Pleural disease Flashcards
what is the normal volume of the pleural space?
<10ml
differences b/w parietal and visceral pleura
parietal has nerves and lymphatics
Transudates vs exudates
transudates result from alterations of starling forces across normal membrane. Exudates result from alteration in membrane permeability
Lights Criteria
1) pleural protein/serum protein >0.5
2) pleural LDH/serum LDH >0.6
3) pleural fluid LDH > 2/3 normal serum LDH (>1000)
What do you call an effusion that doesn’t change with position?
Loculated
Top six causes of transudates
CHF, Cirrhosis, Nephrotic sndrome, Hypoalbuminemia, atelectasis, PE, myxedema, urinothorax, Fontan procedure, Peritoneal dialysis
Top causes of Exudates
Pulm infections, pleural malignancy, PE, obstruction of lymphatics, rupture of esophagus or thoracic duct
what does having pleuritic chest pain tell you?
the parietal pleura is involved
How does fremitus change with effusion? percussion? breath sounds? other findings?
decreased fremitus, dull to percussion, decreased breath sounds w/ bronchial sounds and crackles right above effusion. tracheal deviation away from effusion
How does oxygenation change in effusion? vital capacity?
no change
criteria for complicated pleural effusions
pH1,000, glucose<40
criteria for uncomplicated effusions
pH>7.3
if the pH is between 7.1-7.3 what do you do?
serial testing. If pH is not decreasing it’s uncomolicated
What are some causes for low glucose effusions
complicated parapneumonic effusions, empyema, RHEUMATOID ARTHRITIS, TB, cancer
What is the difference b/w tension and nontension pneumothorax? what causes tension? what are signs of tension?
Nontension-Pip=0. Tension-Pip approaches RA pressure, impeding venous return. Mediastinal shift to opposite side, depressed diaphragm. Tympani of same side. Hypotension/tachycardia.
