Pleural Disease

Question 1

Pleura function

Answer 1

LInes outer surface and inner

Isolates mediastinum and lung

Couples opposing forces

Question 2

Parietal vs. visceral pleura

Answer 2

Parietal - systemic capillary bed, lymphatic stoma, pain innervation

Visceral - pulmonary capillary bed, no lymphatic stoma or innervation

Question 3

Pleural fluid formation and handling

Answer 3

Normally favors production at parietal and resoroptiin of visceral

Visceral has limited resorptive capaicty…with more formation, transported via parietal pleura stomata to lymphatics

Pleural effusion when HS pressure increases, oncotic pressure decreases, cpaillary permeability increasdes or lymph obstruction

Question 4

Transudate vs. exduate

Answer 4

Trans - no inflammation ,no pain, tends to be bilateral

CHF, cirrhoris, hypoalbulienima, neprhotic

Exudates - pleural inflammation/neoplasia, pleuritic pain common, uni or bilateral

Pneumonia, cancer, PE, TB

Question 5

Thoracentesis

Answer 5

Measure Total protein and LDH

Fluid protein/serum>5
Fluid LDH/serum >.6
Flud LDH>2/3 upper limit

Any met, then exudagte

Question 6

Mech of pneumothorax

Answer 6

Air enters pleural space directly via chest wall (thoracic trauma or needle biopsy)

Air enters pleural space through tracheobronchial tree (ruptured lung bullae/bleb