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Lung cancer and diseases > Pleural diseases > Flashcards

Pleural diseases Flashcards

1
Q

What is a pleural effusion?

A
  • abnormal collection of gluid in the pleural cavity

- 2-3mL

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2
Q

State investigations of a pleural effusion

A
  • CXR
  • Ultrasound
  • Pleural aspiration( needle/tube inserted into pleural space to remove fluid)
  • Blood test to assess for tissue damage
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3
Q

State features of a pleural effusion on a CXR

A
  • Loss of costophrenic angle ( place where diaphragm meets rib)
  • Tracheal deviation
  • concave/horizontal fluid level
  • opacifications ( pleural plaque or calcifications due to asbestos exposure)
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4
Q

State the importance of using a chest wall ultrasound in the event of a pleural effusion

A
  • it will help localise area most suited to aspirate pleural fluid
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5
Q

Which signs give a clue to the cause?

A

Foul smell= anaerobic empyema

Pus= empyema

Food particles= oesophageal rupture

Milky= cyclothorax, damage to thoracic duct

Blood stained= malignancy, TB, trauma, infarct

Cloudy: exudate, infection

???

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6
Q

Possible complications of a pleural effusion

A
  • empyema,
  • pneumothorax?
  • vagal reflex( fainting)
  • haemothorax
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7
Q

Pleural fluid inspections

A

Transudative: clear
Exudative: cloudy ( immune cells)
Lymphatic fluid: Milky ( fats)

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8
Q

Investigations of pleural fluid

A
  • check pH
  • Biochemistry( protein level in sample, LDH, glucose, triglyceride, cholesterole, amylase, rheumatpod factpr
  • Microbiology ( gram stain, AAFB + culture
  • Cytology( examination of cells in microscope)
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9
Q

Lights criteria criteria for Exudate + Transudate

A

Exudate: ( lights crieteria only)

  • Protein >3.5
  • LDH high
  • Protein Lights criteria: >0.5
  • LDH /serum LDH >0.6
  • pleural fluid LDH>2/3 the upper limits of normal serum LDH

Transudate:
-protein < 2.5

-LDH normal

to differentiate transudate and exudate; aslong as fluid is 25-35g Lights criteria is used

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10
Q

Exudate causes

A

-inflammation of capillaries>leaky so more proteins leaks to pleural space

Respiratory related problems:

  • infection, malignancy
  • pulmonary embolus, rheumatoid arthritis, SLE
  • pancreatis, benign asbestos effusions, drug related effusions
  • post MI, yellow nail syndrome
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11
Q

Transudate causes

A

-Fluid accumulation due to high hydrostatic pressure + low oncoid pressure in capillaries

Any organ failure/condition causing a decrease in protein levels

  • chylothorax ( TD duct interupted and LF accumulates in pleural space
  • cardiac, liver, renal failure
  • Hypoalbuinemia, hypothyroidism, pulmonary embolus

-Malginancy, constrictive pericarditis, meigs syndrome, nephrotic syndrome, cirrhosis

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12
Q

Where is LDH found?

A

-many tissues; cardiac, skeletal, liver, lungs, kidney

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13
Q

What can a large loculated effusion cause, how is it caused + state the treatment

A
  • caused by pneumonia/TB
  • can lead to empyema
  • surgical removal
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14
Q

Symptoms of a pleural effusion

A
  • dypsnoea ( worsens)
  • unproductive cough
  • pleuritic chest pain ( sharp + stabbing, if due to inflammatory exudate then can improve as inf.exudate causes pleura to seprate, but if malignancy worsens)
  • dull ache
  • pressure on mediastinum
  • weight loss
  • malaise
  • fever
  • night sweats
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15
Q

Clinical signs of pleurall effusion

A
  • refuced lung expansion on affected side
  • dull percussion
  • reduced breath sounds
  • reduced vocal resonance
  • finger clubbing
  • tar stained fingers
  • cervical lymphadenopathy
  • raised jugular venous pressure
  • tracheal deviation ( in very large effusions, if same indicated lung collapse)
  • peripheral oedema
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16
Q

Treatment of parapneunomic effusions

A
  • drain if pH<7.2) as it indicates immune response
  • drain largest locule
  • inoculate blood culture bottles at time of sampling
  • IV ABx?
  • surgical referral early is poor control of sepsis/effusion
17
Q

Treatment of pneumonic effusion

A

-chest drain in 4th intercostal space mid axillary line + patients arm at 45 degree angle + local anesthetic

18
Q

Location of chest drainage ( safe triangle)

A
  • 4th intercostal space of mid axillary line
  • border of pectorals ( antetiorly)
  • anterior border of latissimus dorsi muscle ( posterirly)
  • Line at horizontal level of nipple/5th int space ( whichever is higher)
19
Q

Options after chest drainage

A

Removal:
- if after drainage lung rexpands ( lower chance of infection)

Suction:
- if after drainage the lung has not completely re-expanded then suction is applied

PLeurodesis:
-If after lung has reexpanded but high chance it will occur again, pleurodesis is done(cancer) < seals up pleural space to prevent reoccurence

20
Q

What is pleurodesis + state types

A
  • sealing up of pleural space to prevent PE
  • 2 types: Chemical/Surgical

Chemical

21
Q

What is a chemical pleurodesis?

A
  • talc slurry is injected into pleural cavity through chest drain.
  • talc slurry = 4g fractionated ( prevents ARDS) and 50ml slurry.
  • Talc irritates pleura triggering an inflammatory response which leads to pleura sticking together
  • after talc instilled clamp added around chest drain
  • remove drain after 12-72hrs if lung re-expands
22
Q

What is surgical pleurodesis

A
  • Video assisted thorascopy ( VATS)
  • insert telescope to pleural cavity so fluid can be visualised + suction done
  • talk then insufflated(blown into pleural cavity)
23
Q

What is a tension pneumothorax?

A
  • large pneumothorax that pushes mediastinum to opposite side > reduced venous return to the heart > fall in O2 > cardiac arrest?
  • intrapleural pressure higher than atmospheric pressure
  • air moves into pleural cavity but not out and accumulates
24
Q

Types of pneumothorax

A

tension, primary, secondary

25
Q

Treatment of tension pneumothorax

A
  • O2
  • aspirtate in 2nd intercostal space in midclavicular line + chest drain
  • CXR
26
Q

Asbestos related jobs

A

marine enginerr, ship building, docks, construction sites, jointers, plumbers, engine rooms, boilers
-Latent period ( 20-40)

27
Q

Types of asbestos

A

Chrysotile (white)
Amosite (brown)
Crocidolite (blue)< DA

28
Q

What do pleural plaques indicate?

A
  • previous asbestos exposure

- found normally on parietal pleura

29
Q

Benign asbestos effusion

A
  • exudate, lymphotcytic, blood stained(maybe)
  • chronic
  • diffuse pleural thickening
30
Q

What is a mesothelioma?

A
  • malignant tumour of mesothelial cells(lines cavities)
  • affects pleura of lungs/abdomen
  • begins as nodules in pleura, then grows tos urround lungs + enters dissures, possible cause of pleural effusion
  • linked with asbestos exposure
31
Q

Clinical presentations of mesothelioma

A
  • pleural effusion
  • cough
  • chest pain, breathlesness
  • worsening dypsnoea
  • weight loss, clubbing, haemoptysis, fever
32
Q

Treatment and investigation of malignant mesothelioma

A
  • CXR: pleural effusion, pleural based opacity/mass
  • CT scan
  • aspirtate; blood stained effusion abnormal mesothelial cells
  • image bipsy/thorascopy/VATS
  • chemotherapy
  • palliation: plerudesis + long term drain insetion

Lung cancer and diseases (13 decks)

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