pleural disease Flashcards

1
Q

where does pleural fluid normally come from and go out

A
  • comes in from intercostal and bronchial vessel system
  • goes out the lymphatic drainage system
  • most action on the parietal side
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2
Q

what happens in CHF

A

transudate

  • high pressure in blood vessels pushes fluid in
  • high pressure blocks lymphatic drainage
  • get more in than out
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3
Q

what happens in inflammation

A

exudate

  • high pressure from blood vessels
  • cells wall separate and let proteins into the pleural space
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4
Q

what happens in CA

A

exudate

  • high pressure in vessels
  • tumors can block lymphatics
  • cytokines can cause walls to separate
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5
Q

3 cauese of transudate

A
  1. CHF
  2. hepatic hydrothorax
  3. nephrotic syndrome
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6
Q

4 general cause of exudate

A
  1. infection
  2. malig
  3. inflammatory
  4. other
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7
Q

CXR signs of effusion

A
  • blunting of costophrenic angle
  • meniscus
  • increased opacity
  • pleural fluid layering out
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8
Q

what is thoracentesis

A
  • sampling of fluid

- can be done with local

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9
Q

light’s crit. for exudate

A

it is exudate if any one of:

  1. pleural prot:serum protein >0.5
  2. pleural LDH:serum LDH >0.6
  3. LDH > 200
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10
Q

what is high LDH sign of

A
  1. empyema
  2. RA
  3. malig
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11
Q

what is high protein sign of

A
  1. TB

2. myeloma

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12
Q

what is low pH sign of

A
  1. empymena
  2. TB
  3. RA
  4. malig.
  5. eso rupture
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13
Q

what is low glucose sign of

A
  1. epymnema
  2. TB
  3. RA
  4. malig
  5. eso rupture
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14
Q

what are 3 cell counts to look and and what do they tell us

A
Neutrophil
- bacterial
Lymphocyte
- malig, TB
Eosinophil
- pneumo, hemothorax, drugs, parasites
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15
Q

what is MGMT of transudate

A

TREAT underlying problem

- can also help reduce the afterload

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16
Q

4 possible Tx of malig. effusion

A
  1. repeated thoracentesis
  2. pigtail cath.
  3. pleurodesis - more definitive
  4. indwelling pleural cath - tunneled under skin
17
Q

2 types of spont. pneumothoraxes

A
  1. primary

2. secondary

18
Q

4 risks for primary

A
  1. smkoer
  2. male
  3. fam Hx
  4. marfans
19
Q

4 risks for secondary

A
  1. COPD
  2. CF
  3. pneumocystits
  4. TB
20
Q

mgmt of stable pneumothorax

A
  1. small
21
Q

mgmt of unstable pneumo

A
  1. chest tube
  2. if can do tube or emergency - needle decompression
  3. if all else - VATS