Pleural Disease - Unfinished Flashcards

1
Q

What type of cells make up the pleura?

A

Mesothelial cells

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2
Q

What is the net movement of any fluid that enters the pleural space?

A

It moves through the pleura space, through the visceral pleura and into the lungs

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3
Q

Which other organs (apart from the lungs) are covered by the pleura?

A

Liver, spleen and kidneys

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4
Q

What is a pleural effusion?

A

An abnormal collection of fluid in the pleural space

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5
Q

What are the possible symptoms of a pleural effusion?

A

Increasing breathlessness, pleuritic chest pain, dull ache, dry cough, weight loss, malaise, fevers and night sweats

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6
Q

What other conditions should be asked about if you suspect someone has a pleural effusion?

A

Peripheral oedema, liver disease, orthopnoea and PND

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7
Q

What are the signs of a pleural effusion?

A

On affected side there is: decreased expansion, stony dullness to percussion, a decrease in breath sounds and a decrease I vocal resonance.
Other signs: clubbing tar stained fingers, cervical lymphadenopathy, increased JVP, trachea is not central and peripheral oedema

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8
Q

What are the two main causes of pleural effusions?

A

Transudates and exudates

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9
Q

What is a transudate?

A

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

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10
Q

Are transudates typically unilateral or bilateral?

A

Bilateral

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11
Q

What is an exudate?

A

An increased permeability of the pleural surface and/or local capillaries

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12
Q

Are exudates typically unilateral or bilateral?

A

Unilateral

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13
Q

What amount of pleural fluid protein is considered to be a transudate?

A

<30g/l

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14
Q

What amount of pleural fluid protein is considered to be an exudate?

A

> 30g/l

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15
Q

What are the common causes of transudates?

A

Left ventricular failure, liver cirrhosis, hypoalbuminaemia and peritoneal dialysis

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16
Q

What are the common causes of exudates?

A

Malignancy (lung, breast, mesothelioma etc.) and Pulmonary embolism/infarction

17
Q

What investigations might be done if a pleural effusion is expected?

A

Chest radiograph, CT scan of the thorax and pleural aspiration and biopsy

18
Q

What is the drawback with using a chest radiograph to detect a pleural effusion?

A

At least 200ml of fluid is required before it is detectable on a chest X-Ray

19
Q

What is the benefit of a CT scan?

A

It can differentiate between malignant and benign disease

20
Q

What are the complications of a pleural aspiration?

A

Pneumothorax, empyema, pulmonary oedema, vagal reflex, air embolism, tumour cell seeding and haemothorax

21
Q

Which laboratories would you send an effusion sample to?

A

Biochemistry, microbiology and cytology

22
Q

What is the management of a pleural effusion?

A

Treatment of the cause, palliative (usually malignancy, pleurodhesis and if lung has re-expanded then chemical pleurodhesis

23
Q

What is a pneumothorax?

A

Air within the pleural cavity

24
Q

What are the two main categories of pneumothoraces?

A

Spontaneous and traumatic

25
Q

What is meant by a primary pneumothorax?

A

A pneumothorax in which there is no clinically apparent disease

26
Q

What is believed to be the cause of a primary pneumothorax?

A

The weight of the lung inducing development of apical blebs that rupture

27
Q

What is the main cause of a secondary pneumothorax?

A

Pre-existing lung disease (COPD, asthma, TB, CF etc.)

28
Q

What are the main causes of non-iatrogenic pneumothoraces?

A

Penetrating and blunt chest injuries

29
Q

What are the main causes of latrogenic pneumothoraces?

A

Pleural aspiration/biopsy, subclavian vein cannulation, lung/liver/breast/renal biopsies and acupuncture