Pleural Diseases Flashcards
What do the mesothelial cells look like on visceral pleura?Parietal pleura
very bumpy and loose
Parietal pleura mesothelial cells are very tight together
How would you characterize the MC junctions in Visceral pleura?Parietal?
Tight in visceral, loose in parietal
microcillia population on visceral and parietal?
tons of microcillia on viscera, sparse on parietal
Characterize normal pleural fluid
Clear/odorless with very little in the way of protein
70% macrophages, 10% lymphocuytes, 2% polys
Which way does fluid move?
From parietal pleura to visceral pleura. The intercostal arteries have a high hydrostatic pressure which pushes fluid into the pleural space through the parietal pleura (mesothelial junctions, which are loose). The visceral pleura has a very low hydrostatic pressure which allows fluid to move in.
How are particles, protein and cells removed from the pleural fluid
Through lymphatic openings in the parietal pleura
In general, what causes pleural effusions
Changes in hydrostatic and oncotic pressure
Transudate
pleural effusion with very little protein
Exudate
Rich in protein….real rich
Causes of transudate
Increased hydrostatic pressure pushes fluid into the pleura. What happens is blood backs up in the pulmonary vasculature and the pulmonary circulation, which generally has fairly low jhydrostatic pressure, assumes a higher pressure and fluid is pushed in from both sides. Most commonly seen bilateral and cardiomegaly is present
- Atelectasis: Decreased pleural pressure, fluid comes in from both sides
- Decreased oncotic pressure: low albumin…fluid comes in bilaterally, due to malnutrition, renal loss, etc….
Causes of exudative effusion
Inflammation, infection, cancer….always due to increased vascular permeability
Signs of effusion
Decreased chest expansion, decreased breath sounds, no tactile fremitus, if one side is fluid filled the mediastinum will be pushed to that side.
Whats the difference between transudates and exudate on lab work
Trans= protein below .5, exudates above Trans= pleural LDH below .6, exudates above Trans= Serum lactate below 200, exudates above
pH, cell count, do not effect difference between transudates and exudates
truth…diff b/w transudate and exudate is protein
If the pleural effusion is less than 10 mm on lateral decubitus x-ray….
do nothing
Most common cause of transudate
CHF…..then nephrotic syndrome, then cirrhosis
Most common cause of exudate
cancer, infection,
When do you perform thoracentesis
when the fluid level is over 10 cm on lateral decubitus film
Most common cause of Lymphocytosis in thoracentesis
TB, Cancer…..some shit called AFB is usually positive in cancer
- 5k=chronic exudates (TB, cancer)
- > 10K=inflammation (pneumo, pancreatitis, pulmonary infarction)
- > 50K = parapneumonic effusions only
ok
Primary spontaneous pneumothorax
Usually appears in tall thin males, acute onset of pleuritic chest oain and dyspnea. High risk of recurrence
When do tension pneumothoraxes occur
when a patient is on mechanical ventillation and the you get a pleural breach where air flows out of the lung and into the pleural space. You get circulatory collapse and impaired venous return.
Signs of tension pneumothorax MUST KNOW
Mediastinal shift, lung collapes on x ray, diaphragm depression on that one side, hypotension and hypoxemia, must decompress with a large bore needle.
Farmer falls off the tractor and breaksboth femures
Fat embolism
What is the triad of fat embolism symptoms
Mental status change, petechiae in chest and neck, thrombocytopenia
