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Foundations II- Pulmonary > Pleural Diseases > Flashcards

Pleural Diseases Flashcards

1
Q

What is the pleura?

A

serous membranes, consists of mesothelial cells, CT

Visceral-covers lungs and adjoining structures

Parietal- attached to CW, covers the diaphragm

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2
Q

What is pleuritis?

A

AKA pleurisy

inflammation or irritation of the pleura

the 2 layers rub together which produces pain with inhalation and exhalation

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3
Q

What are some causes of pleuritis?

A

Infection, autoimmune disorder, PE, pneumothorax, lung CA, rib , meds, sick cell disease, post op…

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4
Q

Sxs of pleuritis?

A

Sharp CP worse with breathing, coughing, sneezing. May radiate to shoulders/back

+ other signs and sxs depending on underlying cause: fever, chills, SOB, etc.

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5
Q

PE findings of pleuritis?

A

pleural friction rub

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6
Q

Can you see pleuritis on CXR?

A

NO, it is a clinical dx

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7
Q

Work up for pleuritis?

A

CXR- look for pna, pleural effuse, mass..

CTA chest- r/o PE

Serologic studies

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8
Q

Tx of pleuritis?

A

NSAIDS –> try for 2/3 wks and re-eval

Steroids for refractory pain

treat the underlying cause

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9
Q

Lupus Pleuritis

A

involvement of lung, pleura and pulmonary vasculature is common in SLE

pleurisy can be first sign of disease

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10
Q

Serological testing for SLE

A

ANA if +

anti-dsDNA, anti-Sm, etc.

r/o infection

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11
Q

Tx for lupus pleuritis?

A

NSAIDS

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12
Q

Common signs of rheumatoid pleuritis? tx?

A

pleuritic CP, fever, +/- dyspnea

NSAIDS

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13
Q

What is a pleural effusion?

A

Abnormal fluid collecting in the pleural space as a result of excess fluid production and/or decreased lymphatic absorption

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14
Q

How much fluid is normally contained in the pleural cavity?

A

5-15cc

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15
Q

Causes of pleural effusion?

A

can be caused by lots of disorders.

most caused by: CHF, pna, malignancy, pulmonary embolism

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16
Q

What are the 2 different categories of pleural effusions?

A
  1. Transudative effusions

2. Exudative effusions

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17
Q

sxs of pleural effusion?

A

dyspnea, cough, pleuritic CP

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18
Q

PE findings in pt with pleural effusion?

A

dullness to percussion, decrease/absent tactile fremitus, decreased BS, no voice transmission

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19
Q

How can you dx pleural effusion?

A

CXR-pleural fluid may blunt costophrenic angle and form a meniscus laterally (lat decubitus view is most sensitive)

CT chest/ US

Thoracentesis

Pleural biopsy

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20
Q

Indications for thoracentesis?

A
  • newly dx pleural effusion (for dx purposes)
  • Atypical feat. in CHF
  • therapeutic sxs relief
  • if imaging suggests complicated effusion: loculated, empyema
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21
Q

Contraindications for thoracentesis?

A

small volume of fluid (risk for pneumothorax), skin infx at needle site, mechanical ventilation, uncooperative pt

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22
Q

Potential complications of thoracentesis?

A

pain at puncture site, int. bleeding, pneumothorax, empyema

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23
Q

What is Light’s criteria used for?

A

to differentiate transudate v. exudate

exudate if one of following:
-ratio of pleural fluid protein: serum protein >0.5

  • ratio of pleural fluid lactate dehydrogenase: serum LDH >0.6
  • pleural fluid LDH level > 2/3 of the upper limit of norm serum LDH
24
Q

What causes transudative effusions?

A

systemic imbalances in hydrostatic and oncotic forces

i.e HF, atelectasis, nephrotic syndrome, hepatic hydrothorax

25
Q

What causes exudative effusions?

A

occurs when local factors influencing accumulation of pleural fluid are altered

increased pleural capillary permeability leads to elevated protein/cellular content

i.e. malignancy, infection, PE, post cardiac injury

26
Q

Long term management of pleural effusion?

A
  • tx underlying illness
  • PRN thoracentesis
  • pleurX catheter (refractor effusions)
  • Pleurodesis (obliterates pleural space)
27
Q

What is a pneumothorax?

A

presence of air/gas in the pleural cavity

usually spontaneous

28
Q

Primary spontaneous pneumothorax? Secondary spontaneous pneumothorax?

A

occurs w/o precipitating event in person w/o known lung disease

occurs as comp. of an underlying lung disease

29
Q

When does a pt have the highest risk for recurrent pneumothorax?

A

within the first 30 days

30
Q

risk factors for pneumothorax?

A

smoking (91%)

familial

marfan syndrome

31
Q

Presentation of spontaneous pneumothorax?

A

usually in 20s

tall, thin, young men 20-40

sudden onset dyspnea and pleuritic CP

pain is usually unilateral and can be sharp, agonizing and associated with considerable apprehension

32
Q

PE findings in pt with spontaneous pneumothorax?

A

tachycardia, hypotension

decreased chest expansion on one side

diminished BS, hyperresoinant percussions, labored breathing, subcutaneous emphysema

33
Q

How can you dx spontaneous pneumothorax?

A

1st line: CXR, CT chest

34
Q

blebs and bullae can…

A

rupture and cause pneumothorax

they are seen in COPD

35
Q

What US finding would you seen in a pt with a pneumothorax?

A

absence of “sliding lung sign”

used when dx needed emergently at bedside

36
Q

Tx of spontaneous pneumothorax?

A

100% oxygen administration

If small (<2-3cm) –> observe if clinically stable

If large (>3cm)–> needle aspiration

Recurrent –> chest tube insertion

Unstable –> chest tube

37
Q

When can you discharge a pt with a pneumothorax?

A

After observing for at least 6 hrs

CXR must demonstrate NO progression of pneumothorax

38
Q

How do you perform a needle aspiration?

A
  1. needle inserted in 2nd intercostal space in midclavicular line
  2. catheter left in place & attached to a 3 way stopcock and large syringe
  3. air is aspirated until resistance is met of pt starts coughing
  4. repeat CXR to document lung re-expansion
39
Q

Indications for chest tube?

A

no response to needle aspiration, secondary spontaneous pneumothorax (SSP), recurrent pneumothorax, hemothorax

40
Q

Clinical presentation of SSP?

A

generally more severe than PSP - have less reserve due to underlying lung disease

41
Q

CXR in pt with SSP?

A

may be difficult to distinguish from underlying bleb, emphysematous changes

42
Q

Tx for SSP?

A

admit

almost all will require drainage

tuve thoracostomy > needle aspiration

43
Q

What is a tension pneumothorax?

A

medical emergency!

occurs in 1-2% of PSP

44
Q

Presentation of tension pneumothorax?

A

worsening dyspnea, hypotension, diminished BS on affected side, distended neck veins, tracheal deviated away from the affected side

45
Q

Tx of tension pneumothorax?

A

immediate decompression

needle decompression can be used temporarily until chest tube is placed

46
Q

What is acute respiratory distress syndrome?

A

acute hypoxemic respiratory failure following a systemic or pulmonary insult w/o evidence of HF

47
Q

Clinical findings in ARDS?

A

bilateral radiographic opacities and hypoxemia

48
Q

Pathologic findings in ARDS?

A

diffuse alveolar damage

49
Q

ARDS is a…

A

dx of exclusion

50
Q

Berlin definition to dx ARDS?

A
  • Acute onset w/in 1 week of a known clinical insult
  • B/L radiographic pulmonary infiltrates
  • Respiratory failure not fully explained by HF or volume overload
  • Moderate-severe oxygenation impairment
51
Q

Pathophys of ARDS?

A

acute/diffuse inflammatory lung or systemic disease-> damage to pulmonary capillary endothelial cells and alveolar epithelial cells -> increased vascular permeability (and decreased surfactant) -> pulmonary edema and alveolar collapse –> hypoxemia

52
Q

What are some systemic insults? pulmonary insults?

A

sepsis, shock, trauma, multiple blood transfusions, burns, etc.

diffuse PNA, aspiration, lung contusion, etc.

53
Q

clinical presentation of ARDS?

A

sig. SOB 6-62 hrs after inciting event, worsen quickly

respiratory distress, accessory muscle use, tachypnea, tachycardia, diaphoresis

hypoxemia that is unresponsive to O2

other signs of multiple organ failure

54
Q

Dx tests for ARDS?

A

CXR, CT chest

typically see: diffuse/patchy B/L infiltrates, usually spare the costophrenic angels

  • pleural effusions, enlarged heart

ABGs: hypoxemia, acute respiratory alkalosis

tests to r/o other conditions: BNP, echo, blood cultures

55
Q

Tx for ARDS?

A

identify initial systemic/pulmonary insult and tx

Intubation/mechanical ventilation

Prone positioning (turn bed upside)

nutrition support

prompt tx VAP

DVT/GI prophylaxis

56
Q

ARDS prognosis?

A

high mortality

hypoxemia and infiltrates takes wks-months

survivors will likely be left with significant reduction in QOL

Foundations II- Pulmonary (2 decks)

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