Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

module 103 - theme 4 > pleural & chest wall diseases > Flashcards

pleural & chest wall diseases Flashcards

1
Q

what are the key characteristics of the pleura?

A
  • 0.3-0.5mm thick
  • pleural fluid forms a <1mm film
  • pH is around 7.6
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is the pleura?

A

a thin tissue covered by a layer of cells (mesothelial cells) that surrounds the lungs and lines the inside of the chest wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are the 2 layers of the pleura?

A
  • parietal pleura
  • visceral pleura

these are both completely separate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are the key characteristics of the pleural space?

A
  • normally at negative pressure which keeps the lungs inflated
  • only has a few mls of fluid which helps lubricate the normal movement of the lungs during breathing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is contained in the pleural fluid?

A
  • protein
  • lymphocytes
  • macrophages
  • mesothelial cells
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is a pleural effusion?

A

fluid in the pleural space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is a pneumothorax?

A

air in the pleural space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what are the presenting features of a pneumothorax?

A
  • breathless
  • chest pain
  • cough
  • features within the history
  • raised respiratory rate, may have low oxygen saturation
  • if unwell tension pneumothorax may be very unwell/peri arrest
  • on examination: reduced breath sounds, increased percussion note, reduced expansion, tracheal deviation
  • abnormal CXR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what happens with a pneumothorax?

A
  • air in pleural space
  • entry of air creates positive pressure leading to collapse of lung
  • tension pneumothorax leads to ‘one way valve’
  • primary/secondary/traumatic/latrogenic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are the features of a primary pneumothorax?

A
  • spontaneous
  • occurs in healthy young tall males
  • apical bleb
  • more common in smokers (especially cannabis smoking)
  • tension: rarely occurs
  • managed according to the size and symptoms of the patient
  • won’t always need a drain or admission
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are the features of a secondary pneumothorax?

A
  • background of known lung disease
  • most likely need a drain
  • tension more common
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is the follow up like of a primary pneumothorax?

A
  • 54% recurrence in the first 4 years
  • 20-30% recurrence in the first 2 years
  • recurrent primary: surgical/medical thoracoscopy and pleurodesis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is the follow up like of a secondary pneumothorax?

A

attempt pleurodesis after the first episode as the recurrence rate is high

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is the advice for a pneumothorax?

A
  • no deep sea diving ever (as sudden change in pressure risk is higher)
  • normal swimming and diving to less than 10 depth is fine
  • air travel: one week after full re-expansion of the lung
  • coast guards, naval officers, air force etc need to change jobs
  • high altitude sports and travel should be done with caution and should be discourages
    stop smoking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what happens with a pleural effusion?

A
  • small volume of lubricating fluid is maintained via a delicate balance of hydrostatic oncotic pressure and lymphatic drainage
  • disturbances in any of these mechanisms may lead to pathology and cause pleural effusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are the clinical features of a pleural effusion?

A
  • shortness of breath
  • cough
  • pleuritic chest pain
  • reduced breath sounds
  • ‘dull’ to percussion on examination
17
Q

what are the causes of pleural effusion?

A
  • altered permeability of the pleural membranes
  • reduced oncotic pressure (low albumin)
  • increased capillary hydrostatic pressure
  • decreases lymphatic drainage or blockage
  • increased peritoneal fluid
  • most common cause are heart failure, pneumonia and malignancy
18
Q

what are the infections make pleural effusion more likely?

A
  • bacterial
  • TB
  • fungal
  • viral
19
Q

what benign causes make pleural effusion more likely?

A
  • high oncotic pressure: heart failure, fluid overload
  • low protein state: nephrotic syndrome, protein losing enteropathy, chronic liver disease
  • autoimmune disease: rheumatoid arthritis, SLE
  • reactive: PE, dressers syndrome
20
Q

what malignant causes make pleural effusion more likely?

A
  • primary: mesothelioma

- secondary: most common = primary lung, breast, gynaecological, haematological, renal, GI tract

21
Q

what are the risk factors of pleural infection?

A
  • diabetes
  • immunosuppression
  • alcohol, IVDU
  • poor oral hygiene and aspiration (anaerobic)
  • latrogenic
  • trauma
  • recent hospitalisation
22
Q

what are the predictors for the worse outcome of pleural infection?

A
  • pH <7.2 high LDH
  • low glucose (<2/3rd serum glucose)
  • positive culture
  • loculations (seen on ultrasound or CT)
23
Q

what is the spectrum of parapneumonic effusions?

A

uncomplicated parapneumonic effusion
- resolve on treatment of underlying pneumonia, may not need to be drained

complicated parapneumonic effusion

  • bacterial invasion into the pleural space
  • fibrin deposition may form locules/septations
  • patient will likely need a drain

empyema

  • Frank pus within the pleural cavity
  • may organise with thickening of the pleural surface preventing lung re-expansion and impairing lung function
24
Q

what are the principles of care with pleural infection?

A
  • accurate diagnosis
  • control infection: choosing correct antibiotics
  • drainage of infection material: chest drain, management of the chest drain is key, aim is to remove infection form pleural space so avoid blockages
25
Q

what are the features of malignant effusion?

A
  • high recurrence rate
  • medial life expectancy due to any cause: 6 months
  • significant impact on quality of life: last few weeks of life
  • impact on wider healthy economy: average LOS 4 to 6 days
  • mostly unilateral
  • massive unilateral effusion are usually not benign
26
Q

what are the symptoms of malignant effusion?

A
  • often present with breathlessness
  • cough
  • hypoxia
  • mostly are hemorrhagic
27
Q

how do you manage malignant pleural effusion?

A
  • minimally invasive and reduced number of interventions
  • options available: aspiration >90% recurrence rate, chest drain +/- pleurodesis 60-70% success, indwelling pleural catheter, thoracoscopic drainage + pleurodesis
28
Q

what are the benefits of drainage of effusion in dwelling pleural catheter?

A
  • avoids patient admission to hospital
  • suitable for long term drainage
  • improves quality of life
  • 50% spontaneous pleurodesis
29
Q

what is talc pleurodesis for pleural effusions (without infection)?

A
  • to prevent recurrence
  • mediated talc
  • creates a talc slurry to tick the pleura together
  • works in about 70%
  • lung needs to be reinforced and output <200ml/24hr
  • drainage can’t be blocked: drain needs to be fall out
  • pain, fever
30
Q

what are the characteristics of a haemothorax?

A
  • not a blood effusion
  • traumatic
  • latrogenic
  • aortic dissection
  • depending on cause: resuscitate, urgent drainage, consider VATS

module 103 - theme 4 (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions