syndrome

and certain Drugs

19
Q

Why don’t transudate effusions need much investigation

and when would they be investigated

A

as usually you can just treat the underlying cause

Investigate if:
Unusual features
Failure to respond to appropriate treatment

20
Q

What investigation confirms the presence of a pleural effusion

A 
Chest x ray - 200ml is detectable 
pleural aspiration and a  biopsy 
CT of thorax 
blood gas analyser 
Thorascopy - direct
21
Q

What does a more enhanced CT of the thorax enable you to see in a pleural effusion

A

Differentiates between malignancy or benign disease

looks for lumps on pleural surface

mediastinal and pleural thickening
parietal thickening above 1cm

other malignant manifestations

22
Q

What is the possible complications of an aspiration

A 
Pneumothorax
Empyema
Pulmonary oedema
Vagal reflex
Air embolism
Tumour cell seeding
Haemothorax
 -person is on anticoagulation and you hit a blood vessel
23
Q

what is the difference between aspiration and biopsy

A

aspiration is the removal of fluid with a needle and biopsy is the removal of tissue

24
Q

What does foul smelling pleural aspirin indicate

A

anaerobic empyema - pus

25
Q

What does food particles in the pleural aspiration indicate

A

oesophageal rupture

26
Q

What does a milky plural aspiration indicate

A

chylothorax - lymph formed in the digestive system called chyle accumulating in the pleural cavity due to either disruption or obstruction of the thoracic duct

27
Q

What does a blood stained pleural effusion usually indicate

A

Possible malignancy

28
Q

What does blood in the pleural effusion indicate

A

haemothroax

trauma

29
Q

When would a blood gas analyser be taken in the investigation of pleural effusion and what does it show us

A

If pus isn’t present in pleural aspiration

pH and if the operation is infected

30
Q

When the pleural aspiration is sent to the laboratories what biochemistry is analysed

A

Protein levels - transudate or exudate
LDH - Lactate dehydrogenase
amylase levels
glucose levels

31
Q

What does glucose levels below 3.3mM indicate in pleural effusion

A 
empyema 
rheumatoid arthritis
TB
malignancy 
Systemic lupus erythematosus (SLE) - autoimmune disease
32
Q

What would high amylase levels indicate in a pleural effusion indicate

A

pancreatitis, oesophageal rupture, or malignancy

33
Q

What does the cytology of an pleural effusion aspiration potentially show

A

lymphocytes
malignant cells
eosinophils

34
Q

What does the microbiology of a pleural effusion aspiration allow

A

Gram staining
test for acid-alcohol fast bacilli (resist decolorisation)
culture

35
Q

When protein levels are between 25g/l how do you distinguish between transudate and exudate

A

Lights criteria

36
Q

Using lights criteria when is it classed as an exudate

A

1) Pleural fluid : Serum protein ratio > 0.5
2) Pleural fluid LDH > 2/3 of the upper limit of the serum reference range
3) Pleural fluid : Serum LDH ratio > 0.6

37
Q

How many biopsies should be taken and where are each of these samples sent

A

4 biopsies
Send at least 3 in formaldehyde for histology
Send at least 1 in saline to microbiology if TB suspected

38
Q

What does treatment of pleural effusion dependant on

how do you treat the symptoms of pleural effusion

A

Underlying cause

Chest drain
Pleurodesis

39
Q

When would you use a chest drain in treating pleural effusion

A

Palliative care in treating effusion due to malignancy
If pH is below <7.2
Or if Pleural Aspiration shows infection

40
Q

When would you perform a Pleurodesis and what is the procedure

A

In cases of severe recurrent pleural effusion

A procedure that causes the membranes around the lungs to stick together and prevents the buildup of fluid in the pleural space

41
Q

Where is a chest tube placed?
How does the process work?
What additional resource helps the process?

A

4th intercostal space mid-axillary line

repeated pleural aspiration 1-1.5 litres at any one time

a seal -drains the pleural cavity to dryness

42
Q

What checks the success of a pleurodesis and chest drain treatment

A

A chest X ray to see if lungs has re-expanded

43
Q

What are the two forms of pleurodesis and what is the processes

A

Chemical:
lindocaine or a slurry of talc can be introduced into the pleural space through a chest drain or in thorascopy causing irritation between the parietal and the visceral layers of the pleura which closes off the space between them and prevents further fluid from accumulating

surgical:
Performed in thorascopy, mechanically irritate pleural closing space and preventing re-accumulation fluid

Respiratory system SA (37 decks)

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