pleural disease Flashcards
patient presents with rapid shallow breathing and decreased lung sounds, where is the main localization
pleural space
what are signs associated with pleural space disease
muffled heart sounds, decreased lung sounds, rapid shallow breathing
what is the first step in working up a case that you suspect pleural disease
radiographs and/or ultrasound
where do you perform a thoracocentesis
between 7-8 intercostal space just above the CCJ. at the cranial border of the rib
when is your first choice to place a chest tube
pyothorax, or you are having to drain the chest multiple times with reoccurrence
generally, what are the transudate ranges for fluid samples
lower protein [] and lower nucleated cell count
how do you tell the difference between pure transudate and modified transudate
pure: is the lowest with only mononuclear cells (lymphs and monos)
modified: higher ranges with slightly higher nucleated cell counts and neutrophils on top of the mononuclear cells
what are the reasons we see transudate in the thorax
increased hydrostatic pressure
decreased oncotic pressure
lymphatic obstruction
signs of transudate pleural effusion on an exam
abnormal jugular pulses, gallop/arrhtyhmias, murmurs, ,muffled heart sounds
what are the causes of decreased plasma oncotic pressure
loosing albumin or decreased production
PLE- increased loss
liver disease- decreased production
what is on our differential list for any type of pleural effusion
neoplasia
what is the difference between nonseptic and septic exudate
both are high numbers
nonseptic: nondegenerate cells, no organisms
septic: degenerative neuts are predominant, bacti observed
what are unique clinical signs of non/septic exudate
fever, lethargy, anorexia, weight loss
what antibiotic do we reach for in exudate effusion
clavamox
what is unique about chylous effusion
cells are mostly small lymphs and nondegenerate neuts as it becomes more chronic
moderate numbers
where is the chylous from?
leaking from the thoracic duct
if you have a dog presenting with lethargy, anorexia, weight loss, ex. intol, and cough which pleural effusion is higher on your ddx
exudate and chylous effusion
you diagnose chylous effusion. what could be the primary cause
nothing
lung torsion
HW
neoplasia
trauma
diaph hernia
chronic pleural inflammation results in ______. why do we care?
fibrosis. cant drain all of the fluid out because this can cause the lungs to rupture from fibrous tissue limiting the expansion
how do you medically manage chylous effusion
low fat diet, periodical thoracocentesis, rutin?
hemorrhagic effusion vs hemothorax
hemothorax clots
what is the only neoplasia can you ddx from cytology of pleural effusion
lymphoma
how do you treat traumatic pneumothroax
conservatively, cage rest, periodic thoracocentesis
how to do you work up spontaneous pnuomothorax
remove air, exal for underlying disease
prefered treatment for idiopathic chylous effusion
sx ligation because medical management often doesnt work
