Pleural Disease Flashcards
What is the overall direction of pleural fluid flow?
Into the lungs
What forces influence the flow of pleural fluid?
Plasma Oncotic Pressure, Pulmonary Arterial Pressure and Systemic Arterial Pressure
What abdominal organs does the pleura cover?
The Kidneys, Liver and Spleen
Name three diseases which affect the pleura
Pleural Effusion, Pneumothorax and Mesothelioma
What are two types of pleural effusion?
Transudate and Exudate
What is a Transudate?
Pleural Fluid Protein less than 30g/l (25)
Caused by an imbalance in pressure
What is an Exudate?
PFP more than 30g/l
Caused by increased permeability of the pleura due to damage.
Which is Bilateral?
Transudate
What might trigger a Transudate?
Heart Disease, Low Albumin, Peritoneal Dialysis
Ovarian Hyper stimulation (IVF) , Hypothyroidism
What might trigger an Exudate?
Malignant Disease, Para pneumonic,
Some drugs, yellow nail syndrome
Symptoms of Pleural Effusion?
Breathlessness
Pleuritic chest pain
Dull ache, dry cough, malaise, night sweats
Signs of a pleural Effusion?
Reduced chest expansion Lymphadenopathy Stony Dullness on percussion Decreased vocal reasonance Elevated JVP Trachea moved away from effusion.
What imaging can be used in pleural effusion?
CXR= confirm effusion if over 200ml CT= malignancy if pleural thickening in any area.
Clinical Investigations?
Pleural Aspiration
Pleural Biopsy= always take downwards to avoid artery
In empyema the pus will be…
Foul smelling
Why do we use saline if TB is suspected?
Because putting the sample in formaldehyde would kill the TB cells.
Management of Pleural Effusion?
Transudate= treat the cause (chemo, steroids, anti TB)
Exudate= Palliative care for malignant disease
Could have regular pleural aspiration (1-1.5L)
What is Pleurodhesis?
Drain fluid from pleura (slowly)
Ensure lung is fully expanded- CXR
Blow talc into pleural cavity.
What is a pneumothorax?
Air in the pleural cavity, loss of adhesion, lungs collapse
Two types of pneumothorax?
Spontaneous (primary vs secondary)
Traumatic (iatrogenic vs non-iatrogenic
What is Iatrogenic?
Caused by a surgeon or other health care professional
What is a tension pneumothorax?
When there are one way valves which let air into the pleura on inhalation but don’t let it escape on exhalation.
Tension pneumothorax causes…
Mediastinum is pushed across the chest, Vena cava is stretched CO2 rises and O2 drops= ILL Patient
Symptoms of a pneumothorax?
None
Acute/ worsening breathlessness
Pleuritic Chest pain & extreme breathlessness= tension
Signs of a Pneumothorax?
Surgical Emphysema
Non tension= trachea towards affected side
Tension= trachea away from affected side
Management of a tension PNEUMOTHORAX
Cannula in 2nd intercostal space, intercostal chest drain
Breathless primary
Aspirate, (up to 3l or until lung hits needle)
Chest drain if unsuccessful
Breathless Secondary
Chest drain, 4th intercostal, mid axillary line.
How long should it take for a chest drain to work?
1-2 days chest should inflate and drain stops bubbling
What would happen after 48hrs of chest drain?
Apply suction (high volume, low pressure)
What is the recurrence rate for a pneumothorax?
54% within 4 years, 10-25% within 4 months
Refer for surgery if…
First pneumothorax in high risk profession
First contralateral pneumothorax
Second ipsilateral pneumothorax
Bilateral spontaneous
Procedures for a pneumothorax?
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.
What can asbestos exposure lead to?
Mesothelioma
Symptoms of mesothelioma?
Breathlessness, malaise, weight loss, chest wall pain
Treatment of mesothelioma?
No cure, can only offer palliative care & legal/ government compensation
Procurator Fiscal?
Refer all mesothelioma deaths here
