Pleural disease Flashcards
What is pleural fluid composed of?
- Protein, LDH, glucose, triglyceride, cholesterol, amylase, rheumatoid factor.
How would you analyse pleural fluid in microbiology?
Gram stain, AAFB(alcohol acid fast bacilli) and culture
What is transudate in pleural effusion?
Transudate is fluid pushed through the capillary due to high pressure within the capillary.
- Transudates may be due to increase in venous pressure (cardiac failure, constrictive
pericarditis, fluid overload), or hypoproteinaemia (cirrhosis, nephrotic syndrome, malabsorption).
What is exudate in pleural effusion?
Exudate is fluid that leaks around the cells of the capillaries caused by inflammation, inflection or malignancy.
- Causes: pneumonia, TB,
pulmonary infarction, rheumatoid arthritis.
When would you drain an effusion?
- When it’s large: breathless, raised RR, Hypoxia, Tachycardic, CXR trachea deviated.
- Parapneumonic, pH<7.2
- Pus
- Trauma/post-operative
What is a parapneumonic effusion?
A parapneumonic effusion is a type of pleural effusion that arises as a result of a pneumonia, lung abscess, or bronchiectasis.
- There are three types of parapneumonic effusions: uncomplicated effusions, complicated effusions, and empyema.
Features of parapneumonic effusions
- Exudative effusion associated with a pneumonia
- Anechoic to turbid to pus
- Free flowing to loculated to thick walled
- Outcome poor
How would you treat parapneumonic effusions?
- Drain if pH <7.2
- Drain largest locule
- Inoculate blood culture bottles at time of sampling (40% culture negative)
- IV Abx
- Surgical referral early if poor control of sepsis and effusion established.
Types of pneumothorax
Pneumothorax can be spontaneous or traumatic.
- Spontaneous > Primary or Secondary spontaneous
- Traumatic > Non-iatrogenic or iatrogenic
Any of these can be tension pneumothorax
What is tension pneumothorax?
Tension pneumothorax is the progressive build-up of air within the pleural space, usually due to a lung laceration which allows air to escape into the pleural space but not to return.
Features of tension pneumothorax
- Non-ventilated patients insidious
- Ventilated Dramatic, emergency
- Distressed
- Trachea deviated, subcutaneous emphysema
- Reduced chest excursion
- Hyperresonance
- Hypoxia, tachycardia and hypotension
- Cardiac arrest
How do you treat/check if it’s tension pneumothorax?
- Oxygen
- Aspirate in the 2nd anterior intercostal space in the midclavicular line.
- Chest X-ray
- US to confirm if trained
What are the 3 main types of highly fibrous mineral asbestos?
- Chrysotile (white)
- Amosite (brown)
- Crocidolite (blue)
What could cause Asbestos related pleural disease?
- Occupation
- Spouses or family members
- Marine engineer, ship building, docks, construction sites, joiners, plumbers, engine rooms, boilers.
- Latent Period (20-4-y)
What could pleural plaques indicate?
Although pleural plaques may not place you at a higher risk of developing a more serious asbestos-related disease, the asbestos exposure that caused the plaques does.
