Pleural Disorders Flashcards
Which layer of the pleura contains sensory nerve endings and can detect pain?
-Parietal pleura
Pleural Fluid
- what color should this be?
- purpose
- where is this produced?
- should be light amber/yellow
- provides lubrication and surface tension, continual suction of excess fluid into lymphatic channels acts like a glue to hold lungs to thoracic wall.
- pleural fluid is produced by the parietal pleura and absorbed by the visceral pleura.
Is intrapleural pressure positive or negative?
-negatives, this holds the lungs open
Pleuritis
- what is this?
- aka
- describe pleuritic pain
- localized inflamm of pleural surfaces
- aka: pleurisy
- pleuritit pain is sharp, stabbing pain with “splinting” on inspiration.
Pleuritis
-what lung sounds are associated with pleuritis?
pleural rub (walking on snow, cat purr, “fine crackles”
Causes of pleuritis
- viral infection (Coxsackie B)
- Thoracic Trauma (Rib fx)
- Secondary to pulmonary disorders:
- -bronchiectasis (common)
- -Pneumonia
- -TB
- -Pulmonary Infarct
- -Lung Cancer
- Secondary to systemic dz:
- -rhematoid arthritis
- -systemic lupus
- -metastatic cancer
Pleuritis
Dx
TX
- CXR, normal unless lung dz
- dx is clinical
Tx:
- tx primary cause
- sx tx of chest pain
- -NSAIDS/narcotics
Pleural Effusion
- what is this?
- why does this occur?
- Sx
What is this: fluid collection between the parietal and visceral layers
Why does this occur? when the normal flow of fluid is disrupted d/t either too much fluid produced or not enough fluid removed.
Sx:
- SOB
- Cough
- Pleuritic chest pain
Pleural Effusion
- causes
- dx
- types of exudate
- ***CHF
- pneumona
- malignancy
- pulmonary embolism
- viral
- Mesothelioma
Dx:
- CXR (blunting of costophrenic angle 250-500ml PA)(sub-pulmonic effusion: accumulation of fluid between the lung and diaphragm giving false impression of elevated hemidiaphragm)
- Chest CT
- Pleural fluid analysis
How do you obtain pleural fluid for anaysis?
-thoracentesis
Pleural Fluid Analysis- what tests are included?
- gross appearance
- pH
- gram stain, C&S
- cytology
- LDH
- Protein
- glucose
- cholesterol
- amylase
What is Lights Criteria?
if at least ONE of the following three criteria is present, the fluid is defined as an exudate.
- pleural protein vs serum protein
- pleural LDH vs serum LDH
- Plueral fluid LDH greater than 2/3 the upper limits of the labs normal LDH
What are some exudative causes of pleural effusions?
- anything that causes inflammatory or infiltrative dz of the pleura)
- Neoplasm (lung, breast cancer, lymphoma)
- Infection (Viral pneumonitis, empyema, TB, mycoplasmal pneumonia
- autoimmune dz
- pulmonary infarction
- intra-abdominal pathology
What is a Transudative effusion? What color is this?
- anything that causes increased hydrostatic pressure or decreased capillary colloid osmotic pressure ex:
- CHF
- Sever hypoalbuminemia (nephrotic syndrome and liver failure)
- Cirrhosis (associated with ascites)
Color: straw-colored, clear, odorless fluid
Once you have determined if you pleural fluid is transudative or exudative, how do you treat it?
Transudative: treat the underlying cause, focus on the systemic cause.
Exudative: treat the underlying cause, dependent on the exact cause.
For both considerChest thoracostomy
What is parapneumonic effusion?
-plueral effusions that occur in the pleural space adjacent to a bacterial pneumonia, where bacteria from the lung have invaded the pleural space.
Characteristics of complicated parapneumonic effusion?
- persistent bacterial invasion of the pleural space
- glucose less than 60mg/dL
- positive culture
- pleural LDH
- Pleural fluid is loculated.
- Loculated: compartments/cavities
Malignant Pleural Effusions
- what is this?
- what two major cancers account for the majority of these effusions?
- what finding is indicative of neoplasm?
- cancer causing pleural effusion
- lung and breast cancer account for 50-65% of malignant pleural effusions.
- bloody pleural effusion, w/o trauma.
A true Hemothorax is when the pleural fluid hct exceeds ____ of the peripheral blood hct
50%
Tx of Malignant Pleual effusion
- serial thoracentesis
- chest tube with pleurodesis
- pleuroperitoneal shunt
- pleurectomy
What is Pleurodesis?
What are the typeS?
medical procedure in which the pleura space is artificially obliterated. Used to treat plural effusion.
- Mechanical w/ electrocautery and chemical
- both cause adhesion of the lung to the chest wall by irritation and inflammation.
What is Hemothorax?
Causes
-blood in the pleural space “homorrhagic pleural effusion”
- Causes:
- trauma
- spontaneous
What are some causes of spontaneous pneumothorax?
- pulmonary: emphysema, PE, infarction, TB, AVMs
- Plerual: torn adhesions, endometriosis
- Bood Dyscrasias: thrombocytopenia, hemophilia, anticoagulation
- Thoracic pathology : ruptured aorta, dissection
- Abdominal Pathology: pancreatic pseudocyst, hemoperitoneum
Tx of Hemothorax
- thoracentesis: bedside, ultrasound-guided/CT guided
- thoracostomy drainage: mainsay
- thorascopic surgery
- thoracotomy: massive hemothorax, instability, chronic hemothorax
