Pleural Diseases Flashcards
Differentiate transudative and exudative pleural effusion
Transudative: Normal capillaries, occurs in absense of local pleural disease d/t inc. hydrostatic or dec. oncotic pressures
Exudative: abnormal capillary permeability resulting in high protein fluid
What is the most common cause of transudative pleural effusion?
CHF
What is the most common cause of exudative pleural effusions?
Parapneumonic
associated w/ bacterial PNA
Pleural Effusion Analysis: What are the 4 parameters we look for?
Glucose
Protein
WBC
LDH
If a patient had glucose levels > 60 mg/dL what kind of effusion is suspected?
Transudative
If a patient had protein levels < 3.0 g/dL then what kind of effusion is suspected?
Transudative
If a patient had LDH levels > 200 then what type of effusion is suspected?
Exudative
What is the 2nd most common cause of exudative pleural effusions?
Malignancy
What is the gold standard diagnostics test run for pleural effusions?
CXR
CT’s are helpful and can catch smaller effusions though
Presentation of pleural effusions
Pt comes in for SOB, chest pain (pleuritic), cough usually
Dec. chest movements on effected side Dec. breath sounds over area Dull percussion Pleural friction rub Tracheal deviation away from pleural effusion if it is large enough
Thoracentesis is the gold standard of care but not always necessary. What are the indications for thoracentesis?
- When pleural effusion is large
- Treatment of empyema
- When the cause is unknown
LDH stands for:
lactate dehydronase - released during tissue damage
If a patient had a chylothorax what would the fluid look like? What does it contain? Exudative or transudative?
White/milky appearance and contains chylomicrons and high levels of triglycerides.
Exudative! (lymph)
What is done for treatment if a patient has a malignant effusion?
Pleurodesis
–> it adheres the 2 pleura together irreversibly
What is done for treatment if a patient has empyemas?
Drainage and long term abx
What is the common cause of pleuritis?
Virus
Bacteria and rib fractures can also cause it
What does the presentation of pleuritis look like?
Sharp, localized chest pain worsened by sneezing, deep breathing
How do you treat pleuritis?
Tx underlying dz
NSAIDs and pain control
Is the parietal or visceral pleura inflammed in pleuritis?
Parietal
5 types of pneumothorax
- Primary Spontaneous
- Secondary spontaneous
- Traumatic
- Iatrogenic
- Tension
Distinguish primary and secondary spontaneous pneumothorax
Primary occurs in absense of underlying lung dz and secondary occurs in presense of underlying lung dz
Who is at risk for primary spontaneous pneumothorax and what is the suggested cause of it?
Tall, thin, males 10-30 years old
Rupture of a subpleural apical bleb in response to high negative pressure
Signs and symptoms of all types of pneumothoraxes
Chest pain
Dyspnea
These are the two main!
PE findings of pneumothoraxes
Hyperresonance to percussion Tachycardia Hypotension Mediastinal/tracheal shift suggest tension Unilateral chest expansion
What is the test of choice for pneumothroax?
CXR
What are CXR findings for a patient with a penumothorax and should these x-rays be taken during inspiration or expiration?
Deep sulcus sign (deep lateral costophrenic angle)
Expiratory is best
If a patient has a small pneumothorax then how would you treat?
It should resolve spontaneously
Supplemental O2
Occasionally monitor w/ serial CXR’s
If a patient has a secondary pneumothorax, a large pneumothorax, or is on a ventilator how would you treat?
Chest tube placement (tube thoracostomy) to expand lung
If a patient has a tension pneumothorax then how would you treat?
Immediate decompression followed by chest tube….no time to use anestesia, this is done at bedside
