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Respiratory > Pleural Disease > Flashcards

Pleural Disease Flashcards

1
Q

What is the overall direction of pleural fluid flow?

A

Into the lungs

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2
Q

What forces influence the flow of pleural fluid?

A

Plasma Oncotic Pressure, Pulmonary Arterial Pressure and Systemic Arterial Pressure

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3
Q

What abdominal organs does the pleura cover?

A

The Kidneys, Liver and Spleen

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4
Q

Name three diseases which affect the pleura

A

Pleural Effusion, Pneumothorax and Mesothelioma

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5
Q

What are two types of pleural effusion?

A

Transudate and Exudate

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6
Q

What is a Transudate?

A

Pleural Fluid Protein less than 30g/l (25)

Caused by an imbalance in pressure

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7
Q

What is an Exudate?

A

PFP more than 30g/l

Caused by increased permeability of the pleura due to damage.

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8
Q

Which is Bilateral?

A

Transudate

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9
Q

What might trigger a Transudate?

A

Heart Disease, Low Albumin, Peritoneal Dialysis

Ovarian Hyper stimulation (IVF) , Hypothyroidism

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10
Q

What might trigger an Exudate?

A

Malignant Disease, Para pneumonic,

Some drugs, yellow nail syndrome

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11
Q

Symptoms of Pleural Effusion?

A

Breathlessness
Pleuritic chest pain
Dull ache, dry cough, malaise, night sweats

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12
Q

Signs of a pleural Effusion?

A 
Reduced chest expansion
Lymphadenopathy
Stony Dullness on percussion
Decreased vocal reasonance
Elevated JVP
Trachea moved away from effusion.
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13
Q

What imaging can be used in pleural effusion?

A 
CXR= confirm effusion if over 200ml
CT= malignancy if pleural thickening in any area.
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14
Q

Clinical Investigations?

A

Pleural Aspiration

Pleural Biopsy= always take downwards to avoid artery

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15
Q

In empyema the pus will be…

A

Foul smelling

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16
Q

Why do we use saline if TB is suspected?

A

Because putting the sample in formaldehyde would kill the TB cells.

17
Q

Management of Pleural Effusion?

A

Transudate= treat the cause (chemo, steroids, anti TB)
Exudate= Palliative care for malignant disease
Could have regular pleural aspiration (1-1.5L)

18
Q

What is Pleurodhesis?

A

Drain fluid from pleura (slowly)
Ensure lung is fully expanded- CXR
Blow talc into pleural cavity.

19
Q

What is a pneumothorax?

A

Air in the pleural cavity, loss of adhesion, lungs collapse

20
Q

Two types of pneumothorax?

A

Spontaneous (primary vs secondary)

Traumatic (iatrogenic vs non-iatrogenic

21
Q

What is Iatrogenic?

A

Caused by a surgeon or other health care professional

22
Q

What is a tension pneumothorax?

A

When there are one way valves which let air into the pleura on inhalation but don’t let it escape on exhalation.

23
Q

Tension pneumothorax causes…

A

Mediastinum is pushed across the chest, Vena cava is stretched CO2 rises and O2 drops= ILL Patient

24
Q

Symptoms of a pneumothorax?

A

None
Acute/ worsening breathlessness
Pleuritic Chest pain & extreme breathlessness= tension

25
Q

Signs of a Pneumothorax?

A

Surgical Emphysema
Non tension= trachea towards affected side
Tension= trachea away from affected side

26
Q

Management of a tension PNEUMOTHORAX

A

Cannula in 2nd intercostal space, intercostal chest drain

27
Q

Breathless primary

A

Aspirate, (up to 3l or until lung hits needle)

Chest drain if unsuccessful

28
Q

Breathless Secondary

A

Chest drain, 4th intercostal, mid axillary line.

29
Q

How long should it take for a chest drain to work?

A

1-2 days chest should inflate and drain stops bubbling

30
Q

What would happen after 48hrs of chest drain?

A

Apply suction (high volume, low pressure)

31
Q

What is the recurrence rate for a pneumothorax?

A

54% within 4 years, 10-25% within 4 months

32
Q

Refer for surgery if…

A

First pneumothorax in high risk profession
First contralateral pneumothorax
Second ipsilateral pneumothorax
Bilateral spontaneous

33
Q

Procedures for a pneumothorax?

A

Only used if it does not resolve naturally- the lung should gradually inflate.
Pleurodectomy= remove pleura, create blood seal
Talc Poudrage= coat lung surfaces in talc, v painful.

34
Q

What can asbestos exposure lead to?

A

Mesothelioma

35
Q

Symptoms of mesothelioma?

A

Breathlessness, malaise, weight loss, chest wall pain

36
Q

Treatment of mesothelioma?

A

No cure, can only offer palliative care & legal/ government compensation

37
Q

Procurator Fiscal?

A

Refer all mesothelioma deaths here

Respiratory (20 decks)

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