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Clin Med I - Pulmonary > Pleural Diseases > Flashcards

Pleural Diseases Flashcards

1
Q

Describe the normal physiology of the pleural space

A
  • fluid enters from capillaries in the visceral pleura

- fluid absorbed via lymphatics in the parietal pleura

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2
Q

Define pleural effusion

A
  • abnormal build up of fluid in the pleural space
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3
Q

What can cause a pleural effusion?

A
  • pleural fluid formation > absorption
  • rate of absorption is decreased
  • transport of peritoneal fluid from the abdominal cavity through the diaphragm or via lymphatics from a subdiaphragmatic process
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4
Q

Describe the physiology of pleural effusion and the result of each

A
  • increased production of fluid in normal capillaries (abnormal pressure changes) ==> low protein “transudates”
  • increased production of fluid d/t abnormal capillary permeability/inflam ==> high-protein “exudates”
  • decreased lymphatic clearance ==> high protein “exudates”
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5
Q

Define empyema

A
  • infection in pleural space
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6
Q

Define hemothorax

A
  • bleeding into the pleural space
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7
Q

Define chylothroax

A
  • lymphatic leakage from the thoracic duct or one of the main lymphatic vessels that drains into it
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8
Q

What are the types of pleural effusions?

A
  • transudative
  • exudative
  • pus
  • blood
  • chyle
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9
Q

When do transudative type pleural effusion occur?

A
  • altered systemic factors
  • absence of local pleural disease
  • leakage of fluid from intact normal capillaries d/t increased hydrostatic or decreased oncotic pressures
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10
Q

What are the causes of pleural effusion?

A
  • MC: CHF
  • nephrotic syndrome
  • atelectasis
  • chirrhosis
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11
Q

When do exudative pleural effusions occur?

A
  • altered local factors
  • presence of pleural disease
  • increased production by the capillaries or blocking of lymphatics
  • impaired lymphatic drainage/leaky capillaries
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12
Q

What are the causes of exudative pleural effusions?

A
  • MC: parpneumonic effusion
  • 2nd MC: 2ndary to malignancy
  • mesothelioma
  • PE
  • trauma
  • 2ndary to viral infection
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13
Q

What are the 3 types of parapneumonic pleural effusions?

A
  • simple/uncomplicated
  • complicated
  • empyema
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14
Q

What causes hemothorax?

A
  • MC: trauma
  • surgery
  • tumor
  • ruptured blood vessel
  • spontaneous
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15
Q

What is diagnostic of hemothorax?

A
  • pleural fluid hematocrit:peripheral blood hematocrit > 0.5
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16
Q

What causes chylothorax?

A
  • MC: lymphoma & surgical trauma
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17
Q

What does the cylothorax fluid look like?

A
  • milky, white
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18
Q

What are the symptoms of pleural effusion?

A
  • dyspnea
  • pleuritic chest pain
  • cough
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19
Q

What are the signs of pleural effusion?

A
  • hypoxic
  • decreased unilateral chest movement on affected side
  • decreased breath sounds over area
  • dull to percussion
  • decreased tactile fremitus
  • pleural friction rub
  • tracheal deviation to contalateral side if large
  • egophony
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20
Q

What does a pleural friction rub indicate?

A
  • infarction

- pleuritis

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21
Q

What diagnostic tests are ordered for pleural effusion?

A
  • CXR

- CT

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22
Q

What amount of fluid is required to see pleural effusion

A
  • 75-100mL on lateral view

- 175-200mL on AP/PA view

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23
Q

How is a lateral decubitus CXR view helpful for pleural effusion?

A
  • identifies free flowing vs. loculated effusions
24
Q

What is the treatment of pleural effusion?

A
  • thoracentesis

- tx underlying dz

25
Q

What would purulent fluid from a thoracenteis point towards?

A
  • empyema
26
Q

What would putrid odor from a thoracenteis point towards?

A
  • anaerobic empyema
27
Q

What would milky, white fluid from a thoracenteis point towards?

A
  • chylothorax
28
Q

What would blood from a thoracenteis point towards?

A
  • trauma

- malignancy

29
Q

What is the traditional method to ddx between exudative and trasudative pleural effusions?

A
  • Lights Criteria
30
Q

What would the Lights Criteria yield in exudative pleural effusion?

A
  • meets at least 1 criteria
31
Q

What would the Lights Criteria yield in transudative pleural effusion?

A
  • meets no criteria
32
Q

What is the treatment for malignant effusion?

A
  • pleurodesis

- serial thoracentesis if recurs

33
Q

What is the treatment for empyemas?

A
  • drainage

- long term abx

34
Q

What is the treatment for hemothorax?

A
  • immediate large bore chest tube placement
35
Q

What is the definition of pleuritis/pleurisy?

A
  • pain d/t acute pleural inflam caused by iritation of the parietal pleura
36
Q

What causes pleuritis/pleurisy?

A
  • anything that causes inflam
37
Q

What are S&S of pleuritis/pleurisy?

A
  • sharp, localized chest pain

- worsened by sneezing, deep breathing, or movement

38
Q

What is the treatment for pleuritis/pleurisy?

A
  • tx underlying dz
  • anti-inflam
  • pain control
39
Q

Define pneumothorax

A
  • collection of gas/air in the pleural space ==> collapsed lung
40
Q

What are the types of Ptx?

A
  • primary spontaneous
  • secondary spontaneous
  • traumatic
  • iatrogenic
  • tension
41
Q

What causes a primary spontaneous Ptx?

A
  • absence of underlying lung dz
42
Q

What causes a secondary spontaneous Ptx?

A
  • presence of underlying lung dz
43
Q

What causes a traumatic Ptx?

A
  • penetrating or blunt trauma

- open wound

44
Q

What causes iatrogenic Ptx?

A
  • s/p procedures
45
Q

What causes tension Ptx?

A
  • trauma
  • lung infections
  • mechanical ventilation
  • resucitative efforts
46
Q

What patient population is at highest risk for primary spontaneous Ptx?

A
  • tall, thin, males 10-30 y/o
47
Q

What is the suspected etiology of primary spontaneous Ptx?

A
  • rupture of a subpleural apical bleb
48
Q

For _______ Ptx, air pressure in the _______ _______ exceeds _______ pressure throughout the respiratory cycle

A
  • tension
  • pleural space
  • ambient
49
Q

What happen to the internal chest organs in tension Ptx?

A
  • pushed to contralateral side
50
Q

What are two events that occur with tension Ptx?

A
  • hypoxia

- CV system collapse

51
Q

What are the S&S of all types of Ptxs?

A
  • chest pain on affected side
  • dyspnea
  • anxiety
  • fatigue
  • acute epigastric pain
52
Q

What is seen on PE for Ptx?

A
  • respiratory distress
  • tachycardia
  • unilateral chest expansion
  • decreased breath sounds on affected side
  • decreased tactile fremitus
  • hyperressonace
53
Q

Which of the common PE findings for Ptx suggest tension Ptx?

A
  • tachycardia
  • hypotension
  • mediastinal/trachial shift
54
Q

What tests should be ordered for Ptx?

A
  • CXR
  • ABG
  • EKG
  • CT
  • US
55
Q

What will be seen on CXR for Ptx?

A
  • ipsilateral lung edge/visceral pleural line parallel to chest wall
  • increased lucency
  • deep sulcus sign
56
Q

What is the tx for Ptx?

A
  • small ( observation
  • supplemental O2 to increase rate of reabsorption
  • chest tube
  • immediate decompression for tension
57
Q

How can Ptxs be prevented in patients w/ (+) hx of Ptx?

A
  • surgical removal of blebs or broncho-pleural fistulas
  • smoking cessation
  • minimize high altitude flying
  • avoid SCUBA diving

Clin Med I - Pulmonary (16 decks)

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