Pleural disease Flashcards
What are the characteristics of the normal pleura?
• Glistening, smooth, thin membrane which covers the thoracic cavity and the lungs.
What types of cells are found in the pleural fluid?
• Macrophages, lymphocytes, mesothelial cells
How much protein is found in the pleural fluid?
• 1.5g-2g
What is the pressure of the pleural pressure
• Sub atmospheric (negative), -3cm to - 5cm, most negative pressure is at the apex of the lung.
What are the three main pleural problems?
• Pleural effusion, Pneumothorax, Mesothelioma
What is the pleural effusion?
• Collection of fluid
What is the Pneumothorax?
• Collection of air
What is Mesothelioma?
• Pleural malignancy
What is the cause of pleural effusion?
• Imbalance between production and absorption
What cells are responsible for absorption in the pleura?
• Pleural lymphatics in the parietal pleura
What are the two types of effusion?
• Trnasudate and exudate
What is a transudate?
• The non-inflammatory type of effusion (low protein content)
What is a exudate?
• It is an inflammatory type of exudate (high protein content 3g or more)
What are the main causes of transudate?
• Left ventricular failure, liver cirrhosis, renal failure.
What are the common causes of exudates
• Malignancy, Empyema, Parapneumonic effusions, Tuberculosis
How do you investigate and manage pleural effusion?
- Ultrasound: more sensitive than CXR, mark sire for aspiration, assess pleura, bedside
- CXR: accessible, easy to interpret
- CT Thorax: complex effusions, visualising the pleura, vascular and mediastinal structures
How do you analyse pleural fluid?
- Aspiration: simple and safe, trained operator
- Inspect the fluid
- pH (bedside ABG machine), biochemistry, microbiology and cytology
What action is needed for a pH less than 7.2?
• It may need a chest drain
How would you manage a transudate?
• treat the underlying cause, may not need CT imaging
How would you manage an exudate?
• Unless cause is identified, it will need further investigation for eg further imaging and or pleural biopsy.
What is a primary spontaneous pneumothorax?
• When the pneumothorax takes place in an individual with no underlying health conditions.
What is a secondary spontaneous pneumothorax?
• When the lung collapse happens in a person with a pre-existing lung disease.
What lung diseases can lead to a pneumothorax?
• interstitial lung disease, COPD, Asthma, cystic fibrosis
What is traumatic pneumothorax?
• Pneumothorax as a result of injury to the chest wall
What is a iatrogenic pneumothorax?
• It is as a result of a biopsy of the lung.
What is a tension pneumothorax?
• Air within a pleural cavity following a pneumothorax builds up and pushes the central structures of the chest and squashes the opposite lung. It aso squashes the heart and this results in a reduced blood pressure and because of the other squashed lung this can lead to low blood oxygen. This can lead to cardia arrest.
What is tachypneic?
• Breathing fast
What are the symptoms of a pneumothorax?
• Breathing fast, Hypoxic, Reduced chest wall movement and reduced or no breath sounds,