Pleural Diseases Flashcards
what is important for the management of the pleural fluid that resides on the parietal layer?
stoma that lead to the lymphatic channels
is normal fluid acidic or alkalotic?
alkalotic
what three cell types are commonly found in pleural fluid?
macrophages
lymphocytes
neutrophils
what does transudate fluid usually consist of in the pleura?
non inflammatory fluid with low protein
what does exudate fluid usually consist of in the pleura?
inflammatory proteinaceous fluid
three symptoms of pleural effusion
dyspnea
cough
chest pain
what is the meniscus sign in pleural effusions?
looks like the meniscus of water where the fluid is resting in the cavity
what is a thoracentesis and when is it used?
this is fluid biopsy of pleural effusions that helps with diagnosis
do chronic or rapid onset pleural effusion patients present with dyspnea?
more so the rapid onset
what does it signal when effusion is bloody?
cancer, pulmonary infarction, trauma or recent surgery
what does it signal when effusion is milky or orange?
chylothorax or injury to thoracic duct
what does it signal when effusion has pus in it?
empyema
list the three rules for determining if effusion is exudate or transudate? how many need to be present to be considered an exudate?
fluid protein/serum protein over 0.5
pleural LDH/serum LDH over 0.6
pleural fluid LDH in upper 2/3 of normal LDH range
only 1/3
name a common cardiac cause of transudate effusion?
CHF
name two common causes of exudate effusion
malignancy and pneumonia
what do neutrophils suggest in effusion?
acute inflammation…likely infectious
what two etiologies lead to eosinophils in an effusion?
blood and air
what do lymphocytes signal for effusion?
malignancy or TB
what four things to consider with effusion and low glucose levels in fluid?
parapneumonic or empyema
rheumatic disease
Malignancy
TB
with extremely low glucose levels in effusion…what should we be thinking about?
rheumatic disease
what two things to consider with LDH over 1000, in effusion?
complicated parapneumonic or empyema
and Malignancy
if triglycerides are elevated in effusion…what is it?
chylothorax
if there is amylase in pleural effusion…what two things are we thinking about?
pancreatitis
esophageal rupture
what is the pleurodesis procedure for effusions? when should you do this?
when you totally drain the cavity of all fluid and then add talk or doxycycline that will irritate the layers and make them stick together…do it with recurrent effusions
