Pleural Dz Flashcards
no sensory fibers on the?
visceral pleura
pleural fluid arises from?
pleural capillaries, interstitium, lymphatics, and peritoneal cavity
pH is usually?
alkalotic
lymphatic clearance is ___X higher than fluid formation
28x
what types of cells
macrophages, monocytes, lymphocytes
causes of pleural effusion
increased hydrostatic gradient, increased permeability, decreased oncotic gradient, anatomic issues, decreased pleural fluid absorption (lymph obstruction or elevated SVP, aquaporins)
most common causes of pleural effusion are?
CHF, parapneumonic, maligancies, PE, viral
clinical features of pleural effusion
dyspnea (due to decreased muscle tension), cough, chest pain, fever
physical exam of pleural effusion shows?
dullness to percussion, reduced breath sounds, absent fremitis, reduced expansion of affected side
physiologic effects of a pleural effusion are more from the ____ than the ____
diaphragm, lung
radiographic findings of pleural effusion (standing)
apparent elevation of hemidiaphragm, apex more lateral, contralateral mediastinal shift
radiographic findings of pleural effusion (supine)
homogenous density over lung, loss of diaphragm
diagnostic evaluation of pleural effusion
thoracentesis, dry tap unless sx
contraindication for thoracentesis
bleeding/anticoag therapy, hemodynamic instability
pleural fluid analysis should always include:
LDH, total protein, albumin, cell count, glucose, cytology, gram stain
Light’s criteria for exudate
pleural protein/serum protein > 0.5 OR pleural LDH/serum LDG > 0.6 OR pleural LDH > 163
what cause pleural exudate?
pneumonia, malignancy, PE, GI disease, sometimes CHF
exudate is a sign of?
inflammation and disease of pleura
transudate is due to?
pressure imbalance only (pleura are ok)
causes of transudate
CHF, PE, cirrhosis, protein wasting dz
CHF can cause pseudoexudates due to?
diuretic therapy
other studies that could be helpful
bilirubin, cholesterol, albumin
CHF induced pleural effusions are?
bilateral, more often right sided, and not actually exudates
hepatic hydrothorax is?
pleural transudate secondary to cirrhosis and ascites, usually right sided (due to movement of ascites and decreased albumin)
