Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3 - CR > Pleural Diseases (Effusion/Mesothelioma) > Flashcards

Pleural Diseases (Effusion/Mesothelioma) Flashcards

1
Q

What is the pleura

A

A layer that covers the chest wall and the lung

- made out of the parietal pleura and visceral pleurae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the pleural space

A
  • the potential space between the visceral and the parietal pleura
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is usually in the pleural space

A
  • usually there is a small amount of pleural fluid

- sub atmospheric pressure normally allowing lungs to remain inflated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the pleural space lined with

A

mesothelial cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What goes through the parietal pleura

A

blood vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what goes through the visceral pleura

A

blood vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is on either side of the pleural space

A
  • Next to the parietal pleura is the extra pleural parietal interstitial
  • next to the visceral pleura is the pulmonary interstitial
  • in the middle in the pleural space
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are local factors (exudates) that cause pleural effusion

A
  • increase in capillary permeability = caused by trauma, malignancy, inflammation, infection, pancreatitis
  • increase in pleural permeability = inflammation, malignancy, pulmonary embolus
  • decrease in lymphatic drainage = malignancy, trauma
  • increase in negative pleural pressure (usually negative but becomes even more negative) = atelectasis, mesothelioma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the systemic factors (transudates) that cause pleural effusion

A
  • increase in capillary hydrostatic pressure = due to heart failure
  • increase in pulmonary interstitial fluid = due to heart failure
  • decrease in intravascular oncotic pressure = hypoalbuminaemia, cirrhosis
  • increase in flow of fluid from other cavities = peritoneal dialysis, cirrhosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the symptoms of pleural effusion

A
  • Asymptomatic
  • Dry cough
  • Breathlessness
  • Pleuritic chest pain
  • “Shoulder pain”/ “Heaviness”
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the clinical examination signs of pleural effusion

A

Inspection
- decrease chest expansion

Palpation

  • decrease chest expansion
  • decrease tactile vocal fremitus
  • decrease tracheal deviation

Percussion
- stony dull

Auscultation
- decrease or absent breath sounds, bronchial breathing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is bronchial breathing

A
  • hollow sound
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is classification of pleural effusion

A
  • Pleural fluid protein

- then use Light’s criteria if borderline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

describe the pleural effusion types due to pleural fluid protein

A

Pleural fluid protein

  • exudate - greater than 30g/L
  • transudate - less than 30g/L
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe how lights criteria works and what case you use it in

A
  • use light’s criteria in those with borderline pleural protein (25 to 30g/L) or abnormal serum protein

Lights criteria - pleural fluid is an exudate if one of the following criteria are met:

  • pleural fluid protein divided by serum protein > 0.5
  • pleural fluid LDH divided by serum LDH > 0.6
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

using Lights criteria what makes a pleural effusion an exudate

A

Lights criteria - pleural fluid is an exudate if one of the following criteria are met:

  • pleural fluid protein divided by serum protein > 0.5
  • pleural fluid LDH divided by serum LDH > 0.6
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what are the common causes of exudate pleural effusion

A
  • Para pneumonic effusion
  • Malignancy
  • Pulmonary embolism
  • Rheumatoid arthritis
  • Mesothelioma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the less common causes of exudate pleural effusion

A 
• Drugs
• TB
• Pancreatitis
• Oesophageal rupture
• Post cardiac injury (Dressler’s syndrome)
• Post-CABG
• Benign asbestos-related effusions
- empyema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the two types of pleural effusion

A
  • exudate

- transudate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the common causes of transudate of pleural effusion

A
  • left ventricular failure
  • cirrhotic liver disease
  • peritoneal dialysis
  • nephrotic syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the less common causes of transudate pleural effusion

A
  • constrictive pericarditis
  • hypothyroidism
  • Meig’s syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the investigations that you need for pleural effusion

A
  • Chest x-ray (CXR)
  • Pleural fluid analysis
  • Chest Ultrasound scan
  • Chest CT scan
  • Pleural biopsy (image-guided or Medical thoracoscopy)
  • Video-assisted thoracic surgery (VATS)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Where do you aspirate pleural fluid from

A

Triangle of safety

- lateral border of pec major, lateral edge of lat doors, line along 5th intercostal space, axilla

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What do you remove pleural fluid from the triangle of safety

A
  • triangle of safety - minimise the complications and puncturing of internal organs
25
Q

what do you analyse in the pleural fluid

A 
• Appearance
• pH
• Protein
• Glucose
Pleural Fluid Analysis
• LDH
• Cytology (malignant cells, differential cell counts)
• Microbiology (Gram stain and culture, AFB)
26
Q

What is the diagnostic algorithm for pleural fluid

A
  • History, examination, CXR
  • if yes to clinically transudate - treat cause and if it doesn’t resolve then refer to a chest physician
  • chest physician will do a pleural aspirate ultrasound guided
  • then if still transudate - treat cause
  • if not transudate has the fluid analysis and clinical features given a diagnosis
  • if yes treat appropriately
  • if no request a contrast enhanced CT thorax
  • consider medical thoracoscopy or surgical VATS and consider radiologically guided pleural biopsy +/- chest tube drainage if symptomatic
  • if the cause is found then treat appropriately
  • if not then reconsider treatable conditions such as PE, TB, chronic heart failure, lymphoma
27
Q

how does pleural infection present

A

Fever, sputum, chest pain, breathlessness

28
Q

Who should you consider a diagnosis of pleural infection in

A
  • Slow to respond pneumonias
  • Pleural effusion with fever
  • Malaise/weight loss
• High risk groups
o Diabetes
o Excess ETOH intake
o GORD
o IVDU
o Aspiration and poor dental hygiene
29
Q

How is at high risk of developing a pleural infection in

A 
o Diabetes
o Excess ETOH intake
o GORD
o IVDU
o Aspiration and poor dental hygiene
30
Q

What are the investigations for pleural infection

A
  • Diagnostic pleural tap
  • Blood culture
  • Chest ultrasound
  • Chest CT chest
31
Q

How does a pleural infection progress

A
  • Simple parapneumonic effusion
  • complicated parapneumonic effusion
  • empyema
32
Q

describe the stages of pleural infection progress

A

Simple parapneumonic effusion
- Clear sterile fluid, normal pH, glucose and LDH, resolves with antibiotics, chest drain usually not required

Complicated parapneumonic effusion
- Fibrinopurulent stage, fluid infected but not purulent. pH<7.2, Gluc <2.2 mmol/L, LDH > 1000 IU/L, fluid gram stain may be positive, chest drain indicated

Empyema
- Pus in pleural space, free flowing, or multi- loculated, fluid gram stain may be positive, Drainage required. Fibroblasts may cause thick pleura

33
Q

What can cause community acquired pleural infection

A

o Streptococcus spp. (~ 52%)
S milleri, S pneumoniae, S intermedius

o Staphylococcus aureus (11%)

o Gram-negative aerobes (9%)
Enterobacteriaceae, E coli

o Anaerobes (20%)
Fusobacterium spp., Bacteroides spp., Peptostreptococcus spp., Mixed
34
Q

What can cause hospital acquired pleural infection

A

o Staphylococci
MRSA (25%), S. aureus (10%)

o Gram-negative aerobes (17%)
E coli, Pseudomonas aeruginosa, Klebsiella spp.

o Anaerobes (8%)

35
Q

What is the management of pleural infection

A
  • Antibiotics = IV initially
  • Chest tube drainage if:
  • Purulent or turbid fluid
  • Pleural fluid pH<7.2
  • Organisms in pleural fluid gram stain or culture
  • Intrapleural fibrinolytics (not routinely used)
  • Nutritional support
  • Surgery
  • VATS procedure
  • Thoracotomy and decortication
  • Open thoracic drainage
36
Q

What is a mesothelioma

A

Malignant tumour of serosal surfaces (usually pleura)

- due to tumour on pleura

37
Q

What can cause mesothelioma

A

Asbestos exposure history identified in 90% of cases

38
Q

What is the survival of mesothelioma

A
  • Latent period (> 40 years after exposure)

* Poor prognosis (Median survival : 9 – 12 months)

39
Q

What are the three main types of asbestos

A
  • blue asbestos - thin and can be inhaled easily
  • brown asbestos
  • white asbestos - most commonly used
40
Q

What occupations that are at risk of mesothelioma

A
  • plumbers
  • pipe fitters
  • steamfitters
  • electricians
  • insertion workers
  • carpenters
  • labourers
  • boilermakers
  • welders and cutters
  • janitors
41
Q

What are the symptoms and signs of mesothelioma

A 
• Chest pain (dull ache)
• Symptoms of pleural effusion
• Weight loss and fatigue (uncommon)
• Chest wall invasion-
- clubbing 
- dyspnoea
42
Q

What investigations do you use for mesothelioma

A
  • Radiology (CXR and CT thorax)
  • pleural fluid analysis
  • biopsy - ultrasound or CT guided pleural biopsy, medical thoracoscopy or VATs
  • histological types
43
Q

what would you seen in pleural fluid analysis of mesothelioma

A 
o bloody/straw-coloured
o Cytology (30%-80% yield)
44
Q

What are the histological types of mesothelioma

A
  • Epitheloid (50% of cases, better prognosis)
  • Mixed (biphasic)
  • Sarcomatoid
45
Q

What is the management of mesothelioma

A

• Pleural effusions
- Drainage & pleurodesis (medical or surgical)

• Radiotherapy
- To reduce chest wall invasion risk & pain relief

• Chemotherapy
- Cisplatin with Pemetrexed or Gemcitibine

• Surgery
- selected cases only (high mortality)

  • Pain relief
  • Palliative Care
  • Compensation
46
Q

What chemotherapy drugs should be used for mesothelioma

A
  • Cisplatin with Pemetrexed or Gemcitibine
47
Q

what should CRP be less than

A

5

48
Q

What lung diseases can asbestos cause

A
  • pleural plaques - plaques are benign and do not undergo malignant change
  • pleural thickening - asbestos exposure may cause diffuse pleural thickening
  • asbestosis
  • mesothelioma
  • lung cancer
49
Q

How do you confirm an asbestos related lung disease

A
  • Lung scarring must be evident in imaging scans and lung function tests are frequently abnormal (restrictive lung disease)
  • patient must have a history of asbestos exposure with an appropriate latency period between initial exposure and onset of symptoms
50
Q

What type of lung disease does asbestos produce? restrictive or obstructive?

A

restrictive lung disease

51
Q

What diseases do you have to have to be able to be entitled to compensation from asbestos related lung disease

A
  • asbestosis
  • mesothelioma
  • lung cancer with asbestosis
  • lung cancer without asbestosis if there has been extensive occupational exposure to asbestos in specified occupations
  • diffuse pleural thickening
52
Q

What is blood in the pleural space called

A

haemothroax

53
Q

What is pus in the pleural space called

A

empyema

54
Q

What is lymph with fat in the pleural space called

A

chylothorax

55
Q

describe the management of a pleural effusion

A
  • Drainage = if the effusion is symptomatic drain it, repeatedly if necessary
  • pleurodesis with talc may be helpful for recurrent effusions
  • intra-pleural alteplase and dornase alfa may help with empyema
  • surgery
56
Q

What is the definition of a haemothorax

A

The definition of haemothorax is a pleural fluid to blood haematocrit ratio greater than 50%.

57
Q

What is the management of haemothorax

A
  • intercostal drainage with a chest drain - 28-30G minimum
  • ideal insertion is the 6th intercostal space mid-axillary line
  • If it persists then go to VATs
58
Q

what are the indications for surgery or urgent thoracotomy in haemothorax

A

◆ Haemodynamic instability despite adequate resuscitation.
◆ Initial drainage >1500 mL.
◆ Continued bleeding >200 mL/hour for 3 consecutive hours.
◆ Continued bleeding >1500 mL/day.
◆ Radiographic evidence of significant retained clot (>1/3 of pleural space)

Year 3 - CR (44 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions