pleural diseases Flashcards
1
Q
- ACUTE INFLAMMATION OF THE
PARIETAL PLEURA - CHARACTERIZED BY A SHARP,
LOCALIZED, AND FLEETING PAIn
A
pleuritis
2
Q
causes of pleuritis
A
- INFECTIONS: BACTERIAL, VIRAL, OR
FUNGAL INFECTION/PNEUMONI
3
Q
pleuritis DX
A
- MADE CLINICALLY.
- CHEST X-RAY MAY BE NECESSAR
4
Q
- SHARP, LOCALIZED CHEST PAIN
- EXACERBATED BY COUGHING, DEEP BREATHING, MOVEMENT, OR
SNEEZING - PAIN MAY RADIATE TO THE IPSILATERAL SHOULDEr
A
pleuritis sxs
5
Q
pleuritis treatment
A
- TREAT UNDERLYING CAUSE
- NSAIDS
- CODEINE OR OTHER OPIOIDS MAY BE BENEFICIA
6
Q
Abnormal accumulation of fluid in the pleural space (between
visceral and parietal pleura).
A
pleural effusion
7
Q
associated with bacterial pneumonia,
bronchiectasis, or lung abscess
A
Parapneumonic effusion
8
Q
fluid is anatomically confined within a sac
(not free flowing) in the pleural space. Due to adhesions
between visceral and parietal pleura
A
Loculated effusion:
9
Q
accumulation of fluid between the lung
and diaphragm. Gives a false impression of an elevated hemi-
diaphragm
A
Sub-pulmonic effusion
10
Q
alteration in hydrostatic and oncotic pressure
A
transudative
11
Q
alteration in pleural permeability
A
exudative
12
Q
- Caused by increased hydrostatic or decreased oncotic pressure
- Causes: CHF, atelectasis, renal disease, liver disease
- Pleural fluid characteristics:
- Protein:serum protein < 0.5
- LDH: serum LDH < 0.6
- LDH < 2/3 upper limit of normal for serum LDH
- Intervention: treat underlying caus
A
transudative
13
Q
- Caused by leaky capillaries.
- Causes: infection, malignancy, trauma
- Pleural fluid characteristics:
- Protein to serum protein >0.5
- LDH to serum LDH > 0.6
- LDH > 2/3 upper limit of normal for serum LDH
- Intervention:
- Drainage with consideration for placement of indwelling pleural catheter
- Pleurodesis for refractory cases (recurrence >2 or 3)
A
exudative
14
Q
- Caused by infection in the pleural space
- Causes
- Infection
- Pleural fluid findings:
- Increased WBC count
- Intervention:
- Drainage
- Antibiotics
A
empyema
15
Q
- Caused by bleeding into pleural space
- Causes
- Trauma
- Malignancy
- PE
- Pleural fluid findings:
- Blood
- Pleural fluid to blood hematocrit ratio of > 0.5
- Intervention:
- Drainage as needed
A
hemothorax
16
Q
- May be asymptomatic
- Pleural inflammation leads to pain. Pain can be referred
(phrenic nerve) to peripheral locations (shoulder) - Dyspnea.
o May be out of proportion to the size of the effusion
o Orthopnea is uncommon in the absence of CHF - Cough
- Absent or diminished movements on affected side
- Fullness of chest with bulging intercostal spaces
- Diminished breath sounds over the effusion
- Decreased or absent tactile fremitus
- Dullness to percussion
- Absence of breath sounds over effusion
- Absent vocal resonance
- Pneumonia-like findings such as crackles
A
pleural effusion
17
Q
pleural effusion diagnostics
A
CXR in left lateral decubitus
thoracentesis
18
Q
lights criteria
A
- pleural fluid to serum total protein ratio more than 0.5
- pleural fluid to serum LDH ratio more than 0.6
- pleural fluid LDH more than two third of serum LDH
at least one of these present means exudative
19
Q
pleural effusion tx
A
thoracentesis
19
Q
transudate tx
A
- resolves ties resolution of underlying condition
- diuretics/sodium restriction
20
Q
exudate tx
A
treat underlying condition
21
Q
empyema tx
A
drainage and abx
22
Q
presence of air in pleural space
A
pneumothorax
23
Q
primary pneumothorax
A
No pre-existing lung disease
23
FROM PENETRATING TRAUMA, LUNG
INFECTIONS, CARDIOPULMONARY
RESUSCITATION, POSITIVE PRESSURE
MECHANICAL VENTILATION
tension pneumothorax
23
BLUNT OR PENETRATING TRAUMA
traumatic pneumothorax
23
secondary pneumothorax
Pre-existing lung diseas
24
* INDUCED BY MEDICAL PROFESSIONALS
* THORACENTESIS, PLEURAL BIOPSY,
SUBCLAVIAN OR INTERNAL JUGULAR VENOUS
CATHETER PLACEMENT
iatrogenic pneumothorax
25
* NO UNDERLYING LUNG DISEASE
* AFFECTS MAINLY TALL, THIN BOYS
AND MEN BETWEEN 10 TO 30
YEARS
* RUPTURE OF SUBPLEURAL APICAL
BLEBS FROM INCREASED
NEGATIVE INTRAPLEURAL
PRESSURE
* CIGARETTE SMOKING, FAMILY
HISTORY ARE IMPORTANT RISK
FACTOR
primary pneumothorax
26
* OCCURS IN THE SETTING OF
UNDERLYING LUNG DISEASE
* MORE LIFE-THREATENING
* COPD (MC), ASTHMA, INTERSTITIAL
LUNG DISEASE, CYSTIC FIBROSIS,
TUBERCULOSIS, PNEUMOCYSTIS
PNEUMONIA, MENSTRUATION
* PNEUMOCYSTIS PNEUMONIA IS A
RISK FACTOR FOR
PNEUMOTHORAX
secondary pneumothorax
26
* DUE TO HIGHER PRESSURE OF AIR IN
THE PLEURAL SPACE COMPARED TO
AMBIENT AIR
* CHECK-VALVE MECHANISM ALLOWS AIR
TO ENTER THE PLEURAL SPACE ON
INSPIRATION
* AIR CANNOT EXIT THE PLEURAL SPACE
* LUNGS, TRACHEA, GREAT VESSELS, AND
HEART ARE PUSHED TO THE
CONTRALATERAL SIDE
* LIFE-THREATENING
* PENETRATING TRAUMA, LUNG
INFECTION, CARDIOPULMONARY
RESUSCITATION, POSITIVE-PRESSURE
MECHANICAL VENTILATION
tension pneumothorax
27
* Sudden onset of chest pain
* Dyspnea
* Cough
* Life-threatening respiratory failure
Symptoms
* Decreased breath sounds
* Hyperresonance
* Decreased or absent tactile fremitus
* Mediastinal or tracheal deviation: tension
pneumothorax
* INCREASED JVP, PULSUS PARADOXUS,
HYPOTENSION
Signs
pneumothorax sxs
28
pneumothorax diagnostics
chest xray
29
primary pneumothorax treatment (small: <2)
close observation (6 hrs)
Oxygen
30
primary pneumothorax treatment (large: >2)
needle aspiration then
chest tube
31
secondary pneumothorax TX
chest tube
32
tension pneumothorax tx
- needle aspiration with large bore needle in 2nd or 3rd intercostal space
- then chest tube
