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1ST YEAR SYSTEMS: Respiratory > Pleural disease > Flashcards

Pleural disease Flashcards

1
Q

what is a pleural effusion

A

collection of fluid between two pleural layers of lung (in the pleural space)

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2
Q

what are you looking for when you inspect pleural fluid

A

cloudy
blood
pus

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3
Q

pus in pleural fluid can mean what?

A

empyema

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4
Q

Cloudy pleural fluid can mean what?

A

exudate - protein
infection
milky (chylothorax- rare)

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5
Q

Blood in pleural fluid can mean what?

A

malignancy
TB
trauma
infarct

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6
Q

which microbiology tests are always used to inspect pleural fluid?

A

gram stain
AAFB - Alcohol and acid fast bacilli (continuous automated bacterial culture - can take up to 8 weeks) - mainly checking for AFB for TB diagnosis
culture

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7
Q

when should you drain an effusion?

A

when it is large : breathless, raised RR, Hypoxia, Tachycardic, CXR trachea deviated

Parapneumonic , PH < 7.2 (caused by pneumonia)

Pus

Trauma/Post operative

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8
Q

when should you drain an effusion?

A

when it is large : breathless, raised RR, Hypoxia, Tachycardic, CXR trachea deviated

Parapneumonic , PH < 7.2

Pus

Trauma/Post operative

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9
Q

what does ‘the pleura’; consist of

A

single layer of mesothelial cells - line serous cavities and internal organs. Primary function - provides a slippery, non-adhesive and protective surface.

sub-pleural connective tissue

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10
Q

how many ml of pleural fluid usually found in the layers between pleura

A

2-3 ml

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11
Q

symptoms of a pleural effusion depend on what

A

cause and volume of fluid

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12
Q

a pleural effusion can be asymptomatic if…?

A

it is small and accumulates slowly

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13
Q

name some common symptoms associated with a pleural effusion

A

Increasing breathless (days, weeks, months)

Pleuritic chest pain

inflammatory: early, may improve as fluid accumulates
malignancy: progressively worsening

Dull ache

Dry cough – especially if rapid accumulation

Weight loss, malaise, fevers, night sweats

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14
Q

what are some clinical signs, in the chest area, of a pleural effusion?

A

on the effected side…

the chest should have fallen in (hear a stony dullness to percussion)
decreased breathsounds
decreased vocal resonance

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15
Q

what are some more general signs of a pleural effusion?

A

Clubbing

Chest examination - reduced expansion, breath sounds and vocal resonance. Stony, dull percussion

Cervical lymphadenopathy -enlarged nodes

increased jugular venous pulse JVP

Trachea away from large effusion (if unchanged? collapse)

Peripheral oedema

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16
Q

what can is a pleural effusion classified into by its protein concentration?

A

transudate or exudate

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17
Q

causes of transudate?

A

An imbalance of hydrostatic forces influencing the formation and absorption of pleural fluid.

Normal capillary permeability.
Usually (not always) BILATERAL

increase in venous pressure (cardiac failure, constrictive pericarditis, fluid overload)

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18
Q

causes of exudates

A

increased permeability of pleural surface and/ or local capillaries
basically leakiness of pleural capillaries secondary to infection, inflammation or malignancy ie pneumonia, TB, pulmonary infarction
usually UNILATERAL

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19
Q

what is a transudate?

A

filtrate of blood

caused by increased pressure in the veins and capillaries that forces fluid through the vessel walls

20
Q

what is an exudate?

A

a mass of cells and fluid that has seeped out of blood vessels or an organ, especially in inflammation

21
Q

classically, a pleural fluid protein level >30g/l is…

A

an exudate

22
Q

classically, a pleural fluid protein level <30g/l is…

A

a transudate (proteins not pushed out as can’t fit between endothelial cells)

23
Q

a transudate can very commonly come about from which health problems

A

anything that changes pressure in vessels

left ventricular failure - blood flowing back to pulmonary arteries - increase in pressure - fluid forced out due to this

liver problems

Peritoneal dialysis

24
Q

an exudate can very commonly come about from which health problems

A

usually inflammatory - endothelial cells more spaced out due to inflammation - more proteins can be forced out with the fluid

Malignancy (lung, breast, mesothelioma, metastatic)	
Parapneumonic effusion (as a result of pneumonia)
25
Q

an exudate rarely comes about from which health problems/ drugs

A

Yellow nail syndrome

Drugs :
amiodarone
nitrofurantoin phenytoin penicillamine

26
Q

how man ml of effusion is required before an effusion is detected on CXR

A

at least 200 ml

27
Q

example of investigations carried out for pleural effusion

A

CXR - to confirm the presence of effusion

contrast enhanced CT of thorax - usually differentiates between malignant and benign disease

pleural aspiration - small needle or tube is inserted to remove sample of pleural fluid

biopsy

28
Q

pleural aspiration technique

A

50 ml syringe 21 G needle
lignocaine anaesthesia
blood culture bottles

29
Q

complications with a pleural aspiration (7)

A

pneumothorax
Empyema
Pulmonary oedema
Vagal reflex - feeling faint, warm, nauseous
Air embolism - air bubble entering artery
Tumour cell seeding - local spread of viable tumour cells due to intervention
Haemothorax

30
Q

analysis of pleural aspiration done on the ward?

A

look and sniff

foul smelling - anaerobic empyema

pus - empyema

food particles - oesophageal rupture

milky - chylothorax

blood stained - malignancy?

blood - haemothorax, trauma

31
Q

what results are required from a blood gas analyser before a chest drain is on the cards

A

if it is infected

and pH is <7.2

32
Q

what lab analysis is done on a pleural aspiration?

A

microscopy, gram stain, AAFB- alcohol and acid fast bacilli, culture

33
Q

what things are biochemists looking for in pleural aspiration sample

A

protein, LDH
increased amylase levels
glucose <3.3mM

34
Q

where is a biopsy done?

A

immediately above a rib

35
Q

difference between abram’s needle and tru-cut in pleural biopsy?

A

abram’s needle - blind biopsies

tru-cut CT guided

36
Q

how many pleural biopsies are done at once

A

at least 4 biopsies
3 sent in formaldehyde for histology
1 sent to microbiology if TB is suspected

37
Q

if after a pleural aspiration there is still no diagnosis what is done?

A

a thoracoscopy
or video assisted thoracoscopy

which allows for direct inspection of pleura and directed biopsies

38
Q

treatment of pleural disease

A

directed at the cause:

chemotherapy
antituberculous chemotherapy
corticosteroids

39
Q

how is malignancy detected in pleural disease and what does that mean for treatment

A

repeated pleural aspiration 1-1.5 litres at any one time
hospitalised, very limited life expectancy

palliative care treatment usually

40
Q

what is pleurodhesis

A

procedure performed to obliterate the pleural space to prevent recurrent pleural effusion or pneumothorax or to a treat persistent pneumothorax
chest tube is fixed in place through chest and this drains fluid

41
Q

rate of fluid drainage using pleurodhesis

A

no faster than 500 ml/hr

42
Q

what are asbestos

A

Highly fibrous naturally occurring mineral

most dangerous type- crocidolite- blue

43
Q

who is exposed to asbestos

A

building trade
ship building
plumbers

44
Q

what is malignant mesothelioma and what are some

A

type of cancer that develops in the lining that covers the outer surface of some of the body’s organs

45
Q

What is malignant mesothelioma mostly caused by

A

exposure to asbestos

benign is not cancerous and not due to asbestos

46
Q

what are pleural plaques

A

characterised by areas of fibrous thickening on the pleura and the outermost lining of the lungs or diaphragm.

  • The condition typically arises 20 to 30 years after asbestos exposure.
  • they’re benign

1ST YEAR SYSTEMS: Respiratory (38 decks)

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