pleural disease Flashcards
what is pleural effusion?
abnormal collection of fluid in the pleural space
- do a pleural tap
what does straw coloured fluid mean?
cardiac failure
hypoalbuminaemia
what does bloody coloured fluid mean?
trauma
malignancy
infection
infarction
what does turbid/milky ocloured fluid mean?
empyema
chylothorax
what does foul smelling fluid mean?
anaerobic empyema
what do food particles in the fluid mean?
oesophageal rupture
transudates?
proteins < 30 g/L
heart failure
liver cirrhosis
exudates?
proteins > 30 g/L
malignancy
infection inc TB
fluid pH
normal = 7.6
< 7.3 = pleural inflammatoin
< 7.2 = requires drainage in the setting of infection
when is gluocse low?
in infection TB rheumatoid arthirisis malignancy oesophagela rupture SLE
when is amylase raised?
in pancreatitis and oesophageal rupture
when is creatine raised?
in urinothroax
when is adenosine deaminase raised?
in TB
what are the effects of systematic tumours?
embolism
hypoalbuminaemia
what are the effects of local tumours?
post obstructive infection
lymphatic obstruction
atelectasis
what is mesothelioma?
uncommon malignant tumour in the lining of the lung or very occasionally in the lining of the abdominal cavity
- as a result of asbestos
- may causes breathlessness, chest pain, weight loss, fever, sweating and coughing
what is asbestos?
- chrysotile = white = most common
- amosite = brown
- crocidolite = most dangerous
what is the treatment for mesothelioma?
- pleurodese effusion
- radiotherapy
- surgery
- chemotherapy
- paliative care
what is a long term pleural catheter?
- designed to allow patients to control their effusion and symptoms
- designed to remain in place for life
- complications: incorrect placement, bleeding, infection
how do you treat effusions?
- LVF = diuretics
- infection = drian, antibiotics, may require surgery
- malignancy = drain, pleurodesis, long term pleural catheter
what is the presentation of pneumothorax?
- tachycardia
- hyper-resonant pecussion note
- reduced expansion
- quiet breath sounds on auscultation
how do you manage pneumothorax?
<2cm = oxygen >2cm = high flow O2, aspirate via 16-18g cannula
do you give gentimycin for pleural infections?
no, avoid intra-pleural antibiotics
what do you give for pleural infection?
6 week course of co-amoxiclav
